TEXAS HealthandHuman Services Texas HealthandHuman Services Commission Or.CourtneyN. Phillips Executive Commissioner November 20, 2019 Justin Gordon Office of the Attorney General Open Records Division Price Daniel, Sr., State Office Building P.O. Box 12548 Austin, Texas 78711 Re: Request for decision- DSHS ORR No. 20191024-9227 Dear Mr. Gordon: On October 22, 2019 the Department of State Health Services ("DSHS" or "Department") received an open records request seeking all email communications between specific DSHS officials and specific external parties regarding the prevention, treatment, and control of infectious diseases at immigrant detention or holding facilities. The Department sought clarification of the request on November 4, 2019 and received a response to the clarification request on November 5, 2019. The Department believes portions of the submitted representative sample of information are confidential under sections 552.101 of the Government Code in conjunction with the Homeland Security Act. Additionally, while the Department takes no position as to whether the remaining information at issue is excepted from public disclosure under Chapter 552 of the Government Code, we believe that the release of the requested information may implicate the interests of the third parties. Accordingly, we have notified the third parties of the request and of their respective rights to submit comments to the Attorney General. Please use DSHS Reference number 9227 when discussing this request for ruling. A copy of the request is enclosed as Exhibit A. We have enclosed a representative sample of the records at issue as Exhibit B. This brief was deposited into interoffice mail on November 20, 2019. Please note, the Department was closed on November 11, 2019 for the Veteran's Day holiday. Gov't Code §552.101\Homeland Security Act§,§ 418.177, 418.181 Section 552.101 of the Government Code exempts from disclosure "information considered to be confidential by law, either constitutional, statutory, or by judicial decision." Gov't Code §552.101. Section 552.101 encompasses information made confidential by statute, such as section 418.177 of the Government Code, which is often referred to as the Homeland Security Act. Section 418.178 provides that information is confidential if the information "is collected, assembled, or maintained by or for the governmental entity for the purpose of preventing, detecting, or investigating an act of terrorism or related criminal activity, and ... relates to an assessment by or for a governmental entity, or an assessment that is maintained by a governmental entity, of the risk or vulnerability of persons or property, including critical infrastructure, to an act of terrorism or related criminal activity." Id. §418.177(1 )(2). Section 418.181 provides that the P.O. Box 13247 • Austin, Texas 78711-3247 • 512-424-6500 • hhs.texas.gov Justin Gordon November 20, 2019 Page2 DSHS ORR NO. 9227 documents or portions of documents in possession of a governmental entity are confidential if they identify the technical details of particular vulnerabilities of critical infrastructure to an act of terrorism. Id§ 418.181. "Critical infrastructure" includes all public or private assets, systems, and functions vital to the security, governance, public health and safety, economy, or morale of the state or the nation. See id. § 421.001(2). An entity raising exceptions must demonstrate the applicability of the provision and adequately explain how the responsive records fall within the scope of the claimed provision. The Port of Laredo (hereinafter '·the Port") is a major inland port and trade corridor between the United States and Mexico. Accordingly, the Port constitutes ''critical infrastructure" for the purpose of Chapter 418 of the Government Code. The information we have marked consists of a Multiagency Communicable Disease Response Plan for the Port. The response plan establishes the coordinated response protocols and the operations that will take place in the event of a communicable disease outbreak at the Port. The plan also lays out the various precautions that will occur to prevent a further spread of the disease. Allowing the release of the plan would allow individuals who sought to perform an act of terrorism or related criminal activity to know the Port's response to a communicable disease outbreak and allow them to take advantage of that response to cause further harm. Accordingly, we believe the information we have marked must be withheld under section 552.101 in conjunction with the Texas Homeland Security Act. If you or your staff have any questions, please have them contact Amanda Brown, Program Specialist at 512-707-6054. s ecords Attorney encl: Exhibit A - Open Records Request Exhibit B Records at Issue me: (Requestor: Exhibit A, vi/o Exhibit B) Clay M. Goode American Oversight VIA EMAIL: foia@americanoversight.org (Third Parties: Exhibit A, w/o Exhibit B) Bruno Viana Centers for Disease Control and Prevention VIA EMAIL: bviana@cdc.gov Justin Gordon November 20, 2019 Page2 DSHS ORR NO. 9227 Mark Bittner Department of Homeland Security VIA EMAIL: mark.d.bittner@ice.dhs.gov From: Simon, Elizabeth L. (CDC/ONDIEH/NCBDDD) (CTR) Sent: Tuesday, September 04, 2018 4:42 PM EDT To: Garcia,Imelda M (DSHS) ; Sidwa,Tom (DSHS) ; Nickodem,Colette A (DSHS) ; Broussard,Kelly (DSHS) ; Owens,Kamesha (DSHS) CC: ZIKApregnancy (CDC) Subject: USZPIR September Line list Attachment(s): "InfantTool2018.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hello Texas Partners, This is your confirmation request for US Zika Pregnancy and Infant Registry reporting. We will send you this week’s line list via SAMS [link: https://sams.cdc.gov ] today, Tuesday, September 4. We have also included information below about the USZPIR reporting schedule. • USZPIR Reporting Schedule 0 You will receive a line list today, Tuesday, September 4, with a Tuesday, September 11, deadline for sending data updates to CDC. A reporting schedule for the next three months is located below: CDC POCs send Line List to Jurisdictions Tuesday, September 4th Tuesday, October 2nd Tuesday, November 6th Jurisdiction Deadline for Updated Line List or reporting other data to CDC Tuesday, September 11th Tuesday, October 9th Tuesday, November 13th Date For posting on CDC Web Tuesday, September 25th Tuesday, October 23rd Tuesday, October 27th ** Please note that while the data deadlines (for inclusion in CDC web updates) occur monthly, we appreciate jurisdictions sending data to CDC throughout the month as jurisdictions are able and data become available. · Implementing CDC Guidance for Clinical Management and Evaluation of Infants Born to Mothers with Possible Zika Virus Exposure During Pregnancy; and Testing of Placental, Fetal, or Infant Autopsy Tissues CDC has created a tool outlining this guidance as a resource (attached as a pdf). It is also available on the following web pages: § https://www.cdc.gov/pregnancy/zika/testing-follow-up/testing-and-diagnosis.html § https://www.cdc.gov/pregnancy/zika/testing-follow-up/evaluation-testing.html As always, we are grateful for your collaboration on this important effort – and let us know if you have any questions. Thank you, Elizabeth Elizabeth Simon, MPH Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities Email: kov3@cdc.gov Tel: 312-599-0641 TX-DSHS-19-1309-A-000001 CDC's Response to Zika IMPLEMENTING CDC GUIDANCE FOR CLINICAL MANAGEMENT AND EVALUATION OF INFANTS BORN TO MOTHERS WITH POSSIBLE ZIKA VIRUS EXPOSURE DURING PREGNANCY; AND TESTING OF PLACENTAL, FETAL, OR INFANT AUTOPSY TISSUES(1 , 2) Notes: This tool summarizes general CDC guidance for the following scenarios. Please consult CDC or your state or local health department for case-specific questions. Health departments should adapt CDC guidance depending on local capacity and circumstances. INFANT OR FETUS WITH CLINICAL FINDINGS CONSISTENT WITH CZS (3) WITH maternal laboratory evidence of possible Zika virus infection during pregnancy (4) No maternal laboratory evidence of possible Zika virus infection during pregnancy (4,5) Maternal Zika virus laboratory results and interpretations (4) Zika or flavivirus infection, timing cannot be determined Acute Zika virus infection > 12 weeks after exposure/symptoms (7) and either maternal testing negative, or mother not tested (8) Maternal testing s:12 weeks after exposure/ symptoms (7) negative (9) LIVE BIRTH Clinical evaluation and management At birth: standard evaluation. (10) Infant Zika virus laboratory testing: NAT on serum and urine, consider CSF; lgM on serum, consider CSF. (11,12) By one month: head ultrasound, comprehensive ophthalmologic exam, automated ABR. Refer to developmental specialist, early intervention, and family support services; consider other consultations (e.g., genetics, ID, neurology). (13) Testing of placental tissues Not indicated. (14) Should be considered to aid in maternal diagnosis. (15) Not indicated. PREGNANCY LOSS OR INFANT DEATH FOLLOWING LIVE BIRTH Testing of fetal and placental tissues May be considered to aid in fetal diagnosis. May be considered to aid in fetal and maternal diagnosis. Not indicated. Testing of infant autopsy and placental tissues Should be considered to aid in infant diagnosis. Should be considered to aid in infant and maternal diagnosis. Not indicated. Abbreviations; ABR=Auditory Brain Stem Response, CSF=Cerebrospinal Fluid, CZS= Congenital Zika Syndrome, EEG= Electroencephalogram, ID=lnfectious Disease, lgM=lmmunoglobulin M, IHC=immunohistochemistry, NAT=Nucleic Acid Testing, PRNT= Plaque Reduction Neutralization Test, RNA=ribonucleic acid, RT-PCR= Reverse Transcriptase Polymerase Chain Reaction (1l Zika virus testing on formalin-fixed, paraffin embedded tissue specimens is conducted at CDC's Infectious Diseases Pathology Branch (IDPB} and includes Zika virus RT-PCR on placental and fetal/infant tissues. Zika virus IHC may be pertormed on placental specimens into the second trimester, fetal tissues from any gestational age, and infant autopsy tissues. (5) For infants without findings consistent with CZS with maternal testing pending and maternal specimen was collected within 12 weeks of all exposure, consider collecting, fixing, and storing placental tissues, and collecting and storing infant serum and urine. Once available, maternal test results should guide further management according to this framework. (6) Symptoms of Zika virus disease include acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. (7) All or part of possible maternal Zika virus exposure, or symptom onset, occurred >12 weeks before maternal serum specimen was collected. (1) (8) Includes pregnant women with negative Zika virus NAT and negative Zika virus lgM s12 weeks after symptom onset or exposure. (9) Standard evaluation at birth includes a comprehensive physical exam, including growth parameters; newborn hearing screen at birth, preferably with automated ABR; developmental monitoring and screening using validated screening tools recommended by the American Academy of Pediatrics (https://www.aap.org/ en-us/advocacy-and-policy /aap-health-initiatives/Screening/Pag es/ Screening-Tools.aspx}; and vision screening as recommended by the American Academy of Pediatrics Policy Statement "Visual System Assessment in Infants, Children, and Young Adults by Pediatricians" (http://pediatrics. aappu blication s. org/content/137 /1 /e20153596}. (2) (3) (4) Placental tissues include placental disc, umbilical cord, and fetal membranes. Zika virus RNA can be focal within placental tissues, and testing of three sections of placenta, one section of umbilical cord, and one section of fetal membrane is recommended (https://www.cdc.gov/zika/laboratories/ test-specimens-tissues.html}. For pregnancy losses and infant deaths, submission of fetal or infant autopsy tissues, if available, in addition to submission of placental tissues, is preferred, but if not available will not preclude placental testing. Clinical findings consistent with CZS include severe microcephaly, decreased brain tissue with subcortical calcifications, macular scarring and focal pigmentary retinal mottling, congenital contractures such as clubfoot or arthrogryposis, and hypertonia restricting body movement soon after birth. Additional findings are described at https://www.cdc.gov/pregnancy/zika/testingfollow-up/zika-syndrome-birth-defects. htm I (10) CDC interim infant testing guidance recommends that Zika virus testing should be pertormed on CSF if it is/was collected for other reasons. Since there are reports of congenital Zika virus infection in which CSF was the only sample testing positive, healthcare providers should consider obtaining CSF for Zika virus RNA and lgM antibody testing in infants with clinical findings of possible congenital Zika syndrome but whose initial laboratory tests are negative on serum and urine. Maternal laboratory evidence of possible Zika virus infection during pregnancy includes the following test result interpretations (described at https://www.cdc.gov/pregnancy/zika/testing-follow-up/ documents/lab-table.pdf): Acute Zika virus infection; Zika virus infection, timing of infection cannot be determined; Flavivirus infection, specific virus cannot be identified, timing of infection cannot be determined; Presumptive Zika virus infection, timing of infection cannot be determined; Presumptive fl avivirus infection, specific virus cannot be identified, timing of infection cannot be determined. DOES NOT INCLUDE: Insufficient information for interpretation; No laboratory evidence of Zika virus infection. (11) Because levels of Zika virus RNA and lgM antibodies decline over time, laboratory testing of infants should be performed as early as possible, preferably within the first few days after birth, although testing specimens within the first few weeks to months after birth might still be useful. For infants with clinical findings consistent with CZS with maternal testing pending; consider collecting, fixing, and storing placental tissues until results are available. Do not wait for maternal test results, but instead proceed with infant clinical management and testing. (12) Consultations with specialists may include: ID specialist for evaluation for other congenital infections (e.g., toxoplasmosis, syphilis, rubella, cytomegalovirus, or herpes simplex virus} and assistance with Zikavirus diagnosis, testing, and counseling; neurologist by age 1 month for comprehensive neurologic examination and consideration for other evaluations such as advanced neuroimaging and EEG; ophthalmologist for comprehensive eye exam by age 1 month; clinical geneticist for confirmation of the clinical phenotype and evaluation for other causes of microcephaly or congenital anomalies; early intervention and developmental specialists; family and supportive services. Additional possible consultations, based on clinical findings of the infant include endocrinologist for evaluation of hypothalamic or pituitary dysfunction and consideration for thyroid testing; lactation specialist, nutritionist, gastroenterologist, or speech or occupational therapist for evaluation for dysphagia and man agement of feeding issues; orthopedist, physiatrist, or physical therapist for the management of hypertonia, clubfoot or arthrogrypotic-like conditions; pulmonologist or otolaryngologist for concerns about aspiration. (13) Placental testing does not routinely provide additional diagnostic information in the setting of a maternal or infant diagnosis of acute or confirmed congenital Zika virus infection, respectively. (14) Placental testing is not indicated for the subset of women with maternal laboratory test interpretation "Zika virus infection, timing cannot be determined" whose only possible exposure to Zika occurred during this pregnancy, as the positive Zika virus lgM and PRNT results likely represent acute Zika virus infection during pregnancy when compared with women whose positive serologic results may reflect an infection prior to pregnancy. (15) Contact CDC's Infectious Diseases Pathology Branch at pathology@cdc.gov for case-specific questions. (16) Persons with ongoing possible Zika virus exposure include those who reside in or frequently travel (e.g., daily or weekly} to an area with risk of Zika virus transmission. U.S. Departmant of Health and Human Servlcel Centersfor Disease Controland Prevention TX-DSHS-19-1309-A-000002 CDC's Response to Zika IMPLEMENTING CDC GUIDANCE FOR CLINICAL MANAGEMENT AND EVALUATION OF INFANTS BORN TO MOTHERS WITH POSSIBLE ZIKA VIRUS EXPOSURE DURING PREGNANCY; AND TESTING OF PLACENTAL, FETAL, OR INFANT AUTOPSY TISSUES(1 , 2) Notes: This tool summarizes general CDC guidance for the following scenarios. Please consult CDC or your state or local health department for case-specific questions. Health departments should adapt CDC guidance depending on local capacity and circumstances. INFANT OR FETUS WITHOUT CLINICAL FINDINGS CONSISTENT WITH CZS (3) WITH maternal laboratory evidence of possible Zika virus infection during pregnancy (4) No maternal laboratory evidence of possible Zika virus infection during pregnancy (4,6) Acute Zika virus infection Maternal testing at any time negative, or mother not tested Maternal Zika virus laboratory results and interpretations (4) Clinical evaluation and management Testing of placental tissues Zika or flavivirus infection, timing cannot be determined At birth: standard evaluation. ("10)Infant Zika virus laboratory testing: NAT on serum and urine; lgM on serum. (12) By one month: head ultrasound, comprehensive ophthalmologic exam, automated ABR. If laboratory evidence of congenital Zika virus infection in infant, follow recommendations for infants with clinical findings consistent with CZS even in the absence of clinically apparent abnormalities. May be considered on a case-by-case basis (16) to aid in maternal diagnosis for women who either had symptoms of Zika virus disease during pregnancy, or had ongoing possible Zika virus exposure (17) for the full duration of pregnancy. (15) Not indicated. (14) At birth: standard evaluation. (10) Infant Zika virus laboratory testing: not routinely recommended. If findings suggestive of CZS (3) are identified at any time, refer to appropriate specialists (13) and follow recommendations for evaluation of infants with clinical findings consistent with CZS. Not indicated. PREGNANCY LOSS OR INFANT DEATH FOLLOWING LIVE BIRTH Testing of fetal and placental tissues --------------------------Testing of infant autopsy and placental tissues May be considered on a case-by-case basis (16) to aid in maternal and/or fetal/infant diagnosis for pregnancies where there were maternal symptoms of Zika virus disease during pregnancy, or where there was ongoing possible maternal Zika virus exposure for the full duration of pregnancy. Abbreviations; ABR=Auditoiy Brain Stem Response, CSF=Cerebrospinal Fluid, CZS= Congenital ID=lnfectious Disease, lgM=lmmunoglobulin M, Zika Syndrome, EEG= Electroencephalogram, IHC=immunohistochemistiy, NAT=Nucleic Acid Testing, PRNT= Plaque Reduction Neutralization Test, RNA=ribonucleic acid, RT-PCR= Reverse Transcriptase Polymerase Chain Reaction (1) (2) (3) (4) Zika virus testing on fotmalin -fixed, paraffin embedded tissue specimens is conducted at CDC's Infectious Diseases Pathology Branch (IDPB} and includes Zika virus RT-PCR on placental and fetaVinfant tissues. Zika virus IHC may be perfotmed on placental specimens into the second trimester, fetal tissues from any gestational age, and infant autopsy tissues. Placental tissues include placental disc, umbilical cord, and fetal membranes. Zika virus RNA can be focal within placental tissues, and testing of three sections of placenta, one section of umbilical cord, and one section of fetal membrane is recommended (https://www.cdc.gov/zika/laboratories/ test-specimens-tissues.htmn. For pregnancy losses and infant deaths, submission of fetal or infant autopsy tissues, if available, in addition to submission of placental tissues, is preferred, but if not available will not preclude placental testing. Clinical findings consistent with CZS include severe microcephaly, decreased brain tissue with subcortical calcifications, macular scarring and focal pigmentaiy retinal mottling, congenital contractures such as clubfoot or arthrogiyposis, and hypertonia restricting body movement soon after birth. Additional findings Maternal laboratoiy evidence of possible Zika virus infection during pregnancy includes the following test result interpretations (described at https://www.cdc.gov/pregnancy/zika/testing-follow-up/ documents/lab -table.pdj}: Acute Zika virus infection; Zika virus infection, timing of infection cannot be detetmined; Flavivirus infection, specific virus cannot be identified, timing of infection cannot be determined; Presumptive Zika virus infection, timing of infection cannot be detetmined; Presumptive flavivirus infection, specific virus cannot be identified, timing of infection cannot be detetmined. DOES NOT INCLUDE: Insufficient information for interpretation; No laboratory evidence of Zika virus infection. For infants with clinical findings consistent with CZS with maternal testing pending; consider collecting, fixing, and storing placental tissues until results are available. Do not wait for maternal test results, but instead proce ed with infant clinical management and testing. (5) For infants without findings consistent with CZS with maternal testing pending and maternal specimen was collected within 12 weeks of all exposure, consider collecting, fixing, and storing placental tissues, and collecting and storing infant serum and urine. Once available, maternal test results should guide further management according to this framework. (6) Symptoms of Zika virus disease include acute onset of fever, maculopapular rash, arthralgia, or conjunctivitis. (7) All or part of possible maternal Zika virus exposure, or symptom onset, occutred >12 weeks before maternal serum specimen was collected. (8) Includes pregnant women with negative Zika virus NAT and negative Zika virus lgM s12 weeks after symptom onset or exposure. (9) Standard evaluation at birth includes a comprehensive physical exam, including growth parameters; newborn hearing screen at birth, preferably with automated ABR; developmental monitoring and screening using validated screening tools recommended by the American Academy of Pediatrics (https://www.aap.org/ en-u s/advocacy-and-policy/aap-h ealth-initiatives/Screening/Pages/ Screening-Tools.aspx}; and vision screening as recommended by the American Academy of Pediatrics Policy Statement "Visual System Assessment in Infants, Children, and Young Adults by Pediatricians" (http:! /pediatrics. aappublication s. org/content/137 /1 / e20153596}. (10) CDC interim infant testing guidance recommends that Zika virus testing should be performed on CSF if it is/was collected for other reasons. Since there are reports of congenital Zika virus infection in which CSF was the only sample testing positive, healthcare provide rs should consider obtaining CSF for Zika virus RNA and lgM antibody testing in infants with clinical findings of possible congenital Zika syndrome but whose initial laboratory tests are negative on serum and urine. (11) Because levels of Zika virus RNA and lgM antibodies decline over time, laboratory testing of infants should be petiormed as early as possible, preferably within the first few days after birth, although testing specimens within the first few weeks to months after birth might still be useful. (12) Consultations with specialists may include: ID specialist for evaluation for other congenital infections (e.g., toxoplasmosis, syphilis, rub ella, cytom egalovirus, or herpes simplex virus} and assis- Not indicated. tance with Zika virus diagnosis, testing, and counseling; neurologist by age 1 month for comprehensive neurologic examination and consideration for other evaluations such as advanced neuroimaging and EEG; ophthalmologist for comprehensive eye exam by age 1 month; clinical geneticist for confirmation of the clinical phenotype and evaluation for other causes of microcephaly or congenital anomalies; early intervention and developmental specialists; family and supportive services. Additional possible consultations, based on clinical findings of the infant include endocrinologist for evaluation of hypothalamic or pitu itaiy dysfunction and consideration for thyroid testing; lactation specialist, nutritionist, gastroenterologist, or speech or occupational therapist for evaluation for dysphagia and management of feeding issues; orthopedist, physiatrist, or physical therapist for the management of hypertonia, clubfoot or arthrogrypotic-like conditions; pulmonologist or otolaiyngologist for concerns about aspiration. (13) Placental testing does not routinely provide additional diagnostic infotm at ion in the setting of a maternal or infant diagnosis of acute or confitmed congenital Zika virus infection, respectively. (14) Placental testing is not indicated for the subset of women with maternal laboratory test interpretation "Zika virus infection, timing cannot be determined" whose only possible exposure to Zika occurred during this pregnancy, as the positive Zika virus lgM and PRNT results likely represent acute Zika virus infection during pregnancy when compared with women whose positive serologic results may reflect an infection prior to pregnancy. (15) Contact CDC's Infectious Diseases Pathology Branch at pathology@cdc.gov for case-specific questions. (16) Persons with ongoing possible Zika virus exposure include those who reside in or frequently travel (e.g., daily or weekly} to an area with risk of Zika virus transmission. U.S. Department of Health and Human Sarvices CentersforDisease Control and Prevention TX-DSHS-19-1309-A-000003 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, September 11, 2018 9:19 AM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Hyatt Hotel Link Updated WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning. Thank you for those who let us know the Hyatt registration link in yesterday’s email announcement about the 2019 ELC Annual Meeting was not functional. The updated reservation link is: http://www.hyatt.com/hyatt/reservations/flow6/place/propCheckAvailability.jsp? pid=ATLZB&extCorporateId=G-ELCM Sincerely, The ELC Team TX-DSHS-19-1309-A-000004 From: Aldridge,Tiffany (DSHS) Sent: Monday, September 17, 2018 5:17 PM EDT To: Simpson, De'Lisa D. (CDC/OID/NCEZID) CC: Garcia,Imelda M (DSHS) ; Kubin,Grace (DSHS) Subject: RE: ELC Quarterly Call-1st Quarter 2018 Hi De’Lisa, Our available times are listed below. Please let know the best time for you. September 25, 2018: 2 p.m. and 3 p.m. CST September 27, 2018: 10 a.m. CST September 28, 2018: 11 a.m. and 3 p.m. CST Please let us know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Simpson, De'Lisa D. (CDC/OID/NCEZID) [mailto:ion9@cdc.gov] Sent: Monday, September 10, 2018 11:29 PM Subject: ELC Quarterly Call-1st Quarter 2018 Importance: High WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ELC Governance Team, Attached is a draft agenda for our ELC Governance Call (approximately 1 hour). The call will focus on the recently funded 2018 ELC continuation awards (8/1/18 to 7/31/19). However, please feel free to add other topics of importance for our discussion. In addition, please invite a Fiscal/Financial Representative to participate as we will discuss post award actions and ELC support for a Fiscal/Financial Representative’s Travel to 2019 ELC Meeting. We are trying to schedule calls from September 24th through September 28th Please provide two options (Option 1 and Option 2) of dates/times that you could be available (60 minute time frames). However, we will periodically follow-up with grantees that have not identified preferred dates/times. Below are date/times that ELC staff have committed to standing meetings (blackout dates/times; ELC cannot be available): · • • • • Annual Leave September 10-17, 2018 Mondays from 9AM to 10AM. Tuesdays from 10AM-11AM. Thursdays from 10AM-11AM. Fridays from 12:00 PM – 1PM. I will be back in the office on September 18, 2018 and will schedule your call upon my return based off your selections. Thank you. De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 TX-DSHS-19-1309-A-000005 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-000006 From: Tupy,Shawn (DSHS) Sent: Wednesday, September 19, 2018 12:45 PM EDT To: CDC HAI AR (CDC) CC: Taylor, Janine (CDC/OID/NCEZID) (CTR) ; Aldridge,Tiffany (DSHS) ; Garcia.Imelda M (DSHS) ; Subject: RE: Texas Kick-Off Call Follow-Up Attachment(s): "Project K1A TX HAI Detection Containment and Prevention.pdf" Gamez.Monica (DSHS) Yes, thank you. Tiffany Aldridge is our coordinating contact for ELC to summarize our questions for this call. Many Thanks! Shawn Tupy MT, MBA Branch Manager Emerging and Acute Infectious Disease Branch Texas Department of State Health Services Tower Building, Mail Code 1960 Austin, Texas 78714 Office Phone (512) 776-6355 Fax Number (512) 776-7616 TEXAS Health and Human Services . I Texaspepar_tment ofState llfealt ,h Serv 1ce,s From: CDC HAI AR (CDC) [mailto:HAIAR@cdc.gov] Sent: Wednesday, September 19, 2018 9:33 AM To: Tupy.Shawn (DSHS) Cc: Taylor, Janine (CDC/OID/NCEZID) (CTR) ; CDC HAI AR (CDC) Subject: RE: Texas Kick-Off Call Follow-Up WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Morning Shawn, I just wanted to follow-up to make sure you received your technical review package in preparation for your Kick-Off Call on Friday. Also, please let us know if there are any topics that you would like to discuss on the call. Warm Regards, Gregory J. Juseph, MPH l'ublic Health Analyst Northrop Grumman Contractor CIMS Division of Healthcare Quality Promotion National Center for Emerging and Zornrntic Infectious Diseases Centers for Disease Control and l'rnvention Email - olm~(a).t:dc ('QY l'hone-(404) 718-51:25 From: CDC HAI AR (CDC) Sent: Friday, September 14, 2018 11:49 AM To: Tupy.Shawn (DSHS) Cc: CDC HAI AR (CDC) ; Taylor, Janine (CDC/OID/NCEZID) (CTR) Subject: Texas Kick-Off Call Follow-Up Hi Shawn, I just wanted to follow-up with you before your Kick-Off Call next Friday. Did you receive your technical review package? Also , do you have any topics that you would like to discuss in the call? If you do , please let us know so we can make sure all pertinent subject matter experts are listening in to answer your questions. One of the topics of discussion for the call will be your Ebola extension spending, so please be prepared to talk about it. Lastly, do you have an organizational chart of y our HD? If so, can you please send us a copy for our records? Warm Regards, TX-DSHS-19-1309-A-000007 Gregory J. Joseph, MPH Public Health Analyst Northrop Grumman Contractor CIMS Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Email – olm5@cdc.gov Phone – (404) 718-5225 TX-DSHS-19-1309-A-000008 ELC STREAMLINED OBJECTIVE REVIEW FORM CK14-140105PPHF18 Program Announcement #: CK14-140105PPHF18 FY: 2018 Program Announcement Title: Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (Continuation Application/Interim Progress Reports) Recipient Organization (State/City/Jurisdiction): ____Texas____________________ Group/panel reviewing (e.g., PulseNet Review Team): ______HAI/AR Team____________ Project Reviewing: ______K1A_________________________________________ PROGRESS REPORT (PREVIOUSLY FUNDED) Strengths: EPI:  All staff have been hired.  The Healthcare Safety Advisory Committee has been re-established to focus on activities related to HAIs, Antimicrobial Resistance, Antimicrobial Stewardship, and Preventable Adverse events (including injection safety initiatives).  Reported TAP assessments in 25 facilities. o Unclear how these 25 facilities were identified.  Provided feedback reports to facilities.  LTC Quality Monitoring Program (QMP) program to discuss ongoing infection control issues. Beginning in 2018, the HAI/AR Program adopted the use of an outbreak tracking and response Microsoft Access Database to document HAI/AR outbreaks from CORHA.  Applicant participated in various different activities during the U.S. Antibiotic Awareness Week. They also worked with Superior Health Plan to distribute 150 outpatient commitment posters, and initiated collaborative project with different partners for long-term care and critical access facilities prevention initiatives. Applicant also discussed their other completed prevention activities. LAB:  Full testing directory implemented.  Reporting monthly to CDC through APHL AIMS portal.  Reporting results to clinical labs within two days.  Sending alerts to CDC.  Regular communication with Houston lab. Weaknesses: EPI:  The antibiotic stewardship training activity is not completed.  Discontinued NHSN data quality checks/validation due to Hurricane 1 TX-DSHS-19-1309-A-000009 LAB:  Limited description for soliciting CRE/CRPA isolates from clinical labs. Additional Comments: The numbers grantee reported for TAP reports, assessments, and implementation of intervention are quite high. More detail on how they were able to successfully target this many facilities would be great and probably very useful to other states who are having little to no success. Qualitative Scoring: Unsatisfactory Poor Fair Good Very Good Outstanding X APPROACH & WORKPLAN FOR FY2018 Strengths: EPI:  Staffing and subject matter expertise will be maintained.  The AS Expert, HAI/AR Epidemiologist, and the HAI Coordinator meet with the City of Houston Health Department to form complimentary activities.  Applicant will generate quarterly TAP reports and target at least two facilities in each health services region. Mid-year and year-end reports will be provided to facilities.  Grantee will attempt to have facilities not statutorily required to report HAIs participate  Grantee plans to target facilities with high SSIs. o Included SSI data validation  Applicant will target post-acute care facilities for CDI pilot project.  Develop standardized outbreak investigation tools for five areas of the environment in healthcare facilities. Create an action plan to address the top three gaps in infection control referenced in the HAI outbreak database. Develop a pilot tabletop HAI/AR exercise involving state healthcare preparedness partners. MDRO reporting requirements and reported data will be reviewed for strengths and weaknesses in detecting novel emerging AR threats. Target a portion of hospitals that are found to be in need of a water management plan across the state.  Applicant proposes to continue promoting and providing education on the implementation of Core Elements. They plan to distribute information to providers, patients, and patient’s families through presentations, meetings, and speaking engagements. Applicant plans to continue developing partnership and collaboration in long-term care facilities and critical access hospitals. LAB:  Good descriptions for implementation plan and milestones. Weaknesses: EPI:  The workplan would benefit from additional description of the advisory committee’s composition and priorities. 2 TX-DSHS-19-1309-A-000010  It’s not clear whether ICAR assessments will be used to assess and address gaps identified during outbreak investigations. Additional Comments: EPI:  Requests continued funding for 3 HAI/AR epis for TAP strategy  Good plans for IIIa and IIIb Qualitative Scoring: Unsatisfactory Poor Fair Good Very Good Outstanding X EVALUATION AND PERFORMANCE MEASUREMENT STRATEGY Strengths: EPI:  Grantee reported #3 (very high numbers!)  Plan in place to collect data and report required measures in upcoming year. LAB:  Provided description of reporting on next year’s performance measures.  All performance measures completed Weaknesses: EPI:  Zero reported for #2 (suspended due to hurricane) Additional Comments: EPI:  Home rule state Qualitative Scoring: Unsatisfactory Poor Fair Good Very Good Outstanding X BUDGET NARRATIVE: (NOT SCORED) Strengths: LAB:  Budget items in line with activities. Weaknesses: Additional Comments: GENERAL COMMENTS TO RECIPIENT REGARDING CONTENT OF APPLICATION: 3 TX-DSHS-19-1309-A-000011 From: Snow, Jason N. (CDC/OID/NCEZID) Sent: Wednesday, September 19, 2018 4:17 PM EDT To: Garcia,Imelda M (DSHS) ; Aldridge,Tiffany (DSHS) ; Golden,Sharon (DSHS) CC: Simpson, De'Lisa D. (CDC/OID/NCEZID) Subject: RAL/End-of-Year funding for BP5 - Texas Attachment(s): "TX_FY18_RAL.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon. You might notice a system message through GrantSolutions pertaining to a Notice of Award (NOA) being issued this week. We wanted to let you know that, as in year’s past, additional end-of-year funds were made available to some of the ELC partner programs at the end of CDC’s fiscal year. Because of the priority placed on providing financial support to ELC Recipients, these end-of-year funds are being awarded to select jurisdictions to augment funding issued a few weeks ago for Budget Period 5. Attached is the ELC Funding Spreadsheet for the funding made available through the RAL (Rapid Award List)/end-of-year process. This information is being provided to supplement what was included in the NOA so that you know which ELC projects, along with the various cost category allocations, make up the overall funding. We anticipate having the revised budget mark-ups soon and available on REDCap. If you have any additional questions about the RAL/end-of-year funding, please reach out to your ELC Project Officer. ______________________________________ Jason N. Snow, Ph.D. Health Scientist Scientific & Program Services Branch (SPSB) Division of Preparedness and Emerging Infections (DPEI) National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention (CDC) 1600 Clifton, Building 24, Room 11111.2 Mailstop H24-11 Atlanta, GA 30329 Email: JNSnow@cdc.gov Office: 404-639-4577 Mobile: 404-307-3294 ELC web page: www.cdc.gov/ELC NOTE: I telework on Wednesdays & Fridays and can be reached by mobile or email. TX-DSHS-19-1309-A-000012 Funding recommendations based on current funding available at the time RAL FY18 REQUESTED Recipient TEXAS RECOMMENDED BY PROJECT Recipient TEXAS Sum of Approved Column Labels H1.Cross-Cutting Outbreak Invest Resp & Reporting: Epi/Lab 1 (H1) Q1.Non-Influenza T.Binational Border M1.West Nile M2.U.S. Zika Respiratory Diseases - Infectious Disease Virus and other Pregnancy Diagnostic, Reporting Surveillance (BIDS) Arboviral Registry and Surveillance Program Y.Legionella Prevention LineItem Row Labels Salaries Fringe Travel Equipment Supplies Contractual Other Indirect Grand Total Sum of Requested $7,041 $2,586 $11,528 $331 $50,000 $7,022 $78,508 Project Recipient (All) TEXAS Row Labels 939-0B3S 939-0B3T 939-0BF7 Grand Total Sum of Approved $6,851 $48,149 $23,508 $78,508 RECOMMENDED NU50CK000378 GRAND TOTAL $ 7,041 Salaries $ 2,586 Fringe $ 11,528 Travel $ Equipment $ 331 Supplies $ 50,000 Contractual $ Other $ 7,022 Indirect $ 78,508 IGrand Total $55,000 $2,660 $23,508 $7,041 $2,586 $8,868 $250 $50,000 $81 $2,090 $55,000 $4,932 $23,508 TX-DSHS-19-1309-A-000013 From: Garcia,Imelda M (DSHS) Sent: Wednesday, September 19, 2018 5:09 PM EDT To: Snow, Jason N. (CDC/OID/NCEZID) ; Aldridge,Tiffany (DSHS) ; Golden,Sharon (DSHS) CC: Simpson, De'Lisa D. (CDC/OID/NCEZID) Subject: RE: RAL/End-of-Year funding for BP5 - Texas Thanks Jason. We did receive the NGA this week. Imelda M. Garcia, MPH Director, Infectious Disease Prevention Section Phone: 512-776-7679 Email: ImeldaM.Garcia@dshs.texas.gov CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. From: Snow, Jason N. (CDC/OID/NCEZID) [mailto:itk0@cdc.gov] Sent: Wednesday, September 19, 2018 3:18 PM To: Garcia,Imelda M (DSHS) ; Aldridge,Tiffany (DSHS) ; Golden,Sharon (DSHS) Cc: Simpson, De'Lisa D. (CDC/OID/NCEZID) Subject: RAL/End-of-Year funding for BP5 - Texas WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon. You might notice a system message through GrantSolutions pertaining to a Notice of Award (NOA) being issued this week. We wanted to let you know that, as in year’s past, additional end-of-year funds were made available to some of the ELC partner programs at the end of CDC’s fiscal year. Because of the priority placed on providing financial support to ELC Recipients, these end-of-year funds are being awarded to select jurisdictions to augment funding issued a few weeks ago for Budget Period 5. Attached is the ELC Funding Spreadsheet for the funding made available through the RAL (Rapid Award List)/end-of-year process. This information is being provided to supplement what was included in the NOA so that you know which ELC projects, along with the various cost category allocations, make up the overall funding. We anticipate having the revised budget mark-ups soon and available on REDCap. If you have any additional questions about the RAL/end-of-year funding, please reach out to your ELC Project Officer. ______________________________________ Jason N. Snow, Ph.D. Health Scientist Scientific & Program Services Branch (SPSB) Division of Preparedness and Emerging Infections (DPEI) National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention (CDC) 1600 Clifton, Building 24, Room 11111.2 Mailstop H24-11 Atlanta, GA 30329 Email: JNSnow@cdc.gov Office: 404-639-4577 Mobile: 404-307-3294 ELC web page: www.cdc.gov/ELC NOTE: I telework on Wednesdays & Fridays and can be reached by mobile or email. TX-DSHS-19-1309-A-000014 From: Aldridge,Tiffany (DSHS) Sent: Friday, September 21, 2018 12:09 PM EDT To: CDC HAI AR (CDC) CC: Taylor, Janine (CDC/OID/NCEZID) (CTR) ; Garcia,lmelda M (DSHS) ; Gamez.Monica (DSHS) ; Tupy,Shawn (DSHS) ; Kubin,Grace (DSHS) Subject: RE: Texas Kick-Off Call Follow-Up Hello, Please see our questions below for the meeting scheduled at 2 p.m. EST today. Questions for Discussion: 1. Why was Sue Baumann not funded for Year 5? 2. If only two HAI Epis are funded (region 1 and region 8) are we only required to do colonization screenings in the funded areas? This will mean a drastic reduction in ARLN submissions. 3. What is the long-term expectations for CRE and CRPA and Candida Auris over this year? 4. Discuss Antibiotic Stewardship status. Please let us know if you have any questions. Thanks, Tiffany Aldridge, CTC,\1 Program Sj1ecialist Texas Department of State Ilea/th Sr?rvices Infectious Disease Prevention Sr>ction MC30R2 Ph: (512) 776-6658 Cr>II:(5 l 2) 645-5030 Fax: (512) 776-7443 tiffan p.aldrid gd iidshs.tr>x1.1s. gov From: Tupy.Shawn (DSHS) Sent: Wednesday, September 19, 2018 11:45 AM To: CDC HAI AR (CDC) Cc: Taylor, Janine (CDC/O1D/NCEZID) (CTR) ; Aldridge.Tiffany (DSHS) ; Garcia ,Imelda M (DSH S) < Imelda M. Ga rcia@dshs.texas.gov>; Gamez ,Monica (OS HS) Subject: RE: Texas Kick-Off Call Follow-Up Yes, thank you. Tiffany Aldridge is our coordinating contact for ELC to summarize our questions for this call. Many Thanks! Shawn Tupy MT, MBA Branch Manager Emerging and Acute Infectious Disease Branch Texas Department of State Health Services Tower Building, Mail Code 1960 Austin, Texas 78714 Office Phone (512) 776-6355 Fax Number (512) 776-7616 TEXAS Healthian d Human I T . exas_D~par_tment. of S" tate Services llfealt hServ 1ce,s 1 From: CDC HAI AR (CDC) D:oailtQ"HAIAR@cdc goyJ Sent: Wednesday, September 19, 2018 9:33 AM To: Tupy.Shawn (DSHS) Cc: Taylor, Janine (CDC/O1D/NCEZID) (CTR) ; CDC HAI AR (CDC) Subject: RE: Texas Kick-Off Call Follow-Up WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from TX-DSHS-19-1309-A-000015 the sender and know the content is safe. Good Morning Shawn, I just wanted to follow-up to make sure you received your technical review package in preparation for your Kick-Off Call on Friday. Also, please let us know if there are any topics that you would like to discuss on the call. Warm Regards, Gregory J. Joseph, MPH Public Health Analyst Northrop Grumman Contractor CIMS Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Email – olm5@cdc.gov Phone – (404) 718-5225 From: CDC HAI AR (CDC) Sent: Friday, September 14, 2018 11:49 AM To: Tupy,Shawn (DSHS) Cc: CDC HAI AR (CDC) ; Taylor, Janine (CDC/OID/NCEZID) (CTR) Subject: Texas Kick-Off Call Follow-Up Hi Shawn, I just wanted to follow-up with you before your Kick-Off Call next Friday. Did you receive your technical review package? Also, do you have any topics that you would like to discuss in the call? If you do, please let us know so we can make sure all pertinent subject matter experts are listening in to answer your questions. One of the topics of discussion for the call will be your Ebola extension spending, so please be prepared to talk about it. Lastly, do you have an organizational chart of your HD? If so, can you please send us a copy for our records? Warm Regards, Gregory J. Joseph, MPH Public Health Analyst Northrop Grumman Contractor CIMS Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Email – olm5@cdc.gov Phone – (404) 718-5225 TX-DSHS-19-1309-A-000016 From: Cope, Jennifer R. (CDC/OID/NCEZID) Sent: Wednesday, September 26, 2018 2:53 PM EDT To: Vaidehi Shah ; Lacey Sanders ; Garcia,Imelda M (DSHS) CC: Stuteville,Haylea (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Gamez,Monica (DSHS) ; Gaul,Linda (DSHS) ; Thomas,Whitney (DSHS) ; Morehead,Bonnie (DSHS) ; Carlsen,Conner (DSHS) ; Hill, Vincent (CDC/OID/NCEZID) ; Hlavsa, Michele C. (CDC/OID/NCEZID) ; Fullerton, Katie (CDC/OID/NCEZID) Subject: RE: LHD PAM call Attachment(s): "Whitewater PAM Case_Final CID.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Attached is the whitewater publication I referenced on today’s call. Also, here is a link to a news article about the whitewater center closing. We did our site investigation and sampling on Wednesday, 6/22/2016 and the center voluntarily closed on Friday, 6/24/2018 based on preliminary lab findings. https://www.charlotteobserver.com/news/local/article85846642.html They reopened on August 10, 2016. https://www.charlotteobserver.com/news/local/article94857757.html Let us know if you have additional questions. Jennifer From: Vaidehi Shah Sent: Wednesday, September 26, 2018 12:57 PM To: Cope, Jennifer R. (CDC/OID/NCEZID) ; Lacey Sanders ; Garcia,Imelda M (DSHS) Cc: Stuteville,Haylea (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Gamez,Monica (DSHS) ; Gaul,Linda (DSHS) ; Thomas,Whitney (DSHS) ; Morehead,Bonnie (DSHS) ; Carlsen,Conner (DSHS) Subject: RE: LHD PAM call Great. Can you please send the call-in information. Thanks, Vaidehi From: Cope, Jennifer R. (CDC/OID/NCEZID) [ mailto:bjt9@cdc.gov] Sent: Wednesday, September 26, 2018 11:55 AM To: Vaidehi Shah; Lacey Sanders; Garcia,Imelda M (DSHS) Cc: Stuteville,Haylea (DSHS); Aragon,Antonio (DSHS); Rucas,Hailey (DSHS); Gamez,Monica (DSHS); Gaul,Linda (DSHS); Thomas,Whitney (DSHS); Morehead,Bonnie (DSHS); Carlsen,Conner (DSHS) Subject: RE: LHD PAM call Yes we can talk at noon (1 PM eastern). From: Vaidehi Shah Sent: Wednesday, September 26, 2018 12:37 PM To: Cope, Jennifer R. (CDC/OID/NCEZID) ; Lacey Sanders ; Garcia,Imelda M (DSHS) Cc: Stuteville,Haylea (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Gamez,Monica (DSHS) ; Gaul,Linda (DSHS) ; Thomas,Whitney (DSHS) ; Morehead,Bonnie (DSHS) ; Carlsen,Conner (DSHS) Subject: RE: LHD PAM call Dr. Verner, our Local Health Authority has his private practice and has patients scheduled for this afternoon. The best times available for him are today at noon or 5:30 pm. The next best time would be 11 am tomorrow or Friday. Please let us know as soon as possible if we would want to talk at noon today. Thank you, Vaidehi Shah, BDS, MPH Senior Epidemiologist Waco-McLennan County Public Health District Desk: 254-750-5775 TX-DSHS-19-1309-A-000017 Cell: 254-709-1870 Fax: 254-750-5405 Personal Email: VaidehiS@wacotx.gov Program Email: WacoEpi@wacotx.gov From: Cope, Jennifer R. (CDC/OID/NCEZID) [ mailto:bjt9@cdc.gov] Sent: Wednesday, September 26, 2018 11:02 AM To: Lacey Sanders; Garcia,Imelda M (DSHS) Cc: Stuteville,Haylea (DSHS); Aragon,Antonio (DSHS); Rucas,Hailey (DSHS); Gamez,Monica (DSHS); Gaul,Linda (DSHS); Thomas,Whitney (DSHS); Morehead,Bonnie (DSHS); Carlsen,Conner (DSHS); Vaidehi Shah Subject: Re: LHD PAM call Hi all, Just wrapped up a phone conversation with Linda about our concern around preventing additional infections while we collect additional data. While we understand lab data showing Naegleria in this venue would bolster our case for closing, based on the current epi data and prior investigations, we think this venue (specifically the surf park) poses an ongoing risk to patrons. Could we discuss this by phone today with Waco's local health authority? Thanks, Jennifer From: Lacey Sanders Sent: Wednesday, September 26, 2018 10:55 AM To: "Garcia,Imelda M (DSHS)" CC: "Stuteville,Haylea (DSHS)" ,"Aragon,Antonio (DSHS)" ,"Rucas,Hailey (DSHS)" ,"Gamez,Monica (DSHS)" ,"Gaul,Linda (DSHS)" ,"Cope, Jennifer R. (CDC/OID/NCEZID)" ,"Thomas,Whitney (DSHS)" ,"Morehead,Bonnie (DSHS)" ,"Carlsen,Conner (DSHS)" ,Vaidehi Shah Subject: Re: LHD PAM call I think drafting one just in case is fine. But the reality is we don’t have any lab work saying that the organism is in the water at the park. Right now it is all hear say. We talked here and feel like if we get calls or questions simply saying it is an ongoing investigation and giving out information on how to find more information on PAM to those that call should be fine for now. Calming any possible fears as well. Lacey Sanders Sent from my iPhone On Sep 26, 2018, at 9:34 AM, Garcia,Imelda M (DSHS) wrote: We draft one, but I’m not sure if that’s the right thing to do yet. We need more info on risk at this park before we do anything significant. Imelda M. Garcia, MPH Director, Infectious Disease Prevention Section Texas Dept. of State Health Services iPhone: 512-461-4476 Office: 512-776-7679 CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. Sent from my iPhone On Sep 26, 2018, at 9:32 AM, Stuteville,Haylea (DSHS) wrote: Good Morning, Lacey just called me and notified us that they received a call today from a “concerned TX-DSHS-19-1309-A-000018 citizen” and asking about the BSR cable park. Nothing comes up yet on google when you search for BSR cable park and amoeba so I am not sure how they found out. Since it is already starting to get to the health department, Hailey and I are thinking it may be a good idea to send out a health advisory, similar to the one that was sent out in 2016, and it will be on Dr.Hellerstedt’s letterhead. I have attached that health advisory for everyone to look at. Hailey and I can work on making the necessary changes to the 2016 advisory and can send out for approval. What is everyone’s thoughts on this? Haylea Stuteville, MPH Epidemiologist I Invasive and Respiratory Infectious Disease Team Texas Department of State Health Services Austin, TX 78714-9347 (512) 776-2541 phone (512) 776-7616 fax CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code § 81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000019 Clinical Infectious Diseases MAJOR ARTICLE 9IDSA bllihin Infectiou s Disea ses Society of Ameri ca h1vmed1c1ne assoc1at1on Primary Amebic Meningoencephalitis Associated With Rafting on an Artificial Whitewater River: Case Report and Environmental Investigation Jennifer R. Cope,1 Jennifer Murphy,1 Amy Kahler,1 Daniel G. Gorbett,2 Ibne Ali,1 Brandi Taylor,3 Lisa Corbitt,4 Shantanu Roy,1 Nicole Lee,5 Dawn Roellig,1 Scott Brewer,6 and Vincent R. Hill1 1 Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia; 2Mount Carmel Hospital, Columbus, Ohio; 3Ohio Department of Health, Columbus; Mecklenburg County Health Department, Charlotte, North Carolina; 5North Carolina Department of Health and Human Services, Raleigh; and 6Franklin County Public Health, Columbus, Ohio 4 Background. Naegleria fowleri is a thermophilic ameba found in freshwater that causes primary amebic meningoencephalitis (PAM) when it enters the nose and migrates to the brain. Patient exposure to water containing the ameba typically occurs in warm freshwater lakes and ponds during recreational water activities. In June 2016, an 18-year-old woman died of PAM after traveling to North Carolina, where she participated in rafting on an artificial whitewater river. Methods. We conducted an epidemiologic and environmental investigation to determine the water exposure that led to the death of this patient. Results. The case patient’s most probable water exposure occurred while rafting on an artificial whitewater river during which she was thrown out of the raft and submerged underwater. The approximately 11.5 million gallons of water in the whitewater facility were partially filtered, subjected to ultraviolet light treatment, and occasionally chlorinated. Heavy algal growth was noted. Eleven water-related samples were collected from the facility; all were positive for N. fowleri. Of 5 samples collected from the nearby natural river, 1 sediment sample was positive for N. fowleri. Conclusions. This investigation documents a novel exposure to an artificial whitewater river as the likely exposure causing PAM in this case. Conditions in the whitewater facility (warm, turbid water with little chlorine and heavy algal growth) rendered the water treatment ineffective and provided an ideal environment for N. fowleri to thrive. The combination of natural and engineered elements at the whitewater facility created a challenging environment to control the growth of N. fowleri. Keywords. Naegleria fowleri; primary amebic meningoencephalitis; environmental. Swimming and other recreational water activities are enjoyed by millions of Americans every year during the warm summer months. While these activities provide a health benefit in the form of physical activity, infection from waterborne pathogens can occur. An infrequent but severe waterborne infection is caused by Naegleria fowleri, a free-living ameba that thrives in warm freshwater. This ameba causes primary amebic meningoencephalitis (PAM) when water containing the ameba enters the nose, allowing it to gain access to the brain via the cribriform plate. The resulting infection is fulminant, causing death in 97% of US cases in a median of 5 days [1]. PAM, as a type of meningitis, is often mistaken for other, more common types of meningitis, and diagnosis is often made postmortem. Since 1962, 143 PAM cases have been reported in the United States, predominantly among males and children, with most Received 22 June 2017; editorial decision 1 September 2017; accepted 13 September 2017; published online September 19, 2017. Correspondence: J. R. Cope, 1600 Clifton Rd NE, MS C-09, Atlanta, GA 30329 (jcope@cdc.gov). 2018;66(4):548–53 Clinical Infectious Diseases® Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US. DOI: 10.1093/cid/cix810 reporting recreational water exposure such as swimming, diving, waterskiing, or wakeboarding in lakes in the week prior to illness onset [2]. Whitewater rafting has not been previously documented as a water exposure leading to PAM, and was not considered to be a risk factor because natural whitewater rivers and streams move swiftly and many are cooler water sources originating in the mountains. This contrasts with the warm, slow-moving or stagnant lakes, ponds, and rivers where most infections occur. Artificial whitewater courses gained popularity with the introduction of whitewater slalom as an Olympic sport in 1972. Some artificial whitewater courses worldwide are built in or are diversions from natural streambeds. More recently, whitewater courses have been built that are completely manufactured as concrete channels with closed-loop systems using recirculated water (Scott Shipley, personal communication). There are currently 3 closed-loop concrete-channel whitewater courses in the United States open to the general public. CASE REPORT On the morning of 17 June 2016, a previously healthy 18-yearold woman presented to a Columbus, Ohio, emergency 548 • CID 2018:66 (15 February) • Cope et al TX-DSHS-19-1309-A-000020 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 department with a headache that began 3 days prior associated with fever and lethargy. She had been seen by her primary care physician, who diagnosed possible sinusitis and prescribed amoxicillin. However, following that visit, she started having high fevers with progressive lethargy. In the emergency department, she had altered mental status, responded only to noxious stimuli, and was febrile (39.4 C) with a pulse of 107 beats per minute, blood pressure of 115/69 mm Hg, and respirations of 22 breaths per minute. To evaluate for meningitis, a lumbar puncture was performed, revealing an opening pressure of 36  cm H2O. Cerebrospinal fluid (CSF) analysis showed a white blood cell count of 3808 cells/µL with 78% neutrophils, 18% monocytes, and 4% lymphocytes, a red blood cell count of 516 cells/ µL, protein 410  mg/dL, and glucose <10  mg/dL. A  computed tomography (CT) scan of the brain was interpreted as normal. The patient was admitted and treated empirically for bacterial and viral etiologies of meningitis with ceftriaxone, vancomycin, ampicillin, doxycycline, and acyclovir. Over the next 36 hours, she rapidly declined despite antimicrobial therapy and became obtunded requiring intubation and critical care management. A repeat CT scan of the brain showed interval increased effacement of cerebral sulci and decreased ventricular size compatible with diffuse cerebral edema. A  right frontal extraventricular drain was placed, revealing an intracranial pressure (ICP) of 90 cm H2O at 3:00 pm on 18 June. Strategies to try to manage the patient’s elevated intracranial pressure included the administration of mannitol, hypertonic saline, and dexamethasone, hyperventilation, pentobarbital, and vasopressors to increase mean arterial pressure and generate cerebral perfusion pressure. Therapeutic hypothermia was also initiated. At this time, CSF Gram stain showed no organisms; polymerase chain reaction (PCR) for herpes simplex virus and varicella zoster virus was negative, and the diagnosis of PAM was considered given the patient’s rapid decline and nonresponse to appropriate coverage for bacterial and viral meningitis. The Centers for Disease Control and Prevention (CDC) was consulted on 18 June and conventional amphotericin B, fluconazole, azithromycin, and rifampin were added based on treatment protocols used in PAM survivors [3]. Miltefosine, which is also part of the recommended treatment for PAM, was administered once it arrived from CDC, approximately 8 hours later. A  wet mount of the CSF revealed possible motile trophozoites. Despite multiple aggressive measures, the patient’s ICP remained > 50 cm H2O. At approximately 9 pm on 18 June, the patient had a sudden change in hemodynamics and an acute drop in ICP suspicious for brain death. Cardiac death occurred the following morning on 19 June. She received 1 dose of miltefosine prior to death. CSF arrived at CDC on 21 June, and a real-time PCR test that simultaneously detects N. fowleri, Balamuthia mandrillaris, and Acanthamoeba species was positive for N.  fowleri, which was further characterized as genotype 1. On initial suspicion of PAM, the patient’s family and friends were asked about the patient’s freshwater exposures in the 2 weeks prior to her illness onset. The patient had recently returned from an 8-day youth choir trip to West Virginia and North Carolina. The patient’s only freshwater exposure on that trip occurred during a visit to the US National Whitewater Center (USNWC) on 8 June during which the patient fell out of the raft and was submerged under the water. The patient’s mother reported that the patient had described the incident to her and reported that a large volume of water entered her nose while she was submerged. No other freshwater exposures that resulted in water entering the nose were reported during the incubation period. ENVIRONMENTAL INVESTIGATION The USNWC is located in Charlotte, North Carolina, on 1100 acres near the Catawba River. Activities offered include whitewater rafting and kayaking, flatwater kayaking, stand-up paddle boarding, rock climbing, zip lines, ropes courses, a canopy tour, and mountain biking. Whitewater activities take place in a recirculating artificial whitewater facility. The channel structures within the whitewater facility are poured concrete with a geobarrier and water barrier membrane below the concrete to prevent mixing with groundwater. At the time of the investigation, water for filling and maintaining water levels in the whitewater facility was obtained from on-site wells and county municipal water. At no place is river water introduced into the system. Storm drains and ground drainage around the site are graded to minimize runoff from entering the whitewater channels. However, the channels are open, so water levels do increase during rain storms. Additionally, there was an active construction site directly adjacent to the lower pond section of the whitewater channels at the time the case-patient rafted and during this investigation. The whitewater facility had the capacity to hold 12 million gallons of water. Multiple pumps were used to lift the water approximately 21 feet to an upper pond, and water then flowed by gravity down 1 of 2 channels. A portion of the water in the channels was withdrawn from the lower pond for filtration. The filtration system (filter pore size = 200 μm) was operated to treat a volume corresponding to the total volume of the system once every 24 hours. After filtration, the water passed through a low-pressure ultraviolet (UV) treatment unit. After treatment, the water was discharged to the upper pond. Operators manually added liquid chlorine as a disinfectant to the upper pond only when fecal coliform counts were trending upward or algal growth visibly increased; however, chlorine concentrations were not monitored. Each evening when the facility was closed, pumps were turned off and most of the water drained to the lower pond; however, low levels of water always remained in the channels. Whitewater PAM Case Investigation • CID 2018:66 (15 February) • 549 TX-DSHS-19-1309-A-000021 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 Sediment and algal growth were removed from the upper pond by vacuuming on an as-needed basis when the pumps were turned off. The system was drained and cleaned annually, during which scrubbing and pressure washing was performed to clean the concrete and rock surfaces. The system was left dry for approximately 2  months annually. The facility had a contract with a commercial laboratory to perform weekly water testing for fecal coliform bacteria, turbidity, pH, temperature, and heavy metals. On the date of inspection, the pumps were turned off, revealing a layer of algae and biofilm in the upper pond and channel surfaces. Physical and chemical parameters were measured in water at the USNWC lower pond on 22 June during an on-site visit by health officials. Water, facility filter backwash, submerged plant material, and surface swab samples were collected within the channels and the upper and lower ponds of the USNWC. Water, sediment, and surface swab samples were also collected from or near the adjacent Flatwater Dock in the Catawba River (Figure  1) for comparison. Large volume water samples (33– 50 L) were collected using dead-end ultrafiltration [4]; 1-L grab samples were collected in parallel. Samples were transported and stored in the laboratory at ambient temperature to maintain N. fowleri viability. Sample processing began on the morning of 23 June. All ultrafilters and grab samples collected from the Catawba River and USNWC and facility filter backwash samples were processed using a concentration procedure; sediment, plant material, and surface swab samples were processed using an elution and concentration procedure (Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Environmental Surface Sampling Methods, 2014). Concentrates were divided; 1 aliquot was submitted to a N. fowleri real-time PCR assay (“direct”) and a second aliquot was submitted to a culture assay (“culture”) [5, 6]. Aliquots of 1 top pond sample and the Catawba River sediment sample were also submitted directly (ie, without prior concentration) to the culture assay. If trophozoites or cysts were observed on a culture plate within 7 days of incubation at 44°C, material from the plate was harvested and submitted to real-time PCR for confirmation of culturable N.  fowleri. Cultured organisms were genotyped by sequencing the 5.8S ribosomal RNA gene and internal transcribed spacers 1 and 2 (ITS1 and ITS2) [7]. Total chlorine residual concentration measured in the lower pond of the whitewater facility was 0.15 mg/L and the free chlorine residual was 0.05 mg/L. The turbidity in the lower pond was 6.7 nephelometric turbidity unit (NTU) and the temperature was 30°C. The turbidity near the Flatwater Dock in the Catawba River was 4.1 NTU and the temperature was 28°C. All 11 samples collected within the whitewater facility (ie, small and large volume water, facility filter backwash, and surface swab) were positive for N. fowleri by direct testing and by culture. Additionally, the cycle threshold value for the direct testing performed on the top pond sample was comparable to that seen for culture and did not require concentration to detect amebae. Of the 5 samples taken from the Flatwater Dock area on the Catawba River (ie, small and large volume, sediment, N W ♦ E . 0 W1lflTrutmffle 5 1/4Mile Fodlily Figure 1. Map of Whitewater Center with water and environmental sampling locations. See Table 1 for details on sampling locations. 550 • CID 2018:66 (15 February) • Cope et al TX-DSHS-19-1309-A-000022 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 and surface swab), all were negative for N. fowleri by direct testing and 1 sediment sample was positive by culture (Table 1). All positive N. fowleri cultures were identified as genotype I. With these findings and in consultation with local, state, and federal public health officials, the USNWC decided to voluntarily close the whitewater facility on 24 June until they could assess their water treatment operations and develop a remediation strategy. DISCUSSION Each summer in the United States, 0–8 PAM cases are reported, typically in patients who report warm freshwater exposure in lakes, ponds, and reservoirs located in southern-tier US states. In recent years, new locations and types of water exposures have been documented in PAM cases including the first cases from the northern states of Minnesota, Indiana, Maryland, and Kansas and cases associated with the use of tap water in neti pots, for ritual nasal rinsing, and on backyard water slides [8–11]. The case reported here represents yet another novel type of water Table 1. Naegleria fowleri Testing Results for Samples Collected Within the US National Whitewater Center and From or Near the Flatwater Dock on the Catawba River Sample Number Sample Type Direct Resultsa Culture Resultsa USNWC Samples 1 Pod 1 backwash (0.75 L) Positive Positive 2 Pod 2 backwash (0.75 L) Positive Positive 3 Pod 3 backwash (0.75 L) Positive Positive 4 Pod 4 backwash (0.75 L) Positive Positive 5 Bottom pond small volume water (0.75 L) Positive Positive 6 Bottom pond large volume water (50 L) Positive Positive 7 Top pond small volume water (~0.7 L) Positive Positive NA Positive Unconcentrated 8 Top pond small volume water, unconcentrated (~0.5 L) Positive NA 9 Wilderness channel surface swab (4ʹʹ × 4ʹʹ)b Positive Positive 10 Wilderness channel submerged plant material Positive Positive 11 Boat loading ramp surface swab (4ʹʹ × 4ʹʹ)b Positive Positive Flatwater Dock at Catawba River Samples 12 CR small volume water Negative Negative 13 CR large volume water Negative Negative 14 CR sediment Negative Negative NA Positive Unconcentrated 15 Flatwater dock subsurface swab (4ʹʹ × 4ʹʹ) Negative Negative 16 Flatwater dock above surface swab (4ʹʹ × 4ʹʹ) Negative Negative Abbreviations: CR, Catawba River; NA, not analyzed; USNWC, US National Whitewater Center. a A sample was considered positive for N. fowleri when cycle threshold <40. b Location swabbed is below water level when system pumps are running. exposure associated with PAM. Based on the epidemiologic investigation, the most likely water exposure leading to PAM in this case-patient was falling out of the raft at the USNWC, during which a large volume of water entered the patient’s nasal cavity. This conclusion is supported by environmental sampling that found all samples taken from the whitewater channels to be positive for N. fowleri genotype 1 by culture and direct testing. During the site visit, health officials documented several water conditions that likely allowed for the presence of N. fowleri in the whitewater channels. First, the water temperature was 30°C, offering an ideal temperature for a thermophilic organism like N. fowleri to thrive. Second, the pore size of the filtration system in use at the facility was inadequate for removal of microorganisms. Additionally, the water in the channels was turbid and the water treatment operations in use at the USNWC (ie, ultraviolet light, occasional addition of chlorine) were likely inadequate to control the growth of N. fowleri in turbid water. When chlorine is added to turbid water with a high load of organic content, it is rapidly consumed and does not remain in the water to provide ongoing disinfection. While UV light disinfection can inactivate N. fowleri, it is ineffective when water turbidity is high [12]. A number of factors likely contributed to the elevated turbidity in the whitewater channels and ponds, including the fact that it is a closed-loop system with continuous input of particulate matter and it utilizes a filtration system unable to remove most of these particulates. As a result, there was no effective water treatment occurring in the whitewater channels. Last, the biofilm growth noted on the bottom and sides of the whitewater channels also contributed to growth of N. fowleri in this facility. Free-living amebae, including N. fowleri, are frequent inhabitants of biofilms, which provide a source of nutrients as well as protection from disinfectants [13, 14]. While the whitewater channels provided an ideal environment for N. fowleri to thrive, it is not clear how the pathogen might have initially entered the water. The whitewater channels are drained each year and refilled annually with water primarily from the county utility (with supplementation from on-site wells, as needed) that meets drinking water standards, indicating it contains adequate residual chlorine levels, to which N. fowleri is sensitive; therefore, the source water is unlikely to contain N. fowleri. However, as a common water and soil inhabitant, N.  fowleri could have entered the whitewater channels through storm water runoff or soil blown into the channels, wildlife such as turtles or birds, or on a kayak that had previously been used in a natural water body. The USNWC poses a difficult challenge in the control and prevention of N. fowleri. While it is an artificial water venue, it was designed to mimic the features of a natural whitewater river with the addition of rocks and use of uneven surfaces. Natural water bodies often contain N.  fowleri as a natural constituent of freshwater [15–17]. However, facilities can be designed, constructed, or maintained in ways that unintentionally encourage Whitewater PAM Case Investigation • CID 2018:66 (15 February) • 551 TX-DSHS-19-1309-A-000023 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 the proliferation of N.  fowleri. A  review of CDC surveillance data for PAM documented a number of water exposures that occurred in recreational water venues that had been altered in ways that might have increased the risk of N. fowleri infection (Table 2). Some venues added sand or concrete to the bottom and sides of the venue, potentially increasing surfaces for biofilm growth. Other venues minimally treated the water (eg, for water clarity or aesthetics), which altered the microbial ecosystem and provided a perception of good water quality, but did not inactivate N. fowleri. In addition, some venues added water slides and tow cables (ie, to pull inflatable tubes and water skiers), which altered the way humans interacted with the venue, resulting in an increased risk of nasal exposure to water. In response to this PAM case and investigation, the USNWC worked to reduce the risk of future infections by improving the current water treatment systems. In addition to the existing UV light treatment, the USNWC modified the filtration systems and added ozonation and an automated chlorine injection system with the goal of reducing the organics and maintaining a level of 0.5 ppm of free chlorine. Maintaining a chlorine residual of 0.5 ppm has proven to be effective for preventing infections associated with drinking water systems that previously had PAM cases associated with them [11, 18]. A challenge for reducing the risk of PAM at this venue was that state recreational water regulations, as written, did not apply to this venue. Regulations exist for swimming pools and water parks as well as for swimming areas of lakes and reservoirs. However, facilities such as the USNWC do not fall into either of these categories and, at the time this case occurred, the USNWC was only required, through a lease agreement, to perform weekly testing for fecal coliform bacteria and meet minimum standards (<200 colonies/100 mL). These standards are not designed for N. fowleri control and do not account for the complex engineering challenges, biofilm growth, warm temperatures, and forceful nasal water entry in this venue. As more Table 2. Recreational Water Venues With Artificial Features Associated With US Primary Amebic Meningoencephalitis Cases, 1962–2016 Venue Year County, State Artificial whitewater river (this report) 2016 Mecklenburg, North Carolina Water park 2013 2009 Campground lake Number of Associated PAM Cases Pulaski, Arkansas Sand Chlorine, pH balanced, and chemicals Spring and well 3.5 acres Slides 2 Madison, Florida Sand Chlorine Deep well Orange, Florida Sand Untreated, monthly testing Rain 1979, 1980 Orange, Florida 1950s and 1960s Water Treatment Other Features 1 Water park Lake Concrete Size of Water Source Water Body Closed-loop, recirculated system; whitewater kayaking 2007, 2009 1977 Bottom Composition 200-µm particulate filter, Municipal drink- ~11.5 ing water million ultraviolet, manual, gallons intermittent chlorination and wells Watersports complex Lake recreational water venues are constructed that do not meet traditional definitions of swimming pools or water parks, public health authorities and other state and local regulatory bodies will be required to make difficult decisions in the absence of scientific data to determine how to best regulate these venues to protect the public’s health. In response to this PAM case, the local Board of Health adopted rules governing recreational whitewater systems for the purpose of creating an environment that is not hospitable to potentially pathogenic microorganisms. The primary focus of the rules includes disinfection (ie, to maintain a free chlorine concentration of 0.5 ppm when a secondary disinfection such as ozone or ultraviolet light is active), daily water quality monitoring of pH and water temperature, and the documentation and removal of organic accumulation. While tap water and the water in pools, water parks, and other artificial water venues can be treated to reduce the growth of N. fowleri, there are also personal actions that can be taken to reduce the risk of PAM. These include keeping the head above water, holding the nose shut, or using nose clips when taking part in water-related activities to limit the amount of water going up the nose. When using water for nasal rinsing (eg, using a neti pot or practicing nasal rinsing as part of ritual ablution), water should be boiled, filtered, or bought as sterile or distilled water. Water should not be used directly from the tap for these activities. (http://www.cdc.gov/parasites/naegleria/prevention.html). Since 2010, each summer in the United States has brought reports of PAM cases with newly identified transmission routes, new geographic areas of infection, and new types of water venues where exposures can occur. Once limited primarily to 15 southern-tier states, PAM cases have recently been reported from Minnesota (2010 and 2012), Kansas (2011), Indiana (2012), and Maryland (2016). PAM cases have also been reported from other countries and in US patients who have traveled abroad [19, 20]. As a thermophilic ameba, predictions of a warming climate have implications for the ecology of Sand “Unique filtration system” Lake Richmond, Georgia Sand Untreated Chesterfield, Virginia Likely sand Unknown Unknown 1.5 acres 6 acres Slide 1 Waterskiing and wakeboarding 2 Slides 2 Cement retaining walls 1 Slides, diving boards, fountains 4 Abbreviation: PAM, primary amebic meningoencephalitis. 552 • CID 2018:66 (15 February) • Cope et al TX-DSHS-19-1309-A-000024 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 N. fowleri and for infections, which warrants further research, monitoring, and awareness of this pathogen. Clinicians in all regions of the United States and internationally should be aware of this infection and recognize that not all patients will have the traditional exposure to warm recreational freshwater. Notes Acknowledgments. The authors acknowledge Zack Moore, Michael Beach, Jonathan Yoder, Katie Fullerton, and John Rossow for their contributions to this investigation. Disclaimer. The findings and conclusions in this report are those of the authors and do not necessarily represent those of the CDC. Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed. References 1. Capewell LG, Harris AM, Yoder JS, et  al. Diagnosis, clinical course, and treatment of primary amoebic meningoencephalitis in the United States, 1937–2013. J Pediatric Infect Dis Soc 2015; 4:e68–75. 2. Yoder JS, Eddy BA, Visvesvara GS, Capewell L, Beach MJ. The epidemiology of primary amoebic meningoencephalitis in the USA, 1962–2008. Epidemiol Infect 2010; 138:968–75. 3. Linam WM, Ahmed M, Cope JR, et  al. Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis. Pediatrics 2015; 135:e744–8. 4. Mull B, Hill VR. Recovery of diverse microbes in high turbidity surface water samples using dead-end ultrafiltration. J Microbiol Methods 2012; 91:429–33. 5. Mull BJ, Narayanan J, Hill VR. Improved method for the detection and quantification of Naegleria fowleri in water and sediment using immunomagnetic separation and real-time PCR. J Parasitol Res 2013; 2013:608367. 6. Qvarnstrom Y, Visvesvara GS, Sriram R, da Silva AJ. Multiplex real-time PCR assay for simultaneous detection of Acanthamoeba spp., Balamuthia mandrillaris, and Naegleria fowleri. J Clin Microbiol 2006; 44:3589–95. 7. Zhou L, Sriram R, Visvesvara GS, Xiao L. Genetic variations in the internal transcribed spacer and mitochondrial small subunit rRNA gene of Naegleria spp. J Eukaryot Microbiol 2003; 50(Suppl):522–6. 8. Kemble SK, Lynfield R, DeVries AS, et  al. Fatal Naegleria fowleri infection acquired in Minnesota: possible expanded range of a deadly thermophilic organism. Clin Infect Dis 2012; 54:805–9. 9. Yoder JS, Straif-Bourgeois S, Roy SL, et al. Primary amebic meningoencephalitis deaths associated with sinus irrigation using contaminated tap water. Clin Infect Dis 2012; 55:e79–85. 10. Centers for Disease Control and Prevention. Notes from the field: primary amebic meningoencephalitis associated with ritual nasal rinsing—St. Thomas, U.S. Virgin Islands, 2012. MMWR Morb Mortal Wkly Rep 2013; 62:903. 11. Cope JR, Ratard RC, Hill VR, et  al. The first association of a primary amebic meningoencephalitis death with culturable Naegleria fowleri in tap water from a US treated public drinking water system. Clin Infect Dis 2015; 60:e36–42. 12. Sobsey M. Inactivation of health-related microorganisms in water by disinfection processes. Wat Sci Tech 1989; 21:179–95. 13. Miller HC, Wylie J, Dejean G, et al. Reduced efficiency of chlorine disinfection of Naegleria fowleri in a drinking water distribution biofilm. Environ Sci Technol 2015; 49:11125–31. 14. Sheehan KB, Fagg JA, Ferris MJ, Henson JM. PCR detection and analysis of the free-living amoeba Naegleria in hot springs in Yellowstone and Grand Teton National Parks. Appl Environ Microbiol 2003; 69:5914–8. 15. Wellings FM, Amuso PT, Chang SL, Lewis AL. Isolation and identification of pathogenic Naegleria from Florida lakes. Appl Environ Microbiol 1977; 34:661–7. 16. Painter SM, Pfau RS, Brady JA, McFarland AM. Quantitative assessment of Naegleria fowleri and Escherichia coli concentrations within a Texas reservoir. J Water Health 2013; 11:346–57. 17. Sifuentes LY, Choate BL, Gerba CP, Bright KR. The occurrence of Naegleria fowleri in recreational waters in Arizona. J Environ Sci Health A Tox Hazard Subst Environ Eng 2014; 49:1322–30. 18. Robinson BS, Christy PE. Disinfection of water for control of amoebae. Water 1984:21–4. 19. Booth PJ, Bodager D, Slade TA, Jett S. Primary amebic meningoencephalitis associated with hot spring exposure during international travel—Seminole County, Florida, July 2014. MMWR Morb Mortal Wkly Rep 2015; 64:1226. 20. Shakoor S, Beg MA, Mahmood SF, et  al. Primary amebic meningoencephalitis caused by Naegleria fowleri, Karachi, Pakistan. Emerg Infect Dis 2011; 17:258–61. Whitewater PAM Case Investigation • CID 2018:66 (15 February) • 553 TX-DSHS-19-1309-A-000025 Downloaded from https://academic.oup.com/cid/article-abstract/66/4/548/4161734 by Stephen B. Thacker CDC Library user on 05 February 2018 From: Aragon,Antonio (DSHS) Sent: Wednesday, October 10, 2018 5:52 PM EDT To: VPD Surv ELC (CDC) CC: Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Sierocki,Allison (DSHS) ; Leos,Greg (DSHS) ; Aldridge ,Tiffany (D SH S) Subject: Texas - Surveillance Coordination Activity Summary July-Sept 2018.DOCX Attachment(s): "Texas - Surveillance Coordination Activity Summary July-Sept 2018.docx" Hello Please find the attached Texas Surveillance 2018. Coordination Activity Summary for ELC Rl for July 2018 - Sept Thank you, Tony Antonio (Tony) Aragon, MS Manager/Invasive & Rcspimtory Infectious Disease and Vaccine Preventable Disease Gro up Emerging and Acute Infectious Disease Branch Texas Department of State Health Services Mailcodc 1960 PO Box 149347 Austin, TX 78714-934 7 (512) 776-6335 voice (512) 739-2197 cell (512) 776-7616 fax ~E-TEXAS IINltl! IMl!!INO .-, s:.ntct1 I,.... j ~fjllrtl !IH1 •fStOI H... 1111 WAi Quarterly Activity Summary for Vaccine-Preventable Diseases (VPDs) Surveillance Coordination Surveillance Coordination for NNDSS Vaccine Preventable Diseases and Enhanced Surveillance for Meningococcal Disease, Varicella, and Acute Flaccid Myelitis (ELC R1 CoAg) Your responses below should briefly describe the status of VPD surveillance coordination activities in your jurisdiction. For each of the 7 strategies, select the progress level that best describes your jurisdiction’s current activity status (i.e., exceeds expectations, meets expectations, needs improvement, no change from previous quarter) and provide a brief rationale (2-3 sentences) for your selection. You also have the option to describe specific successes and challenges related to each strategy. When completing this summary, it will be helpful to focus on the progress made toward specific activities proposed by your jurisdiction in the annual application for the ELC R1 CoAg. Quarter being assessed: July 1 - September 30, 2018 Jurisdiction: Texas Summary completed by: Allison Sierocki Strategy 1: Enhance investigation, response and reporting for VPDs (1a) · Describe status of activities to establish a VPD surveillance coordinator position that will: o serve as a point of contact for selected vaccine-preventable diseases for which surveillance is conducted through NNDSS or the ELC R1 CoAg; o ensure the use of standard investigative questionnaires, data sharing tools, and methods; o lead/assist in the timely investigations of cases, clusters, and outbreaks; and o engage in ongoing evaluation of ELC R1 CoAg activities. · Describe status of activities listed in application related to meningococcal disease, varicella and AFM. Jurisdiction Status and Rationale Progress level selection for milestone 1: Exceeds expectations Rationale for selection (2-3 sentences): The Texas Department of State Health Services (DSHS) Vaccine Preventable Disease (VPD) team has exceeded all disease surveillance procedures to ensure the timely and adequate reporting of notifiable infectious diseases. During this quarter there was a 10 percent increase in Haemophilus influenzae under five years of age isolates submitted. Ten suspected cases of acute flaccid myelitis were reported, and the VPD team continuned to have 100 percent of meningococcal isolates submitted. Additional Narrative (Optional) Successes: The VPD team is making progress on team objectives and continues to collaborate with CDC and public health partners. The VPD team assisted local and regional health departments with guidance on investigation, control measures, and working with other states on varicella outbreaks in a household, daycare, school, and correctional facility. During this quarter, the VPD team assisted regional and local health departments and coordinated with DSHS laboratory on several VPD exposures. These exposures included three cases of measles in which 22 people were tested for measles, a current ongoing mumps outbreak Quarterly Activity Summary – VPD Surveillance Coordination 1 TX-DSHS-19-1309-A-000027 involving six cases on a college campus, and a case of tetanus. Well defined collaborative efforts with the local and regional health departments allowed for prompt investigations of cases and close contacts, and the implementation of necessary control measures. These colloaborative actions reduced the amount of potential exposures. Challenges: DSHS did not experience any challenges to note at this time. Strategy 2: Improve surveillance to drive public health action (1b) · Describe status of activities to: o Develop, implement, and maintain surveillance systems. o Conduct regular assessment of surveillance data and review of surveillance indicator reports to identify areas for improvement (e.g., electronic, programmatic). o Evaluate and enhance surveillance systems based on CDC guidelines. · Describe status of activities listed in application related to meningococcal disease, varicella and AFM. Jurisdiction Status and Rationale Progress level selection for milestone 2: Exceeds expectations Rationale for selection (2-3 sentences): During this quarter and other previous quarters, the VPD team conducted extensive data quality assurance in the National Electronic Disease Surveillance System (NEDSS) to ensure data was accurate for 2017 data close out. The Texas Department of State Health Services (DSHS) VPD team has exceeded all disease surveillance procedures to ensure the timely and adequate reporting of notifiable infectious diseases using weekly and quarterly data quality assurance. During this quarter there was a 10 percent increase in Haemophilus influenzae under five years of age isolates submitted. Additional Narrative (Optional) Successes: Through the intensive data quality assurance process, the VPD team has identified areas where improvements to reports can be made. This will reduce the time spent on the process. Documentation for future improvements have been made via open communication between internal teams. The VPD team has restructured their case investigation forms to collect additional standardized and condition specific information. During this quarter, the VPD team also revised the VPD Texas DSHS webpages to increase ease of access and to encourage increased usage. These revisions should be live in the next quarter. In addition, ten suspected cases of acute flaccid myelitis were reported compared to four the previous quarter and 100 percent of meningococcal isolates were submitted, contiuning the trend of past quarters. Challenges: DSHS did not experience any challenges to note at this time. Strategy 3: Implement and evaluate epidemiologic public health practice, and prevention and control strategies (1c) Quarterly Activity Summary – VPD Surveillance Coordination 2 TX-DSHS-19-1309-A-000028 · Describe status of activities to: o Develop and advance policies for the prevention, detection, and control of VPDs. o Participate in routine evaluations related to standard vaccine programs. Jurisdiction Status and Rationale Progress level selection for milestone 3: Exceeds expectations Rationale for selection (2-3 sentences): Constant communication and strong partnerships with local health jurisdictions and the Immunizations Unit at DSHS streamlined the process to get Immune Globulin (IG) and vaccine to jurisdictions during recent VPD outbreaks sometimes resulting in same day vaccine and IG shipments. During this quarter, in collaboration with the DSHS Immunization Unit and local health departments, IG and vaccines were ordered and distributed in response to Hepatitis A cases and a mumps outbreak. Also, Texas House Bill 970 Streptococcus pneumoniae state plan was created regarding measures to be taken to educate and prevent Streptococcus pneumoniae in targeted age groups within Texas. Additional Narrative (Optional) Successes: The VPD team has a very strong partnership with local health jurisdictions and the Immunizations Unit at DSHS. During this quarter, the VPD team provided investigation guidance and outbreak control mesaures that involved ordering additional vaccines and IG to prevent the spread of VPD diseases. During this quarter 300 doses of Hepatitis A vaccine were ordered and shipped along with IG for 20 persons. In an ongoing mumps outbreak on a college campus, 800 doses of MMR were ordered and 545 doses were administered during campus vaccine clinics. During this quarter, an additional 400 vaccines were ordered and will be given through the university clinic and potential subsequent vaccine clinics. Challenges: DSHS did not experience any challenges to note at this time. Strategy 4: Improve coordination and collaboration for VPD surveillance (1d) · Describe the status of activities to: o Foster collaboration among city, county, state and federal partners, and other external partners. o Support and integrate epidemiology, laboratory, immunization, and health information activities. · Describe status of activities listed in application related to meningococcal disease and varicella. Jurisdiction Status and Rationale Progress level selection for milestone 4: Exceeds expectations Rationale for selection (2-3 sentences): Extensive coordination between the VPD team, a local health department, and two hospital laboratories was required to facilitate shipment of a specimen for a suspected meningococcal case. After several hours of phone calls and Quarterly Activity Summary – VPD Surveillance Coordination 3 TX-DSHS-19-1309-A-000029 directions, two specimens were able to be sent to DSHS where they tested positive for Neisseria meningitidis. Strong working relationships with local health departments supported completion of the CDC enhanced line list for cases from 2014- 2017 of invasive meningococcal disease in college students. Additional Narrative (Optional) Successes: Through continued collaboration during this quarter, 10 suspected cases of AFM have been reported and two new providers have begun reporting. Education was provided to multiple hospital infection preventionists and a new reporting system was established for a reporting laboratory. During the ongoing mumps outbreak this quarter, collaboration between the VPD team, DSHS immunization unit, and local health department resulted in MMR vaccination of 545 college students. More clinics are expected to be held during the next quarter time frame. Challenges: DSHS did not experience any challenges to note during this time. Strategy 5: Sustain and enhance laboratory diagnostic capacity (2a) · Describe status of activities to: o Support maintenance of culture, serotyping/serogrouping, and other appropriate, pathogen-specific diagnostic and surveillance testing capacities within state public health laboratories, and/or available through regional reference centers and/or CDC laboratories. o Implement a plan for flexible use and acquisition of laboratory supplies and testing that addresses changing/multi-disease purposes and needs. o Ensure linkage of laboratory specimens with available epidemiologic and clinical casepatient data. · Describe status of activities listed in application related to meningococcal disease and AFM. Jurisdiction Status and Rationale Progress level selection for milestone 5: Exceeds expectations Rationale for selection (2-3 sentences): The VPD team continues to work closely with the DSHS laboratory regarding pulsed-field gel electrophoresis (PFGE) patterns from meningococcal cases and reported AFM cases. One of the largest successes for Texas is the continued and constant communication built around the relationships between DSHS laboratory, Central Office, and regional/local health departments. The newly established relationship with DSHS Virology teams has resulted in reporting of CDC AFM specimen results within six hours of receipt of notifcaiton from the CDC. Additional Narrative (Optional) Successes: This seamless collaboration and open communication allows for resolving laboratory specimen issues quickly and reduces potential stagnation of the testing timeline or process. Quarterly Activity Summary – VPD Surveillance Coordination 4 TX-DSHS-19-1309-A-000030 Challenges: DSHS did not experience any challenges to note at this time. Strategy 6: Improve laboratory coordination and outreach/ information flow (2b) · Describe status of activities to coordinate increased access to isolates so that test results can be linked to surveillance activities and data. · Describe status of activities listed in application related to meningococcal disease. Jurisdiction Status and Rationale Progress level selection for milestone 6: Meets expectations Rationale for selection (2-3 sentences): The close collaboration with the DSHS laboratory has allowed for quick resolution to any specimen linkage issues that may arise. It has allowed us to further define, refine, and simplify the specimen reporting process. Future reporting procedure changes have been identified and will be address in the coming quarter. Additional Narrative (Optional) Successes: The VPD team's ability to run reports from our laboratory system has continuously allowed for timely follow up on missing isolates and specimen. Another strength with the laboratory system continues to be the constant contact and coordination between the DSHS laboratory, VPD team, and the AFM team at the CDC. Challenges: DSHS did not experience any challenges to note at this time Strategy 7: Sustain and enhance integrated surveillance information systems (3c) · Describe status of activities to support coordination of VPD surveillance with surveillance information systems (e.g., NNDSS, Immunization Information Systems, ELR, HL7 messages) to enhance use and exchange of electronic data files. Jurisdiction Status and Rationale Progress level selection for milestone 7: No change from previous quarter Rationale for selection (2-3 sentences): NEDSS has continued to be our base for collecting surveillance data for vaccine preventable diseases in Texas. To date, coordination between the VPD team and the NEDSS DSHS team allows the VPD team to utilize the system to collect and report on disease investigations throughout the state. The VPD team utilizes ImmTrac 2, an immunization information system, to look up every disease case to ensure complete and accurate vaccination history are recorded for every case covered by the VPD team. Quarterly Activity Summary – VPD Surveillance Coordination 5 TX-DSHS-19-1309-A-000031 Additional Narrative (Optional) Successes: Maintaining the NEDSS system at DSHS allows us to have support for our NEDSS needs and produce custom reports to better track VPDs in the state of Texas. Challenges: The VPD team continues to experience some technical problems with NEDSS data quality assurance reports. Through collaboration with the NEDSS team, the VPD team is working to determine the root of the issue and discuss options to repair or replace the reports to make future data clean up efficient. Quarterly Activity Summary – VPD Surveillance Coordination 6 TX-DSHS-19-1309-A-000032 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 12, 2018 11:54 AM EDT CC: Bellis, Kimberly (CDC/DDID/NCEZID) ; Brathwaite, Wayne (CDC/DDID/NCEZID) ; Chung, Christina L. (CDC/DDID/NCEZID) ; Downing, Janice S. (CDC/DDID/NCEZID) ; Ganim, Alexandra M. (CDC/DDID/NCEZID) ; Gemella, Athena (CDC/DDID/NCEZID) ; Nonnenmacher, Patrick (CDC/DDPHSIS/CSTLTS) ; O'Connor, Angelica (CDC/DDID/NCEZID) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID) ; Shultz, Alvin (CDC/DDID/NCEZID) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID) ; Snow, Jason N. (CDC/DDID/NCEZID) ; Zansky, Shelley (CDC/DDID/NCEZID) (CTR) Subject: Opportunity for technical assistance WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. As we move closer to the beginning of our new 5-year coag cycle, we want to provide opportunities for technical assistance that may help with your programmatic execution as well as your application process. Many of you had the pleasure of meeting Shelley Zansky at our annual meeting. She has graciously agreed to continue assisting our team with TA outreach in the coming year. Recall that Shelley has decades of experience in managing infectious disease programs in New York State. She has been where you are and is keenly aware of the challenges you face. Working with Shelley may provide you a great opportunity to discuss items from your technical reviews where you may need additional assistance or guidance. Should you wish to take advantage of some 1:1 consultation time with Shelley, please contact your ELC Project Officer to set something up! TX-DSHS-19-1309-A-000033 From: Simpson, De'Lisa D. (CDC/DDID/NCEZID) Sent: Friday, October 12, 2018 12:23 PM EDT To: Garcia,Imelda M (DSHS) ; Aldridge,Tiffany (DSHS) Subject: Milestone Training WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, I wanted to follow-up with you regarding your request for additional milestone training with Shelley. I reached out to her and she will actually be in Austin next month. She has offered to hold another in-person training at the health department on Monday, November 19th if you all are available. Please let me know if that date works for you all. Thanks De’Lisa De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-000034 From: Garcia,Imelda M (DSHS) Sent: Monday, October 15, 2018 1:49 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID) Subject: RE: Welcome Imelda Garcia, new Associate Commissioner for Laboratory and Infectious Disease Services Thank you De’Lisa. Yes, it will be a bit crazier than normal for a while. But I’m hoping to post my old position quickly. Imelda M. Garcia, MPH Director, Infectious Disease Prevention Section Phone: 512-776-7679 Email: ImeldaM.Garcia@dshs.texas.gov CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. From: Simpson, De'Lisa D. (CDC/DDID/NCEZID) [mailto:ion9@cdc.gov] Sent: Monday, October 15, 2018 12:33 PM To: Garcia,Imelda M (DSHS) Subject: FW: Welcome Imelda Garcia, new Associate Commissioner for Laboratory and Infectious Disease Services WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Congrats Imelda. It sounds like you’re about to be even busier. Lol De’Lisa From: Aldridge,Tiffany (DSHS) Sent: Monday, October 15, 2018 1:22 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID) ; Anderson, Noelle (CDC/OPHPR/DSLR) Cc: Garcia,Imelda M (DSHS) ; Eisenberg,Anna (DSHS) Subject: FW: Welcome Imelda Garcia, new Associate Commissioner for Laboratory and Infectious Disease Services Good Afternoon, Please see the below email with the announcement of Imelda Garcia’s new position as Associate Commissioner for the Laboratory and Infectious Disease Services Division at Texas Department of State Health Services beginning November 1, 2018. This will not change her role with ELC as PI or as the Programmatic Lead Contact for the Foodborne/Waterborne/Mold, Vector Control, Healthcare Infection Control, or Immunizations projects in the Crisis CoAg, at this time. If any changes are to occur with these at a later time, we will inform CDC of this. Please let me know if you have any questions. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: DSHS Commissioner Sent: Thursday, October 11, 2018 12:07 PM To: DL DSHS All Employees Subject: Welcome Imelda Garcia, new Associate Commissioner for Laboratory and Infectious Disease Services Dear Colleagues, TX-DSHS-19-1309-A-000035 It is my pleasure to announce Ms. Imelda Garcia as the new Associate Commissioner for Laboratory and Infectious Disease Services, effective November 1, 2018. The division houses programs that support Texas communities with core public health activities, including the laboratory services, infectious disease prevention, and TB/HIV/STD sections. Imelda’s extensive knowledge and experience in public health will be essential in her new role. Currently, Ms. Garcia serves as the Director of the Infectious Disease Prevention Section. In her role, she oversees prevention and control activities related to zoonotic and emerging and acute infectious diseases, healthcare safety including healthcare acquired infections and preventable adverse events, antibiotic stewardship, and child and adult immunization programs. Prior to agency’s transformation in 2017, she also oversaw tuberculosis, HIV/STD, refugee health, Hansen’s disease, and public health pharmacy operations. Her work over the past four years has included response activities related to Hurricane Harvey, Ebola, Zika, and other infectious diseases. Ms. Garcia also led the Community Health Services Section at the Texas Department of State Health Services. In that capacity, she was responsible for oversight over preventive and primary care safety-net services, and all contracts and data analytics in the Family and Community Health Services Division. Imelda is a graduate of The University of Texas at Austin with a bachelor’s degree in Mexican American Studies with a concentration in public policy. Ms. Garcia is also a graduate from The Mailman School of Public Health at Columbia University with a master’s degree in public health with a focus on health policy and management. Please join me in welcoming Imelda to the DSHS executive team. Thanks, John Hellerstedt, M.D. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000036 From: Downing, Janice S. (CDC/DDID/NCEZID) Sent: Friday, October 19, 2018 11:56 AM EDT To: Garcia,Imelda M (DSHS) ; Aldridge,Tiffany (DSHS) CC: Simpson, De'Lisa D. (CDC/DDID/NCEZID) Subject: FW: SAS Grantee License Renewal Forms Attachment(s): "SAS Grantee Licenses Request Form 2018.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Afternoon, I am sending this email because I don’t have a SAS License renewal from your IT POC. The deadline was October 15 th. If I don’t have it in by COB today, your SAS Licenses will not be renewed. Please fill out the appropriate information and get it back to me as soon as you can. Thanking you in advance for you immediate attention to this matter. Janice S. Downing ELC Program Project Officer/Advisor (Public Health Analyst) Scientific and Program Services Branch (SPSB) Division of Preparedness and Emerging Infections (DPEI) National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Mailstop H24-11 Office: (404) 639-7808 Cellphone: (404) 405-1330 Email: jbattle@cdc.gov NOTE: I telecommute on Wednesdays and Fridays, Thanks! From: Downing, Janice S. (CDC/DDID/NCEZID) Sent: Wednesday, October 10, 2018 2:09 PM To: kayode.olupinyo@dshs.state.tx.us Cc: Downing, Janice S. (CDC/DDID/NCEZID) Subject: SAS Grantee License Renewal Forms EITPO Notification Dear: Texas Department of State Health Services Your SAS license(s) are scheduled to expire December 30, 2018. Please use the attached request form to communicate your SAS license requirements for CY 2019 which begins December 31, 2018 thru December 30, 2019. The form requires acceptance and signature to the terms as outlined. The attached Grantee MOA must be signed and returned to your Project Officer on or before October 15, 2018. This is a hard deadline. • • This is the only process for Grantees to receive a SAS License from CDC. Failure to respond will result in your current license(s) becoming inactive. There are two types of licenses available for grant and cooperative agreement recipients through the HHS Enterprise License Agreement with SAS Institute; workstation licenses and server licenses. These licenses are available through the various cooperative agreements, and each branch is responsible for monitoring requests and certifying that the information supplied is accurate. Grantees should expect to receive their license renewal keys from the CDC SAS License Manager between January 1 and no later than March 30. Our current details on file include GrantID : 1 U50 CK000378 Grant Title: Epidemiology & Lab Capacity Grantee: Texas Department of State Health Services Institution: Texas Department of State Health Services FullName: Kayode Olupinyo PC: City: PC ZIP: 78756 Email: kayode.olupinyo@dshs.state.tx.us SAS Request History for: FY 2018 Dec 31-30 Total Quantity of Licences: 13 Period: FY 2018 Dec 31-30 PO: Downing, Janice S. (CDC/OID/NCEZID) Total Cost: $ 15,241.72 TX-DSHS-19-1309-A-000037 Products ====== Product: Base SAS 9.3 TS1M0 Qty: 10 Type: 32-Bit Workstation Version: Media:CD/DVD set and license file Owner: kayode.olupinyo@dshs.state.tx.us Product: Base SAS 9.3 TS1M0 Qty: 3 Type: 64-Bit Server Version: Media:CD/DVD set and license file Owner: kayode.olupinyo@dshs.state.tx.us Thanking you for your cooperation. Respectfully, CDC Project Officer: Downing, Janice S. (CDC/OID/NCEZID) CIO: NCEZID TX-DSHS-19-1309-A-000038 SAS LICENSING REQUEST Center Name 09/24/2018 Date: * Grant Title: * Grant Institution: * Grant State: * Grant Principal Contact: *Grant Principal Contact email: * Is this a new Grant? 0 Grantee Number (Ex: 5 H46 EH000 184) * Yes Q No Number of Workstatwns & 32/64 bit (ex 3W/64) Number of Servers & 32/64 bit (ex 3S/64) SAS Product Version d Requeste (9. 1I 9.2 I 9.3 I 9.4) License Owner Email Address (Needed if licensesare to be sent by CDC SASLicense Manager to multiple I dd ) ema1 a resses Briefly describe the "bona fide" need for SAS. If requestingmore than 3 licensesjustifi.cation is required: CDC Internal Use Only for Grants no longer using SAS *Grantee Number *Number of LicensesApproved *Total Cost of approved licenses *Insert 7-digit CAN# (Only 1 CAN# pet Division) I acknowledge responsibility for monitoring the use of all SAS software provided to the above-designated Grant recipient and assure that the software is used only for CDC activities that are a legitimate part of the Grant as specified. I acknowledge responsibility to recover all SAS software media once recipient completes the work of the Grant the DHHS/SASlicense agreement is terminated, or that the recipient fails to carry outtheir responsibilities as enumerated above . ..Project Officer (Print): MO/Approving Official Name (Print): (Form must be scanned and returned to Project Officer after completion. Submit questions to eitposasl icense@cdc.gov . Approval Signatures will be captured by SharePoint workflow • information is required • TX-DSHS-19-1309-A-000039 Memorandum of Acceptance Responsibility For The Use of SAS Institute Products Provided by CDC To: SAS Program Consultant/Project Officer Centers for Disease Control and Prevention 1600 Clifton Rd NE (MS-K91) Atlanta, GA 30333 Email: EITPOSASLicense@cdc.gov Section I. CDC Partner Acceptance of Responsibility Name: Organization: ~~---~~--~~~~---~~~----~I am an official of my organization, which has been awarded the CDC Grant designated: Number: Title: Expires: ---------- My role within the Grant or Cooperative Agreement is: CDChas provided my organization access to certain SASsoftware products as described in the Enterprise License Agreement between DHHSand parties representing SAS Institute.I understand that the license products are for the sole benefit of CDC must be used strictly in accordance with specific limitations set forth in the licensing terms. Specifically: 1. I agree to actively monitor the distribution and use the SAS products to assure that they are used 2. 3. 4. 5. to perform only CDCfunded Program activitiesas specified in the applicable Grantor Cooperative Agreement between CDCand the CDC Grantee. I agree to provide an annual detailed fistingof Software requirements for workstations and servers,the number of users and location information prior to CDC SAS product distribution. I will assure that my organization restricts access to the products to legitimate users and will avoid providing any opportunity for inappropriate distribution of the software to other parties. In the event that my organization completes or ends the funded Program activity prior to the expiration of the license I assure my organization will promptly destroy or return all the licensed materials to CDC. I understand that failure of my organization to abide by these requirements will obligate CDCto request the return of the SAS products to CDCand the termination of their use by my organization. 6. I agree to report to CDCany violations of these terms whether intentional or unintentional. 7. I understand that at the termination of the DHHSlicense for the SAS products, within which my organization's use of the products is allowed CDCmay be required to request the return of some or all of the provided SAS products. 8. I acknowledge that no ownership rights to the provided SAS products accrue to my organization by virtue of the use of the provided products. 9. I agree to assure that all organization or location personnel will be informed of the obligations and responsibilities acknowledged by this agreement. 10. I understand that the license does not obligate SAS Institute to provide user support for any of the SAS products provided to my organization. TX-DSHS-19-1309-A-000040 GRANTEESIGNATURE PAGE Signature: Date: Email: Phone: ---------- Mai Iing Address: --------------------------- Section II. CDC Program Official responsible for Grant Name: ------------------------------ CDC Administrative Code and Organizational Unit: You must print, sign and return this form as an attachment to the EITPO S4S LicenseManager TX-DSHS-19-1309-A-000041 From: Garcia,Imelda M (DSHS) Sent: Friday, October 19, 2018 11:57 AM EDT To: Downing, Janice S. (CDC/DDID/NCEZID) CC: Aldridge,Tiffany (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID) ; Gamez,Monica (DSHS) Subject: Re: SAS Grantee License Renewal Forms Thanks for the heads up Janice! We will follow up ASAP. Imelda M. Garcia, MPH Director, Infectious Disease Prevention Section Texas Dept. of State Health Services iPhone: 512-461-4476 Office: 512-776-76 CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. Sent from my iPhone On Oct 19, 2018, at 10:56 AM, Downing, Janice S. (CDC/DDID/NCEZID) wrote: WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Afternoon, I am sending this email because I don’t have a SAS License renewal from your IT POC. The deadline was October 15 th. If I don’t have it in by COB today, your SAS Licenses will not be renewed. Please fill out the appropriate information and get it back to me as soon as you can. Thanking you in advance for you immediate attention to this matter. Janice S. Downing ELC Program Project Officer/Advisor (Public Health Analyst) Scientific and Program Services Branch (SPSB) Division of Preparedness and Emerging Infections (DPEI) National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Mailstop H24-11 Office: (404) 639-7808 Cellphone: (404) 405-1330 Email: jbattle@cdc.gov NOTE: I telecommute on Wednesdays and Fridays, Thanks! From: Downing, Janice S. (CDC/DDID/NCEZID) Sent: Wednesday, October 10, 2018 2:09 PM To: kayode.olupinyo@dshs.state.tx.us Cc: Downing, Janice S. (CDC/DDID/NCEZID) Subject: SAS Grantee License Renewal Forms EITPO Notification Dear: Texas Department of State Health Services Your SAS license(s) are scheduled to expire December 30, 2018. Please use the attached request form to communicate your SAS license requirements for CY 2019 which begins December 31, 2018 thru December 30, 2019. The form requires acceptance and signature to the terms as outlined. The attached Grantee MOA must be signed and returned to your Project Officer on or before October 15, 2018. This is a hard deadline. • • This is the only process for Grantees to receive a SAS License from CDC. Failure to respond will result in your current license(s) becoming inactive. There are two types of licenses available for grant and cooperative agreement recipients through the HHS Enterprise License Agreement with SAS Institute; workstation licenses and server licenses. These licenses are available through the various cooperative agreements, and each branch is responsible for monitoring requests and certifying that the information supplied is accurate. Grantees should expect to receive their license renewal keys from the CDC SAS License Manager between January 1 and no later than March 30. TX-DSHS-19-1309-A-000042 Our current details on file include GrantID : 1 U50 CK000378 Grant Title: Epidemiology & Lab Capacity Grantee: Texas Department of State Health Services Institution: Texas Department of State Health Services FullName: Kayode Olupinyo PC: City: PC ZIP: 78756 Email: kayode.olupinyo@dshs.state.tx.us SAS Request History for: FY 2018 Dec 31-30 Total Quantity of Licences: 13 Period: FY 2018 Dec 31-30 PO: Downing, Janice S. (CDC/OID/NCEZID) Total Cost: $ 15,241.72 Products ====== Product: Base SAS 9.3 TS1M0 Qty: 10 Type: 32-Bit Workstation Version: Media:CD/DVD set and license file Owner: kayode.olupinyo@dshs.state.tx.us Product: Base SAS 9.3 TS1M0 Qty: 3 Type: 64-Bit Server Version: Media:CD/DVD set and license file Owner: kayode.olupinyo@dshs.state.tx.us Thanking you for your cooperation. Respectfully, CDC Project Officer: Downing, Janice S. (CDC/OID/NCEZID) CIO: NCEZID TX-DSHS-19-1309-A-000043 From: Phippard, Alba (CDC/DDID/NCEZID) Sent: Monday, October 22, 2018 3:49 PM EDT To: Brady, Shane (CDC azdhs.gov) ; Komatsu, Kenneth (CDC azdhs.gov) ; Robert Guerrero ; Iniguez-Stevens, Esmeralda@CDPH ; Banicki,Allison (DSHS) ; Margarita Santibanez (margarita.santibanez@cdph.ca.gov) ; Sidwa,Tom (DSHS) ; Shuford,Jennifer (DSHS) ; Torres,David (DSHS) ; Tyler,Carla (DSHS) ; Paula Kriner ; Maria Fierro ; Arizmendi, Olivia (CDPH-COBBH) ; April Fernandez (april.fernandez@cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Kao, Annie (CDC sdcounty.ca.gov) ; Delossantos,Rosy (DSHS) ; Sandra Melman ; Torres, Salina, DOH ; Smelser, Chad CS (CDC state.nm.us) ; Freida Adams (Freida.Adams@state.nm.us) ; Michelle S McConnell (mcconnellms@state.gov) ; Villarino, Elsa (CDC/DDID/NCEZID) ; Groseclose, Samuel L. (CDC/OPHPR/OD) ; Waterman, Steve (CDC/DDID/NCEZID) ; Escotto, Dianne A. (CDC/DDID/NCEZID) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID) ; Moser, Kathleen (CDC/DDID/NCEZID) ; Arrouzet, Cory ; Justine.Kozo@sdcounty.ca.gov ; Fonseca-Ford, Maureen (CDC/DDID/NCEZID) ; Clements, Crystal (CDC/DDID/NCEZID) ; Garcia,Imelda M (DSHS) ; Gaul,Linda (DSHS) ; Ledezma,Elvia (DSHS) ; Waters, Janine (CDC state.nm.us) ; erica.martinez@state.nm.us ; Fortune, Diana (CDC state.nm.us) ; ralph.zimmerman@state.nm.us ; Mariana G. Casal ; Eugene Livar CC: Goryoka, Grace (CDC/DDID/NCEZID) ; Angelo, Kristina (CDC/DDID/NCEZID) ; Contreras, Sonia (CDC/DDID/NCEZID) ; Montiel, Sonia (CDC/DDID/NCEZID) (CTR) ; Shaw, Alina Gauntlett (CDC/DDID/NCEZID) (CTR) ; Gray, Thomas (CDC/DDID/NCEZID) (CTR) Subject: Disease Prioritization Workshop Summary Attachment(s): "US Southern Border Region Infectious Disease Prioritization_Workshop Summary_FINAL.docx.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Afternoon, Thanks once again to all of you for participation in the disease prioritization process over the past several months. Attached is a brief summary of the workshop. Please feel free to share it with interested partners. The CDC team is in the process of drafting a detailed report and will be in touch with next steps for the report, as well for additional discussions on how best to address the priority diseases. Thank you, Alba Alba Phippard BIDS Program Manager US - Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 3851 Rosecrans St., Ste 715 San Diego, CA 92110 Office: (619) 692-8479 Mobile: (619) 206-0461 Telwork (Fri): (619) 206-0461 Email: APhippard@cdc.gov To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html TX-DSHS-19-1309-A-000044 Infectious Disease Prioritization for Multijurisdictional Engagement at the United States Southern Border Region San Diego1 California September 27-28 1 2018 Workshop Summary Infectious Disease Prioritization for the United States Southern Border Region • The Centers for Disease Control and Prevention (CDC)United States-Mexico Unit worked with CDC'sOne Health Office to host an infectious disease prioritization workshop for the U.S. southern border region in San Diego, California September 27-28, 2018. • This workshop was the first time CDC's One Health Zoonotic Disease Prioritization (OHZDP)tool was used to prioritize infectious diseases beyond zoonoses and for a regional approach to prioritization. Workshop Goals: • • 1 To prioritize endemic and emerging diseases of particular concern in the US southern border region 1 to identify common USfederal and state priorities, and determine how to jointly address them. Specifically, these are diseases that can be introduced and amplified, or cause an outbreak, due to the movement of people, products, or animals between the US and Mexico. To develop plans to address gaps in surveillance, response, or other relevant activities for the prioritized diseases The 44 US counties with the majoritv of their area within the 100 km line, as established bv the 1983 La Paz agreement 1 TX-DSHS-19-1309-A-000045 Workshop Participants: The workshop was attended by 32 participants from federal and state agencies. There were 12 voting members (4 federal and 8 state representatives) and many advisors providing subject matter expertise (see Appendix A). Workshop Outcomes: Federal and state health officials agreed upon a prioritized list of four infectious disease groups: 1. Tuberculosis 2. Aedes-transmitted arboviral diseases (dengue, chikungunya, Zika) 3. Enteric diseases (Vibrio spp., Listeria monocytogenes, non-typhoidal Salmonella, and Brucella spp.) 4. Rickettsioses (R. rickettsiae, R. typhi, R. parkeri) Workshop Methods The prioritization process used a semi-quantitative tool developed by CDC’s One Health Office2. During a pre-workshop webinar, a preliminary list of 20 infectious diseases (see Appendix B) based on recent border health initiatives was reviewed, discussed, and finalized in collaboration with voting participants and advisors. During the workshop, participants jointly identified five criteria for quantitative ranking of these infectious diseases. Participants then worked in groups to develop one categorical question for each criterion (see Appendix C). All questions had ordinal multinomial answers, as required for the OHZDP tool. Once the five criteria and questions were agreed upon by the broader group of participants, each voting member determined the relative importance of each criterion from their agency’s perspective. These individual rankings were used to generate a final group of weights for each criterion. The questions were then answered for each disease using data from available literature and subject matter expertise, generating a score for each disease. The scores for all five questions were weighted, summed, and then normalized, yielding a prioritized list with the highest final score being 1.0. The ranked list of 20 infectious diseases was presented to the workshop participants on Day 2 for general discussion (see Appendix D). The twelve voting members from federal and state agencies determined a final prioritized list of four infectious disease groups. After the disease list was finalized, workshop participants discussed potential actions and next steps regarding the prioritized infectious disease groupings. 2 Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. One Health Zoonotic Disease Prioritization [Internet]. Available at: https://www.cdc.gov/onehealth/globalactivities/prioritization.html 2 TX-DSHS-19-1309-A-000046 VOTING MEMBERS DISCUSSING THE DISEASE LIST APPENDIX A: List of participating agencies:            Arizona Department of Health Services California Department of Public Health New Mexico Department of Health Texas Department of State Health Services Imperial County Public Health Department San Diego Country Health and Human Services Agency, Office of Border Health US Health and Human Services Agency, Office of Global Affairs Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, US-Mexico Unit (CDC–USMU) Centers for Disease Control and Prevention, Division of Vector-borne Diseases (CDC– DVBD) Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response (CDC–OPHPR) Centers for Disease Control and Prevention, One Health Office 3 TX-DSHS-19-1309-A-000047 APPENDIX B: Infectious Disease List Table 1. This list of infectious diseases was used for the U.S. Southern Border Region Infectious Disease Prioritization workshop. Infectious Disease Brucellosis Campylobacteriosis Chagas disease Chikungunya Dengue Hepatitis A Hepatitis B HIV infection Influenza Listeria Pertussis Rickettsioses Salmonellosis (non-typhoidal) Shigella Shiga toxin-producing Escherichia coli (STEC) Syphilis Tuberculosis Varicella Vibrio infection Zika Etiological Agent Brucella species Campylobacter species Trypanosoma cruzi Chikungunya virus Dengue viruses Hepatitis A virus Hepatitis B virus Human immunodeficiency virus Influenza A and Influenza B viruses Listeria monocytogenes Bordetella species R. rickettsiae, R. parkeri, R. typhi Salmonella species Shigella species Escherichia coli species Treponema pallidum Mycobacterium tuberculosis complex Varicella-zoster virus Vibrio species Zika virus 4 TX-DSHS-19-1309-A-000048 APPENDIX C: Numerical Weights for the Criteria Selected for Ranking Infectious Diseases at the U.S. Southern Border Region 1. Epidemic / Pandemic Potential (criterion weight=0.307)  What is the number of outbreaks (defined as using the CDC case definition) in the US southern border states in the past 10 years? o (4) Multiple outbreaks (>1) and at least one outbreak has occurred in all 4 US southern border states o (3) Multiple outbreaks (>1), but outbreaks have not occurred in all 4 US southern border states o (2) Only one outbreak in any US southern border state o (1) No outbreaks in the US southern border states but at least one outbreak has occurred in Mexico (country) OR no outbreaks have occurred in US southern border states nor Mexico (country) but there is potential for an outbreak 2. Presence and rate of disease (criterion weight=0.249)  Is the highest reported incidence rate (2017, or most recent available data) from the United States southern border state county with the population >100,000 persons (within a single state) greater than the national incidence rate? o (3) Yes, all for states have a higher incidence rate o (2) Yes, < 4 states have a higher incidence rate o (1) No states have a higher incidence rate 3. Impact on human health (criterion weight=0.230)  Does the disease have a significant case fatality rate (untreated, ≥5%), and does it have significant DALYs (at least one per 100,000 population/year or 0.1 logscale per case/year) or a significant hospitalization rate (≥10%) for the disease? o (3) CFR ≥ 5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (2) CFR ≥ 5% but DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% o (2) CFR < 5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (1) CFR < 5% AND DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% 5 TX-DSHS-19-1309-A-000049 4. Capacity (criterion weight=0.115)  Is there an unmet need in a given state in the border region (unmet need is defined as no or poor lab capacity (from collection of samples to reporting) including use of available technology) OR insufficient staffing OR other substantial gap that is generally available outside the border region)? o (5) Four states have an unmet need o (4) Three states have an unmet need o (3) Two states have an unmet need o (2) One state has an unmet need o (1) No states have an unmet need 5. Effective prevention and control measures (criterion weight=0.099)  Are recognized effective surveillance systems in place in the state OR effective prevention and control measures (vaccine, treatment – but not supportive care) available in the state OR there is a potential intervention (beyond vaccine or treatment, such as case management, vector control, infection control, etc.) available in the state for this disease in all 4 southern border states? o (3) + Surveillance AND + Prevention/control measures AND + Potential intervention o OR + Prevention/control measures AND + Potential intervention o OR + Surveillance AND + Prevention/control measures o OR + Surveillance AND + Potential intervention o (2) + Surveillance only OR + Prevention/control measures only OR + Potential intervention only o (1) No surveillance, prevention/control measures, or potential interventions 6 TX-DSHS-19-1309-A-000050 APPENDIX D: Final Results of Infectious Disease Prioritization Workshop for the US Southern Border Region Table 2. Infectious diseases considered for prioritization: Final results of prioritization and normalized weights for 20 infectious diseases. The top prioritized infectious diseases selected by the voting members are shown in bold. Rank Infectious Disease Raw Score Normalized Final Score 1 Tuberculosis 1.266686081 1 2 Vibrio infection 1.237911983 0.977283955 3 Hepatitis A 1.218692442 0.962110866 4 Dengue 1.193208165 0.941992008 5 Syphilis 1.164434067 0.919275963 6 Listeria 1.159788977 0.915608843 7 Pertussis 1.151600921 0.909144688 8 Varicella 1.151600921 0.909144688 9 Influenza 1.142046364 0.901601732 10 Rickettsioses 1.115085159 0.880316896 11 Campylobacteriosis 1.102252014 0.870185621 12 Salmonellosis (non-typhoidal) 1.102252014 0.870185621 13 STEC 1.102252014 0.870185621 14 Zika 1.090956151 0.861267971 15 Shigella 1.007741664 0.795573331 16 Hepatitis B 0.991800712 0.782988561 17 HIV infection 0.959930039 0.75782789 18 Chikungunya 0.947096894 0.747696614 19 Brucellosis 0.918322796 0.724980569 20 Chagas disease 0.707818409 0.558795443 7 TX-DSHS-19-1309-A-000051 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Wednesday, October 24, 2018 12:08 PM EDT CC: Shultz, Alvin (CDC/DDID/NCEZID) ; O'Connor, Angelica (CDC/DDID/NCEZID) ; Downing, Janice S. (CDC/DDID/NCEZID) ; Brathwaite, Wayne (CDC/DDID/NCEZID) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID) ; Snow, Jason N. (CDC/DDID/NCEZID) ; Njoroge, Charlene F. (CDC/DDID/NCEZID) ; Ganim, Alexandra M. (CDC/DDID/NCEZID) ; Gemella, Athena (CDC/DDID/NCEZID) ; Light, Megan (CDC/DDID/NCEZID) ; Jackson, Kandice (CDC/DDID/NCEZID) ; Montgomery, Meagan (CDC/DDID/NCEZID) (CTR) ; Bellis, Kimberly (CDC/DDID/NCEZID) ; Chung, Christina L. (CDC/DDID/NCEZID) ; Hall, Christopher (Jason) (CDC/DDID/NCEZID) ; Nonnenmacher, Patrick (CDC/DDPHSIS/CSTLTS) ; Achim, John (CDC/DDID/NCEZID) ; Lavelle, Judith M. (CDC/DDID/NCEZID) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID) Subject: ELC Annual Meeting Website Now Live!!! WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, The Centers for Disease Control and Prevention’s (CDC) Division of Preparedness and Emerging Infections (DPEI) is hosting the 2019 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Annual Meeting, which will take place April 2-4, 2019. The meeting will be held in the Global Communications Center at CDC’s Roybal Campus in Atlanta, GA. Participants will include state, local, and territorial leaders in epidemiology, laboratory, and health information systems, as well as infection control professionals and national partners. By now you should have received registration information via emails from the ELC mailbox andEventbrite. Registration is free but necessary in order to attend; therefore, it is strongly recommended that you register. If plans change, you can always cancel your registration at a later time. We wanted to let you know that you can now find the most recent meeting-related details on the2019 Annual ELC Annual Meeting Website, such as information on registration information (deadline = March 9, 2019), hotel reservation details, and lunch ordering instructions. Within the next couple of months, the meeting agenda will also be posted to the 2019 ELC Annual Meeting Website. Approximately one week before the 2019 ELC Annual Meeting, additional information will be shared to all registered attendees about how to access the presentations through REDCap. Consistent with previous communications, we ask that each ELC-funded jurisdiction limit the number of attendees to no more than five (5) attendees, including a representative who is responsible for the fiscal management of the ELC Cooperative Agreement in the jurisdiction. Therefore, please coordinate with your ELC Principal Investigator (PI) to determine the optimal representation at the meeting. If you have any additional questions regarding the 2019 ELC Annual Meeting, please contact the ELC at elc@cdc.gov. Thank You, The ELC Team TX-DSHS-19-1309-A-000052 From: Electronic Data Exchange (CDC) Sent: Monday, November 05, 2018 11:26 AM EST To: Electronic Data Exchange (CDC) CC: Hoover, Michele (CDC/DDPHSS/CSELS/DHIS) Subject: NNDSS Publishes Finalized Annual Infectious Disease Data WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. NNDSS Publishes Finalized Annual Infectious Disease Data CDC is pleased to announce that finalized 2017 National Notifiable Diseases Surveillance System (NNDSS) annual infectious disease data are now available as tables on the data and statistics section of the NNDSS webpage. In addition to links to the tables, hosted by the CDC Wide-ranging Online Data for Epidemiological Research (WONDER), the website provides detailed information about the data themselves. Highlights of the tables include the following: · Table 1 displays reported infectious notifiable disease case counts and rates for the United States overall. · Tables 2a–2q display reported infectious notifiable disease state and territory specific case counts. · Table 3 displays reported infectious notifiable disease cases by month for the United States overall. · Tables 4–7 display reported infectious notifiable disease case counts and rates by age group, sex, race, and ethnicity, respectively, for the United States overall. The list of nationally notifiable diseases for 2017 is available on the NNDSS website along with the respective national surveillance case definitions. Surveillance case definitions are a set of uniform criteria to define a disease or condition for public health surveillance. They enable public health to classify and count cases consistently across reporting jurisdictions. About NNDSS To protect Americans from serious disease, NNDSS helps public health monitor, control, and prevent about 120 diseases. These diseases are important to monitor nationwide and include infectious diseases such as Zika, viral hepatitis, sexually transmitted diseases, and E. coli. About 3,000 public health jurisdictions gather data on these diseases from sources such as healthcare providers, hospitals, and laboratories and use the data to protect their local communities. Through NNDSS, CDC receives and uses these data to keep people healthy and defend America from health threats. TX-DSHS-19-1309-A-000053 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, November 09, 2018 3:40 PM EST CC: Eisen, Rebecca J. (CDC/DDID/NCEZID/DVBD) ; Eisen, Lars M. (CDC/DDID/NCEZID/DVBD) ; Hinckley, Alison F. (CDC/DDID/NCEZID/DVBD) ; Mead, Paul (CDC/DDID/NCEZID) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID) ; Chung, Christina L. (CDC/DDID/NCEZID) ; Bellis, Kimberly (CDC/DDID/NCEZID) ; Kersh, Gilbert (Gil) (CDC/DDID/NCEZID/DVBD) ; Nichols Heitman, Kristen M. (CDC/DDID/NCEZID) ; Bellis, Kimberly (CDC/DDID/NCEZID) ; Brathwaite, Wayne (CDC/DDID/NCEZID) ; Chung, Christina L. (CDC/DDID/NCEZID) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Lavelle, Judith M. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) Subject: A message from our ELC colleagues in the Division of Vector-Borne Diseases: Tick surveillance guidance Attachment(s): "TickSurveillance_Ipac_102418_508.pdf","TickSurveillance_Ixodes_scapularis_092518_508Compliant.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Diseases spread by ticks are an important public health concern. Among the nearly 50,000 cases of vector-borne diseases reported annually to the CDC, roughly 95% are spread by ticks. The majority of reported vector-borne disease cases are Lyme disease, with an average of 30,000 cases reported annually. Over the past two decades, the number of reported tickborne disease cases has roughly tripled, cases have been reported over an expanding geographical region, and new human pathogens spread by ticks continue to be discovered. Some of these trends are explained by expanding ranges of ticks that carry human pathogens. The best way to avoid tickborne diseases is to avoid tick bites. The first step to doing so is knowing which ticks are in the areas where people spend time outdoors and knowing when those ticks are active. To provide the public, health care providers and policy makers with current and accurate information on the distribution and abundance of ticks and the presence and prevalence of human pathogens in ticks, the Division of Vector-Borne Diseases has increased funding to states through the ELC to enhance tick surveillance activities. To support those efforts, CDC’s tick surveillance goals and appropriate methods of achieving those goals are outlined in newly released guidance documents. Currently, surveillance guidance documents are available for the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus) and their associated human pathogens. Similar guidance will be issued for other human-biting ticks and their associated human pathogens. Beginning in 2019, state health departments can voluntarily report to ArboNET county level data on the presence and abundance of ticks and the presence and prevalence of human pathogens within ticks. Using information reported to ArboNET, CDC will begin sharing annual tick surveillance reports that track changes in the distribution and abundance of medically important ticks and in the presence and prevalence of human pathogens within ticks. This collaborative work involving CDC and state health departments has moved us closer to having a standardized surveillance system for ticks and their associated pathogens. The program enhances our capacity to monitor changes in risk for human exposure to ticks and their associated pathogens and aids in raising awareness of tickborne diseases and prevention in communities at risk for exposure to ticks and tickborne pathogens. Attached, you will find some useful surveillance guidance for the blacklegged tick (Ixodes scapularis) and the western blacklegged tick (Ixodes pacificus). Should you wish to be put in contact with any subject matter experts in the Division of Vector-Borne Diseases, please feel free to contact your ELC Project Officer. TX-DSHS-19-1309-A-000054 Surveillance forlxodes pacificusand pathogens foundin thistickspecies inthe UnitedStates Table of Contents Contributors and Reviewers .................................................................... ........................................................................... Intended Audience and Objectives ..................................................................... ................................................................ Public Health Importance of lxades pacificus ..................................................................................................................... Life Cycle of lxades pacificus ..................................................................................................................................... 3 3 .......... 4 Tick Surveillance Objectives ................................................................................................................................................ Classify County Status for lxades pacificus ................................................................................................. 3 5 .................... 6 Identify Presence and Prevalence of Human Pathogens in lxades pacificus Ticks ......................................................... 6 Estimate the Density of Host-Seeking { Infected) lxades pacificus Ticks ......................................................................... 7 Document Host-Seeking Phenology of lxades pacificus Ticks ............. ........... ............ ............... ...... ............................... 8 Tick Collection Methods .......................................................................... ........................................................................... Drag Sampling or Flagging .............................................................................. ................................................................ Background and methods ........................................................................................................................................... 9 9 9 Acceptable to use to address the following key surveillance objectives: ............................. ........... ........................ 10 Walking Sampling ................................................................................ ............................................ ............................. 10 Background and methods ......................................................................................................................................... 10 Acceptable to use to address the following key surveillance objectives: ................................................................ 10 Carbon Dioxide-Baited Tick Traps .................................................................. .............................................................. 10 Background and methods ......................................................................................................................................... 10 Acceptable to use to address the following key surveillance objectives: ................................................................ 11 Tick Collection from Deer ............................................................................................................................................. 11 Background and methods ......................................................................................................................................... 11 Acceptable to use to address the following key surveillance objectives: ................................................................ 11 Tick Collection from Small- or Medium-Sized Mammals, Birds and Lizards ................................................................. 11 Background and methods ......................................................................................................................................... 11 Acceptable to use to address the following key surveillance objectives: ........ ..................... ...... ............................. 11 Ticks Found on People and Pets ................................................................................................................................... Background and methods ........................................................................... 11 .............................................................. 11 Acceptable to use to address the following key surveillance objectives: ................................................................ 12 Estimating the Density of Host-seeking {Infected) lxades pacificus Ticks .......... ........................... ........... ............ ............ 12 Where to Sample .......................................................................................................................................................... ••• 1 TX-DSHS-19-1309-A-000055 12 Size of Area to Sample ......................................................................... ......................................................................... 12 When to Sample ........................................................................................................................................................... 13 How Many Sites to Sample ............................................................................. 13 .............................................................. How to Estimate Infection Prevalence in Host-Seeking Ticks ....................................................................................... 13 How to Calculate the Density of Host-Seeking {Infected) Ticks with Confidence Intervals ....................... .................. 13 Describing Host-Seeking Phenology of lxodes pacificus Ticks ................. ......................................................................... Where to Sample ................................................................................. 14 ............................................ ............................. 14 How to Sample .............................................................................................................................................................. 14 When to Sample .................................................................................. 14 ......................................................................... Pathogen Detection ............................................................................................................................ .............................. 14 Recommended Tick Samples and Preservation for Pathogen Testing ........... .............................................................. 14 Minimum Criteria for Acceptability of Pathogen Detection Assay ...... ......................................................................... 15 Important considerations for Borre/ia testing ............................................ .............................................................. 16 Notes on nomenclature: ............................................................................. Important considerations for Anaplasma phagocytophilum ........................... ........... ........................ 16 testing .......................................... ............................. 16 Samples CDC will Test for Pathogens ................................................................. ............................................ .................. 17 In Counties Where the Pathogen of Interest has Never Been Identified ..................................................................... 17 In Counties Where the Pathogen of Interest has Been ldentified ................................................................................ 17 Limitations to Tick Surveillance .......................................................................... .............................................................. 18 References .......................................................................................................... .............................................................. 18 Supplemental Material ............................................................................ ...................................... ................................... 21 Avoiding Tick Bites .............................................................................................. While You Are Outdoors ................................................................................. After You Come Indoors ..................................................................... .............................................................. 21 ............................................ .................. 21 ............................................. ............................. 21 How to Remove a Tick ....................................................................................... ............................................................... 22 How to Make Tick Drags ............................. ............ .......................... ...................................... .......................................... 23 Blanket-Style Drag ........................................................................................................................................................ Supplies ...................................................................................................... Sewing instructions .......................................................................... 23 ............................................................... 23 ......................................................................... 23 Sewing diagrams ....................... ...... .......... ...................... ...... ...................................... ...... ................................ ........ 25 Modified Drag with "Fingers" ....................................................................................................................................... Supplies ............................................................................................ 26 ............................................ ............................. 26 Sewing instructions ................................................................................................................................................... Sewing diagrams ............................................................................................................................................... ••• 2 26 ........ 27 TX-DSHS-19-1309-A-000056 Contributors and Reviewers The following Centers for Disease Control and Prevention (CDC), Division of Vector-Borne Diseases staff members formed the technical development group that prepared or reviewed this report: • Rebecca J. Eisen, Ph.D. (Bacterial Diseases Branch) • Lars Eisen, Ph.D. (Bacterial Diseases Branch) • Christine B. Graham, Ph.D. (Bacterial Diseases Branch) • Andrias Hojgaard, Ph.D. (Bacterial Diseases Branch) • Paul S. Mead, M.D., M.P.H. (Bacterial Diseases Branch) • Gil Kersch, Ph.D. (Rickettsial Zoonoses Branch) • Sandor Karpathy, Ph.D. (Rickettsial Zoonoses Branch) • Christopher D. Paddock, M.D., M.S. (Rickettsial Zoonoses Branch) We are grateful to the following state health partners for their thoughtful review and contributions to this document: • Vicki Kramer, Ph.D., Kerry Padgett, Ph.D., and Melissa Yoshimizu, Ph.D., California Department of Public Health Intended Audience and Objectives Public health entomologists/biologists are the intended audience for this document. The primary objective of this document is to provide guidance for surveillance of the western blacklegged tick, lxodes pacificus, and pathogens found in this tick species in order to provide health care providers and the public with current and accurate information on where this tick occurs, when the different life stages are most active during the year, and which human pathogens are of the greatest local concern. Public Health Importance of lxodes pacificus The western blacklegged tick, lxodes pacificus, is the primary vector to humans in the far western United States of Borrelia burgdorferi sensu stricto {Lyme disease), Anaplasma phagocytophilum {anaplasmosis) and most likely Borrelia miyamotoi {B. miyamotoi disease) {Table 1). ••• 3 TX-DSHS-19-1309-A-000057 Table 1. Pathogens transmitted by lxades pacificus, life stages that can be infected, and the human diseases caused by infection with these pathogens. Disease Pathogen{s) Life stages infected Barrelia burgdarferi sensu stricto, Lyme disease Barrelia mayanii Nymphs, Adults Anaplasmosis Anaplasma phagacytaphilum Nymphs, Adults Barre/ia miyamatai disease Barre/ia miyamatai Larvae, Nymphs, Adults Life Cycleof lxodes pacificus .... Eggs lxodes pacificus • tlO.st! t-11'181-~:Hl:IIO"g• Elt>oo•looclng Generalized life cycle of lxodes pacificus. lxades pacificus is primarily a woodland-associated tick. In north -coastal California where the tick has been studied most extensively, it has, minimally, a 3-year life cycle consisting of four life stages: egg, larva, nymph, and adult {Padgett and Lane 2001). Larval and nymphal ticks each take a single bloodmeal before molting to the next life stage and may acquire human pathogens through blood-feeding on infectious hosts or by co-feeding transmission (infected and uninfected ticks feeding in close proximity; pathogen transmission can occur in the absence of a systemic host infection). Larvae and nymphs feed primarily on lizards, squirrels, and ground-dwelling birds. However, they can also infest other mammals including deer. Female ticks take a single bloodmeal (most commonly from deer but also from other medium-sized and large mammals), lay a large batch of eggs and then die. Based on evidence from closely related lxades species and in contrast to other human pathogens transmitted by this tick, Barrelia miyamatai, is likely transmitted transovarially by/. pacificus {vertical transmission from infected females to their offspring). Barrelia ••• 4 TX-DSHS-19-1309-A-000058 burgdarferi sensu stricto, and Anap/asma phagacytaphilum (and likely Barre/ia miyamatai) are maintained via horizontal transmission, where infected nymphal or female ticks transmit the agents to vertebrate hosts, and na·ive larval or nymphal ticks then acquire pathogens while feeding on the infectious hosts. Adults are active mainly during the cool months of the year from late fall to early spring. Females typically lay eggs in spring but hatched larvae do not seek hosts actively until the following spring. After blood-feeding, larvae molt to nymphs, but do not begin host-seeking until the following spring. Peak nymphal host seeking is typically observed in May and June, depending on location. After blood-feeding, nymphs moltto adults and seek hosts in the fall, w inter or early spring, resulting in a minimum of three years to complete a life cycle {Figure 2; Padgett and Lane 2001). Notably, host-seeking phenology may differ across the geographic range of this tick species. For example, in central and southern California, the host-seeking period, particularly of juvenile ticks is truncated, with activity occurring in March and April (MacDonald and Briggs 2016). Tick SurveillanceObjectives Tick surveillance is intended to monitor changes in the distribution and abundance of ticks and the presence and prevalence of tickborne pathogens in order to provide actionable, evidence-based information to clinicians, the public and policy makers. Key questions address when and where humans are at risk for exposure to ticks and tickborne pathogens. Specifically, at the spatial scale of U.S. counties, CDC aims to: 1) 2) classify county status for I. pacificus: established, reported, or no data available, and classify county status for presence of specific pathogens in I. pacificus ticks: present or no data available. Additional objectives include the following: (3) generate estimates for local prevalence of specific pathogens in relevant/. pacificus life stages and local density of host-seeking (infected) nymphs or adults, which then can be aggregated and displayed at county scale; and (4) document host-seeking phenology of all/. pacificus life stages in strategic locations across the tick's range and display this information at state or regional spatial scales. For more details on tick sampling methods, please see the 'Tick Collection Methods" section of this document. Objective 1 provides the most basic information for risk assessment (i.e., is the tick known to be reported or established in the county of interest?). Presence of a vector tick species does not necessarily indicate presence of human pathogens, and therefore, Objective 2 provides additional information pacificus-bome about potential exposure to/. human pathogens. While documenting the presence of a human pathogen in a county is useful, estimates of infection prevalence in host-seeking ticks (the percentage of ticks tested that are infected) provides a better indication of the likelihood that ticks encountered by humans may be infected with the pathogen of interest. Tick-borne infections in humans arise following the bite of infected ticks. The refore, a measure that captures the abundance of host-seeking ticks, often referred to as density of host-seeking nymphs (DON) or females (DOF), provides more accurate information establishment. on the likelihood of human encounters than simple measures of tick presence or That is, although human behavior affects the likelihood of human-tick encounters, assuming similar human behavior across tick habitats, human-tick encounters are likely to increase with increasing DON or DOF. Overall, acarological risk measures such as pursued in Objective 3 that combine the density of host-seek i ng nymphs ••• 5 TX-DSHS-19-1309-A-000059 and local estimates of infection prevalence {often referred to as the density of host-seeking infected nymphs or DIN) provide more accurate estimates of human encounters with infected host-seeking nymphs than simple measures of tick/pathogen presence or abundance {Mather et al. 1996, Eisen et al. 2006, Pepin et al. 2012, Eisen and Eisen 2016). Finally, recognizing that acarological risk measures often differ by life stage, documenting when each life stage is actively host-seeking aids in identifying when humans are at greatest risk for exposure to tick bites and tick-borne pathogens. Therefore, Objective 4 aims to document host-seeking phenology of larval, nymphal and adult/. pacificus ticks. Criteria for classifying county establishment status for/. pacificus and estimating infection prevalence, densities of host-seeking {infected) ticks and documenting host-seeking phenology are summarized below. CDC aims to collate tick surveillance data to make county-level data available to the public on national-scale maps that will be displayed on the CDC website. State health departments and other CDC public health partners may submit data through ArboNET. For additional information us at ticksurveillance@cdc.gov. on ArboNET submissions, please see httos://wwwn.cdc.gov/arbonet Additional information or contact can be found in subsequent sections of this document. ClassifyCounty Status for lxodes pacificus • Objective: Update the I. pacificus distribution map based on county level establishment criteria {Dennis et al.1998). • Data will be displayed at: https://www.cdc.gov/ticks/surveillance/ County status classification criteria are as follows: o Established:~ 6 /. pacificus of a single life stage or> 1 life stage collected per county within a 12month period • o Reported:< 6 /. pacificus of a single life stage collected per county within a 12-month period o No records For this objective and all others, ticks should be identified to species and life stage using published taxonomic keys {e.g., Keirans and Clifford 1978, Furman and Loomis 1984). • • For counties reporting new records, voucher specimens supporting the status change should be archived. Because we have greater confidence in presence than absence data, after a county is classified as "established," it will remain so and will not regress to "reported" as "reported" may progress to "established" and counties classified as "no records" may progress to "reported" or "no records" status. Counties classified or "established" when criteria for those classifications have been met. After a county is classifi ed as "established" surveillance efforts should focus instead on pathogen presence and prevalence and assessments of acarological risk of human exposure to/. pacificus-borne pathogens. Identify Presence and Prevalence of Human Pathogens in lxodes pacificus Ticks • Objective: Map the county level distribution of human pathogens in I. pacificus ticks or in natural hosts for this tick. Data will be displayed at: https://www.cdc.gov/ticks/surveillance/ • Data to be mapped include: o Shading counties where the/. pacificus -borne pathogen of interest has been detected in/. pacificus ticks or in natural hosts of/. pacificus. This is a simple binary response {pathogen detected or not). Pathogen detection assays must meet minimal assay requirements described in "Minimum Criteria for Acceptability of Pathogen Detection Assay." Samples from which potential exposure could have occurred in other counties will not be included {ticks from people or pets are not acceptable unless travel outside of the county within 10 days prior to detection of the tick can be ruled out) but infection in ticks collected from the environment {by dragging, flagging, walking, or trapping) or infection in ticks collected from trapped mammals {provided their home ranges are limited enough ••• 6 TX-DSHS-19-1309-A-000060 to infer exposure occurred in the county of interest) are acceptable for documenting presence of pathogens in a county. o For counties where the pathogen of interest already has been detected in/. pacificus ticks {this information will be updated annually on https://www.cdc.gov/ticks/surveillance /l . pathogen prevalence and 95% confidence intervals can be estimated per relevant tick life stage and per collection site in Excel using the Pooled Infection Rate Add-In . Inclusion of confidence intervals is recommended in addition to point estimates in order to convey the level of uncertainty in point estimates. Confidence intervals can be interpreted as "there is a 95% probability that the true infection prevalence is between [insert lower confidence limit] and [insert upper confidence limit]." As sample sizes increase, the width of the confidence intervals decrease. Typically, testing 50 nymph al or adult ticks per site gives reasonable confidence limits for most/. pacificus-borne pathogens. For example, when 10 of 50 tested ticks are positive, infection prevalence is estimated as 20% {95%CI: 11-33%). Likewise, if no ticks are infected in a sample of 25 or 50 ticks, infection prevalence could be as high as 13% or 7%, respectively. Although infection prevalence can be calculated for smaller sample sizes, uncertainty in estimates is high; pathogen prevalence will not be displayed unless a minimum of 25 ticks have been tested with i n a given county for a given life stage. Overall, estimates of infection prevalence improve with increasing sample sizes. Infection prevalence and associated 95% confidence intervals will be calculated by CDC for data submitted to ArboNET. Estimate the Density of Host-Seeking(Infected) lxodes pacificus Ticks For each of the objectives listed below, when sufficient data have been submitted to ArboNET, CDC will post annual surveillance reports at https://www.cdc.gov/ticks/surveillance/. • Objective: Map the county level density of host-seeking I. pacificus nymphs. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking nymphs collected per 100 m 2 or displayed as the inverse showing the distance covered before expected encounter with a nymph. ■ Requires at least 750 m2 drag sampled per site for density estimate; drags should be inspected for ticks at consistent intervals and at least every 10-20 m; sampling should be timed to coincide with the peak in nymphal host-seeking activity {Eisen et al. 2010, DiukWasser et al. 2012); ideally, estimates of nymphal density should be based on at least 2-3 visits to the site within the perceived seasonal peak in host-seeking {Dobson 2013). For more information on sampling, please see: "Estimating the Density of Host-seeking {Infected) lxodes pacificus ticks." ■ Requires at least 1 site sampled per county, otherwise county will be displayed as "no records." ■ In ecologically diverse counties, sampling at multiple sites representing the range in suitable habitat for the tick is recommended; when multiple sites are sampled per county, average and range will be accessible. ■ Although timed sampling {e.g., dragging for fixed amounts of time, rather than fixed distances) is a valid sampling approach, in the interest of comparability among localities, we will only accept distance-based assessments of DON and DIN for ArboNET. • Objective: Map the county level density of host-seeking infected I. pacificus nymphs. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking infected nymphs collected per 100 m2 or displayed as the inverse showing the distance covered before expected encounter wlthani~ectednymph. • •• 7 TX-DSHS-19-1309-A-000061 ■ Calculated by multiplying the estimated density of nymphs by infection prevalence (both described above). ■ • When multiple sites are sampled per county, average and range will be accessible. Objective: Map the county level density of host-seeking I. pacificus females. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking females collected per 100 m 2 {DOF) or displayed as the inverse showing the distance covered before expected encounter with a female tick. ■ Requires at least 750 m2 drag sampled or flagged per site for density estimate; because adults drop off more readily than nymphs, drags or flags should be inspected for ticks every 10 m; sampling should be timed to coincide with the peak in adult host-seeking activity; ideally, estimates offemale density should be based on at least 2-3 visits to the site within the perceived seasonal peak in host-seeking. ■ Requires at least 1 site sampled per county, otherwise county will be displayed as "no records." ■ Sampling at three or more sites per county is recommended; when multiple sites are sampled per county, average and range will be accessible. ■ In ecologically diverse counties, sampling at multiple sites representing the range in suitable habitat for the tick is recommended; when multiple sites are sampled per county, average and range will be accessible. ■ Although timed sampling (e.g., dragging for fixed amounts of time, rather than fixed distances) is a valid sampling approach, in the interest of comparability among localities, we will only accept distance-based assessments of DOF and DIF for ArboNET. • Objective: Map the county level density of infected host-seeking I. pacificus females. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking infected females collected per 100 m2 or displayed as the inverse showing the distance covered before expected encounter with an infected female tick. ■ Calculated by multiplying the estimated density of females by infection prevalence in tested adult ticks ( both described above). ■ When multiple sites are sampled per county, average and range will be accessible. Document Host-SeekingPhenologyof lxodes pacificus Ticks • Objective: Describe when I. pacificus ticks are actively host-seeking (phenology). • Data display and minimal sampling requirements include: o Displayed as region of the state, or state-wide {or neighboring state) records of tick activity by life stage. This will be a categorical response (records of the tick being active for a particular month of the year or not, or no records if phenology studies were not reported from a particular state or its neighbor). o Based on weekly, bi-weekly, or monthly non-removal sampling over a 12-month period, excluding winter months too cold for tick activity in colder parts of the tick's range and excluding months that are too hot for tick activity in the warmer parts of the tick's range. For more information, see "Describing Host-Seeking Phenology of lxodes pacificus Ticks." ••• 8 TX-DSHS-19-1309-A-000062 Tick Collection Methods Several methods can be used to collect I. pacificus ticks, however, some are better suited than others for addressing specific surveillance objectives (Table 2). For example, all of the methods described below can be used to demonstrate the presence of I. pacificus or I. pacificus-borne pathogens in a county of interest. Demonstrating that both the vector and pathogen are present within a county provides fundamental data for assessing the risk of human encounters with infected ticks. However, for Lyme disease, which is most commonly acquired through the bite of infected nymphs, estimates of the density of Borrelia burgdorferi sensu stricto (s.s.)-infected host-seeking nymphs are a more accrurate predictor of human Lyme disease occurrence than simple measures of the presence of the tick or pathogen, or quantitative measures of the density of host-seeking nymphs or the infection prevalence in the nymphs alone (Mather et al. 1996, Stafford et al. 1998, Pepin et al. 2012, Eisen and Eisen 2016)) Table 2. Summary of tick collection methods that are acceptable or unacceptable for each surveillance objective. Collection Method Objective: Objective: Classifycounty Presence/Prevalence of status pathogens in ticks Objective: DON/DIN Objective: or DOF/DIF Phenology Dragging/Flagging Acceptable Acceptable Acceptable Acceptable Walking Acceptable Acceptable Not Acceptable Acceptable CO2traps Acceptable Acceptable for presence, Not Acceptable Not but not prevalence Ticks collected from deer Acceptable Acceptable for presence, Acceptable Not Acceptable but not prevalence Ticks collected from small- Acceptable or medium-sized mammals, Acceptable for presence, Not Acceptable Not Acceptable Acceptable Not Acceptable Not but not prevalence birds, lizards Ticks from people/pets Acceptable, if Acceptable for presence, travel history is but not prevalence Acceptable accounted for Drag Samplingor Flagging Background and methods Drag sampling and flagging are similar methods used to collect host-seeking lxodes spp. ticks (Daniels and Fish 1990, Carroll and Schmidtmann 1992, Falco and Fish 1992; Talleklint-Eisen and Lane 2000). Both typically use a 1 m wide by 1 m long flannel, denim or other sturdy white fabric with sufficient texture for ticks to grip. To increase contact between the fabric and vegetation, weights (e.g., metal washers or chains) may be sewn into the trailing edge and/o r the trailing edge may be cut into "fingers" or "strips" rather than using a solid cloth. Modified handles (e.g. wooden dowel or rope) may be used to increase maneuverability. For additional details on how to make tick drags, please see the "How to Make Tick Drags" supplemental information. The tick drag or flag is moved horizontally across ••• 9 TX-DSHS-19-1309-A-000063 vegetation or leaf litter {drag) or more vertically {flag). This method of sampling provides good spatial precision fo r documenting the occurrence and/or abundance of ticks in a county. Acceptable to use to address the following • Classifying county status for • Identifying • key surveillance objectives: lxodes pacificus presence and prevalence of pathogens in ticks (all active life stages) Estimating the density of host-seeking (infected) nymphs or females; although either dragging or flagging can be used, horizontal distance sampled should be reported to ArboNET • Documenting host-seeking phenology Walking Sampling Background and methods Walking sampling entails an investigator walking through tick habitat and checking his/her clothing and body for crawling ticks {Carey et al. 1980, Schulze et al. 1986, Lane 1996). The distance walked and the number of ticks encountered per distance should be recorded. Investigators typically wear light-colored clothing to more easily detect ticks on clothing. Long sleeves and long pants, tucked into socks, are required to reduce the risk fo r tick bites. This method of collection may be more accurate for assessing human-tick encounters than drag sampling, flagging or collection from hosts or carbon dioxide baited traps, but more so in areas with emergent vegetation for ticks to ascend than in leaf litter where tick exposures more commonly may be related to human behaviors exposing legs or hands/arms directly to the substrate {e.g., when playing or doing yardwork). Walking sampling generally yield fewer adult/. pacificus compared with dragging {Lane 1996). This method of sampling provides good spatial precision for documenting the occurrence and/or abundance of ticks in a county. Acceptable to use to address the following • Classifying county status for • Identifying • Documenting key surveillance objectives: lxodes pacificus presence and prevalence of pathogens in ticks (all active life stages) host-seeking phenology Carbon Dioxide-Baited Tick Traps Background and methods Carbon dioxide traps work on the premise that ticks have well-developed chemo-receptors and are att racted to carbon dioxide to find a host. Traps consist of a solid base to hold dry ice {a solid form of carbon dioxide) w ithin an insulating material that is surrounded by a sticky tape to capture ticks attracted to the carbon dioxide released as the dry ice sublimates {Wilson et al. 1972). These traps were developed originally for collection of lone star ticks {Amblyomma americanum) which display a more aggressive and mobile host-seeking behavior compared with/. scapularis or/. pacificus. Carbon dioxide traps capture/. scapularis, but appear to be less effective than drag sampling or flagging {Ginsberg and Ewing 1989, Falco and Fish 1992). Carbon dioxide trapping is generally less labor-intensive than several other tick collection methods, but because of its inefficiency at collecting/. scapularis, it is not recommended for assessments of host-seeking densities/. scapularis or/. pacificus. However, this method of sampling provides good spatial precision for documenting the occurrence and/or presence or prevalence of pathogens in a county. •10•• TX-DSHS-19-1309-A-000064 Acceptable to use to address the following • Classifying county status for • Identifying key surveillance objectives: lxodes pacificus presence and prevalence of pathogens in ticks (all active life stages) Tick Collectionfrom Deer Background and methods Columbian black-tailed deer serve as important hosts for adult I. pacificus ticks. Inspection of hunter-killed deer brought into check stations is a cost-effective means of detecting changes in the distribution of I. pacificus, particularly in areas where the tick is emerging. However, owing to the home range of deer, it is spatially nonspecific. Based on studies of closely-related I. scapularis, abundance of ticks on deer may not correlate wel I wit h estimates of host-seeking tick densities obtained from drag sampling {French et al. 1992, Bouchard et al. 2013, Lee et al. 2013, Raizman et al. 2013). Because infection rates derived from blood-fed ticks is not representative of infection rates in host-seeking ticks, we do not recommend assessing infection prevalence in ticks collected from deer to infer infection prevalence in host-seeking ticks. Acceptable to use to address the following • Classifying county status for • Identifying key surveillance objectives: lxodes pacificus presence but not prevalence of pathogens in ticks (all active life stages) Tick Collectionfrom Small- or Medium-Sized Mammals, Birdsand Lizards Background and methods Small- and medium-sized mammals, birds and lizards often serve as hosts of larval and nymphal I. pacificus ticks. Trapping and inspecting these animals for ticks can provide useful information on the presence and abundance of ticks and presence of associated pathogens in the collected ticks, as well as data on host-seeking phenology of immature life stages, in a county of interest. Spatial precision of estimates is associated with the home-range of the target animals, with migratory birds having the greatest home-range and providing low spatial precision in estimating exposure sites to ticks. Host trapping is generally more labor-intensive than drag sampling, however, in areas where/. pacificus immatures are seldom collected on drags, host sampling may be an effective means of demonstrating establishment of I. pacificus populations and documenting host-seeking phenology. Acceptable to use to address the following • Classifying county status for • Identifying • Documenting key surveillance objectives: lxodes pacificus presence but not prevalence of pathogens in ticks (all active life stages) host-seeking phenology TicksFound on People and Pets Background and methods Identification of ticks collected from people or pets can be a useful means of assessing human- or pet-tick encounters. However, because people and their pets often travel long distances, ticks collected from these hosts should only be included in assessments of county status when travel history is considered. Specifically, because ticks can remain ••• 11 TX-DSHS-19-1309-A-000065 attached to a host for 7-10 days, samples obtained from persons or pets who traveled outside the county of residence within 10 days of tick encounter should be excluded. Likewise, records with more than one possible exposure site should not be reported. CDC does not recommend testing ticks from people for human diagnostic purposes . Acceptable to use to address the following key surveillance objectives: • Classifying county status for lxodes pacificus (iftravel history is considered) • Identifying presence but not prevalence of pathogens in ticks (all active life stages; if travel history is considered) Estimating the Density of Host-seeking (Infected) lxodes pacificus Ticks Where to Sample lxodes pacificus is primarily a woodland-associated tick. Therefore, sampling will typically focus on forested or wooded settings, including their edges, and especially along trails. Nymph al ticks are more likely to be found in leaf litter and on substrates such as logs, tree trunks and rocks. Specific sampling sites should focus on areas considered to be a public health concern and might include, but not limited to, the following: • novel areas of potential human exposure to/. pacificus • counties where/. pacificus is newly established • counties (or counties neighboring areas) where incidence of/. pacificus-borne illnesses have changed over time • heavily used recreational areas, including those bordering on neighborhoods • areas where novel pathogens are suspected to be circulating • representative habitat types within counties where/. pacificus-borne infections are prevalent Size of Area to Sample The density of host-seeking nym phal or female ticks varies spatially and tern pora lly. To get a representative sample of the density of host-seeking {infected) nymphs or females, the sampling area should be expansive {spanning at least 750 m of linear transects, or 50 transects of 15 m dragged with a cloth measuring 1 m wide). Distance sampled can be assessed using several methods including: 1) setting fixed sampling grids where flags, stakes or other objects are used to mark the start and end points of each measured length of the transect, 2) using a measu red rope or cable and dragging or flagging its full length, 3) measuring the collectors stride length and walking a fixed number of strides prior to checking the flag or drag, or 4) measuring distance sampled with a global positioning system. Because ticks can drop off from the drag or flag easily, inspecting the cloth at regular intervals is important {typically between 10-20 m; adults detach more readily than nymphs and therefore the drag or flag should be checked minimally every 10-15 m) {Diuk-Wasser et al. 2006, Eisen, Eisen and Lane 2006, Diuk-Wasser et al. 2010, Eisen et al. 2010, Diuk-Wasser et al. 2012, Johnson et al. 2017, Johnson et al. 2018a, Johnson et al. 2018b). Drags/Flags should be checked systematically and all parts of the cloth should be examined, including the leading edge, ropes, and seams. Samplers should also inspect their hands at each check and include any ticks recorded on their person while in the field. Wearing white or other light-colored clothing is recommended to more easily detect ticks on the tick collector . ••• 12 TX-DSHS-19-1309-A-000066 When to Sample • Sampling should be conducted during the perceived peak of nymphal or adult tick activity. This information could be gleaned from previous phenology studies conducted in the region, timing of onset of human Lyme disease cases or data obtained from passive surveillance (submission ofticks from people or pets, etc.). • Sampling each site 3 or more times within the perceived peak of host-seeking activity provides the most accurate density estimates, but this may not always be feasible; sampling twice improves precision over a single sample (Dobson 2013). • Sampling should NOT be conducted when it is raining, when the vegetation is wet enough to saturate the tick drag or when it is unseasonably cold or extremely windy. How Many Sites to Sample Sampling numerous sites per county provides better estimates of spatial variation in the density of host-seeking {infected) ticks within a county. Sampling multiple sites is strongly encouraged, particularly within ecologicallydiverse counties. However, data will be displayed if minimum sampling requirements are met of only a single site per county. How to Estimate Infection Prevalence in Host-SeekingTicks In some situations, particularly where the densities of host-seeking ticks are low, it will not be possible to collect a reasonable sample size for pathogen testing within the defined 750 m sampling area even when combining ticks collected over multiple sampling sessions. In this case, it is recommended to collect additional ticks through drag sampling or flagging in the area surrounding the sampling plot. These ticks should not be included in estimates of nymph al or females densities, but can be included in assessing site-specific estimates of pathogen prevalence. Pathogen detection assays should meet the minimal requirements described above {"Minimum criteria for acceptability of pathogen detection assay"). Pathogen prevalence and 95% confidence intervals can be estimated per tick life stage and per site in Excel using the Pooled Infection Rate Add-In . Inclusion of confidence intervals is recommended in addition to point estimates in order to convey the level of uncertainty in point estimates. Confidence intervals can be interpreted as "there is a 95% probability that the true infection prevalence is between [insert lower confidence limit] and [insert upper confidence limit]." As sample sizes increase, the width of the confidence intervals decrease. Typically testing 50 ticks per site gives reasonable confidence limits. However, the number of ticks that need to be tested is dependent on how infection prevalence estimates will translate to public health action. Pathogen prevalence will not be displayed unless a minimum of 25 /. pacificus ticks of a given life stage have been tested within a given county. NOTE: infection prevalence and confidence intervals will be calculated per site upon submission of data to the ArboN ETTick Madu le {described below: ArboN ET Tick Module). How to Calculatethe Density of Host-Seeking(Infected) Tickswith Confidence IntervaIs • Density of host -seeking nymphs {DON) is estimated as the total number of/. pacificus nymphs collected per total area sampled. DON can be scaled per 100 m 2 by multiplying the total number of/. pacificus nymphs collected per sampling session by 100 m 2, then dividing the product by the total area sampled. • Density of host-seeking infected nymphs {DIN) is estimated by multiplying prevalence{% DON by the local infection ofticks infected or the point estimate derived using the Pooled Infection Rate Add-In ). To ••• 13 TX-DSHS-19-1309-A-000067 include a confidence interval, DON should be multiplied by the lower infection prevalence confidence limit and then by the upper infection prevalence confidence limit. • Density of host-seeking females (DOF) is estimated as the total number of/. pacificus females collected per total area sampled. DOF can be scaled per 100 m 2 by multiplying the total number of/. pacificus females collected per sampling session by 100 m 2, then dividing the product by the total area sampled. • Density of host-seeking infected adults (DIF) is estimated by multiplying DOF by the local infection prevalence(% ofticks infected or the point estimate derived using the Pooled Infection Rate Add-In). To include a confidence interval, DOF should be multiplied by the lower infection prevalence confidence limit and then by the upper infection prevalence confidence limit. DescribingHost-SeekingPhenology of lxodes pacificus Ticks Where to Sample Because/. pacificus is a primarily woodland-associated tick, phenology study sites should be situated in woodlands, ideally in an area where the tick is abundant in order to accurately assess temporal changes in density. Sites with low tick density are susceptible to stochastic variation. Typically, significant differences in host-seeking phenology are not expected over short-distances. Therefore, this labor-intensive sampling should be conducted in strategic locations to identify regional differences in host-seeking phenology, such as in 1-2 sites per State. How to Sample Drag sampling, flagging or collection of ticks from hosts trapped within a fixed area provide suitable samples for documenting when ticks are actively host-seeking. When to Sample Sampling should be conducted at the same site, using the same standardized methods across sampling sess ion. Sites should be sampled weekly or every two weeks to assess either the presence or abundance of ticks collected by life stage per visit. For drag sampling or flagging, ticks should be returned to the transect from which they were collected {non-removal sampling) to avoid artificial depletion of ticks over time in the study area due to intensive sampling. Pathogen Detection RecommendedTick Samplesand Preservationfor Pathogen Testing Pathogen testing in host-seeking, unfed ticks is recommended • Identifying presence and prevalence of pathogens • Calculating DIN and DIF ••• 14 for the following surveillance objectives: TX-DSHS-19-1309-A-000068 Resultsfrom pathogen testing in fed ticks, or from vertebrate host blood or tissue, should be considered with caution because: 1) in some casesticks can acquire pathogens from hosts while feeding and become infected, but not be able to maintain infection through the molt to the next life stage, and 2) infection rates derived from blood-fed ticks or from hosts is not representative of infection rates in host-seeking ticks. Pathogen testing in fed ticks, or from vertebrate host blood or tissue, is acceptable for the following surveillance objectives: • Documenting presence of pathogens in a county Prior to testing, ticks or tissue samples should be preserved in one of the following: • 70-95% ethanol (denatured ethanol should be avoided as it contains additives that may inhibit PCR) • RNALater • Frozen at -80"C without preservatives Minimum Criteria for Acceptability of Pathogen Detection Assay To improve accuracy in estimates of infection prevalence and to enable detection of co-infections, ticks should be tested individually, rather than in pools. However, testing pools of ticks can be useful in some situations, including 1) when prevalence of infection is expected to be very low and testing resources are limited, or 2) when simply noting the presence, rather than prevalence of pathogens is the goal. In order to report that an I. pacificus or pool of I. pacificus is positive for Barrelia burgdarferi s.s., Barre/ia miyamatai, or Anap/asma phagacytaphilum, based on the results of molecular testing of a nucleic acid extract, that testing must include: • A detection assay or assays (e.g., real-time PCRor standard PCR)specific to the target pathogen. To demonstrate that an assay is pathogen species-specific, it should be tested against a panel comprising genetically-similar species, ideally including any genetically-similar species that might also be found inf. pacificus ticks (see the specific considerations for each pathogen below). A published assay that has previously been shown not to detect genetically-similar species meets this requirement. OR • An assay or assays that detect a genus followed by sequencing to identify the pathogen to species orto at least confirm or rule out the target species. If a molecular target sequence is similar to homologous sequences from multiple species such that it is impossible to confirm or rule out the presence of the target species, testing must incorporate sequencing of at least one additional molecular target. In addition to the minimum requirements listed above, we highly recommend using a molecular testing scheme that has been published in a peer-reviewed journal and includes: • Multiple targets for each pathogen. • Established limits of detection for each real-time and/or standard PCRtarget in the presence of tick DNA. If the testing scheme includes a multiplex assay designed to detect multiple pathogens, the limit of detection for each pathogen target should also be confirmed in the presence of more abundant DNA from other pathogens targeted by the same assay. • An internal control (e.g., a segment of the tick actin gene) that can be used to confirm the presence of amplifiable DNA in each specimen. A specimen that does not contain amplifiable DNA should not be included in infection prevalence calculations. See,for example, Graham et al. {2018). •15•• TX-DSHS-19-1309-A-000069 All real-time or standard PCRtesting should include no-template controls and, if possible, negative extraction controls {extracts from DNA-free water or buffer taken through the entire DNA extraction process alongside tick specimens). To limit the risk of contaminating field-collected samples with amplicons from previously processed samples, nucleic acid extraction, PCRreaction set-up, and any work with amplicons {e.g., setting up sequencing reactions) should be conducted in separate work areas, ideally with dedicated pi pets. Important considerations for Borre/ia testing The Borre/ia genus comprises two major clades: a relapsing fever {RF) group and a distinct Borre/ia burgdorferi sensu lato {s.I.) complex. Phylogenetic analyses place B. miyamotoi within the RF group. To date, B. miyamotoi is the only RF group Borre/ia associated with/. pacificus {Barbour 2014). Borrelia miyamotoi is known to cause human disease in the United States {Krause et al. 2015). There are at least 9 recognized {named) species within the B. burgdorferi s.l. complex occurring in the United States {Schotthoefer and Frost 2015, Pritt et al. 2016, Margos et a I. 2017a). At least 5 of those have been detected in fieldcollected /. pacificus: B. burgdorferi s.s., B. americana, B. bissettiae, B. califomiensis, and B. lanei {Margos et al. 2017a, Margos et al. 2016, Fedorova et al. 2014, Rudenko et al. 2009). Notes on nomenclature: • Publications may use "8orrelia burgdorferi" to refer to 8. burgdorferi s.s. and/or 8. burgdorferi s.l. If you are using a published assay that is reported to be 8. burgdorferi-specific, it is important to determine whether it is truly specific to 8. burgdorferi s.s., which causes human disease, orto 8. burgdorferi s.l., which includes a number of species that are not known to cause human disease. • Some have proposed dividing the genus 8orrelia into two genera, with 8orrelia continuing to encompass species in the RF group, and a new genus, 8orreliefla, to encompass species previously included in the 8orrelia burgdorferi s.l. group (Adeolu and Gupta 2014). Investigators continue to debate this proposal (Barbour et al. 2017, Ma rgos et al. 2017b). Those querying databases to identify specimens to species should be aware, however, that 8orreliefla was included in a validation list (no. 163: list of new names and new combinations previously effectively, but not validly, published (Oren and Garrity 2015)), and that 8. burgdorferi s.l. species in the National Center for Biotechnology (NCBI) nucleotide databases may be identified as 8orrelia species or 8orreliefla species. To demonstrate that an assay is 8. miyamotoi specific, it should be tested against at least one B. burgdorferi s.l. species {e.g., B. burgdorferi s.s.). It should also be shown not to detect other RFBorrelia species. To demonstrate that an assay is 8. burgdorferi s.s. specific, it should be tested against a panel including non-target B. burgdorferi s.I. species, ideally including B. americana, B. bissettiae, B. ca/iforniensis, and B. /anei. There are a number of published assays for amplifying and sequencing Borrelia targets to identify Borrelia to species. Assays including nested PCRprotocols are useful for amplifying the often scarce pathogen DNA in ticks. See Wang et al. {2014) for descriptions of and references to several approaches for molecular typing of B. burgdorferi s.l. Note that protocols for PCR-based RFLPcan also be used to generate amplicons for sequencing. Important considerations for Anap/asma phagocytophilum To demonstrate that an assay is specific to A. phagocytophilum, testing at a minimum, sequence analysis using BLASTor a similar database search tool should be used to confirm that primer and probe target sites are not conserved across Anaplasmataceae or Rickettsiaceae, as/. pacificus can harbo r at least one rickettsial endosymbiont, Cryptoplasma ca/ifomiense {a novel Anaplasmataceae Candidatus species) {Eshoo et al. 2015, Rounds et al. 2012), and Ehrlichia ••• 16 TX-DSHS-19-1309-A-000070 chaffeensis, though detection of£. chaffeensis in/. pacificus has been rare and may be highly focal {Lane et al. 2004). Assays should be tested for specificity against Rickettsia and Ehrlichia spp. as well as against other Anap/asma spp., ideally including A. ovis, A. bovis and A. margina/e. Molecular assaysdesigned to detect A. phagocytophilum in I. pacificus may not differentiate A. phagocytophilum strains known to cause disease in humans from strains not known to infect humans {Rejmanek et al. 2012). You should interpret PCR-basedA. phagocytophilum testing results with this in mind. It is possible to differentiate strains by amplifying and sequencing selecttargets including the ank or groESL genes {Rejmanek et al. 2012). This is advisable when reporting an A. phagocytophilum-positive tick from a county that has never reported a human anaplasmosis case and/or has never reported an A. phagoctophilum-positive tick. Samples CDC will Test for Pathogens In support of tick surveillance efforts, CDChas limited resources available to support pathogen detection in I. pacificus ticks submitted by public health partners. Samples will not be accepted for testing from the general public. We offer tick testing for the following pathogens: Borre/ia burgdorferi s.s., Borrelia miyamotoi, and Anap/asma phagocytophilum. By submitting ticks to CDCfor testing, submitters agree to allow CDCto reserve at least 50 µI of the extraction for our reference collection. In Counties Where the Pathogen of Interest has Never Been Identified In counties where Borrelia burgdorferi s.s., Borrelia miyamotoi, or Anaplasma phagocytophilum have not been identified previously in ticks or hosts, CDCwill test the following samples submitted by collaborating public health partners for presence of pathogens: • Host-seeking nymphs (collected from vegetation, walking samples or tick traps); pathogen prevalence will be estimated if sample size is :::25 individuals per site per county. • Host-seeking females (collected from vegetation, walking samples or tick traps); pathogen prevalence will be estimated if sample size is :::25 individuals per site per county. • Ticks collected from hosts; ticks will be tested for pathogen presence only, but prevalence will not be estimated. Blood-fed adults will not be tested due to assays not being optimized for that purpose. In Counties Where the Pathogen of Interest has Been Identified In counties where Borre/ia burgdorferi s.s., Borre/ia mayonii, Borre/ia miyamotoi, Anap/asma phagocytophilum or Babesia microti has been identified previously in ticks or hosts, CDCwill test the following samples submitted by collaborating public health partners for prevalence of pathogens: • Host-seeking nymphs (collected from vegetation, walking samples or tick traps) where :::25 individuals are submitted per site per county. • Host-seeking females (collected from vegetation, walking samples or tick traps) where >25 individuals are submitted per site per county. • In areas where drag sampling/flagging was conducted to assess DIN or DIF, we will test ticks from low density sites, even if the total sample size is less than 25 individuals. Collection of additional ticks from area surrounding the density sampling site should be attempted, but in some cases, collection of 25 individuals will not be feasible. •17•• TX-DSHS-19-1309-A-000071 Limitations to Tick Surveillance • Presence of/. pacificus within a county may be a poor indicator of human disease risk. For example,/. scapufaris has been reported in many counties in the southeastern United States, but Borrefia burgdorferi s.s. infection rates are typically low and nymphs do not commonly ascend vegetation when host-seeking, thus limiting contact between people and nymphs. • Although county estimates ofthe density of host-seeking infected nymphs is a better predictor of human disease occurrence compared with simple measures of tick presence or density of host-seeking nymphs, DIN and DON do not always accurately estimate risk oftick-borne diseases in humans. This may relate to spatial heterogeneity in where ticks are found and where people spend time outdoors, human behaviors that may increase or decrease risk of exposure to infected ticks, or other factors. References Adeolu, M., and R. S. Gupta. 2014. A phylogenomic and molecular marker based proposal for the division of the genus Borrelia into two genera: the emended genus Borrelia containing only the members of the relapsing fever Borrelia, and the genus Borreliel/a gen. nov. containing the members of the Lyme disease Borrelia (Borrelia burgdorferi sensu lato complex). Antonie Van Leeuwenhoek 105: 1049-1072. Barbour, A. G. 2014. Phylogeny of a relapsing fever Borrelia species transmitted by the hard tick lxodes scapularis. Infect. Genet. Evol. 27: 551-558. Barbour, A. G., M. Adeolu, and R. S. Gupta. 2017. Division of the gen us Borrelia into two genera (corresponding to Lyme disease and relapsing fever groups) reflects their genetic and phenotypic distinctiveness and will lead to a better understanding of these two groups of microbes .. Int. J. Syst. Evol. Microbiol. 67: 2058-2067. Bouchard, C., P.A. Leighton, G. Beauchamp, S. Nguen, L. Trudel, F. Milord, L. R. Lindsay, D. Belanger, and N. H. Ogden. 2013. Harvested white-tailed deer as sentinel hosts for early establishing lxodes scapularis populations and risk from vector-borne zoonoses in southeastern Canada. J. Med. Entomol. 50: 384-393. Carey, A. B., W. L. Krinsky, and A. J. Main. 1980. lxodes dam mini (Acari: lxodidae) and associated ixodid ticks in Southcentral Connecticut, USA.J. Med. Entomol. 17: 89-99. Carroll, J. F., and E.T. Schmidtmann. 1992. Tick sweep: modification of the tick drag-flag method for sampling nymphs of the deer tick (Acari: lxodidae). J. Med. Entomol. 29: 352-355. Daniels, T. J., and D. Fish. 1990. Spatial distribution and dispersal of unfed larval lxodes dammini (Acari: lxodidae) in southern New York. Environ. Entomol. 19: 1029-1033. Dennis, D. T., T. S. Nekomoto, J.C. Victor, W. S. Paul, and J. Piesman. 1998. Reported distribution of lxodes scapularis and lxodes pacificus (Acari: lxodidae) in the United States. J. Med. Entomol. 35: 629-638. Diuk-Wasser, M.A., A. G. Gatewood, M. R. Cortinas, S. Yaremych-Hamer, J. Tsao, U. Kitron, G. Hickling, J. S. Brownstein, E. D. Walker, J. Piesman, and D. Fish. 2006. Spatiotemporal patterns of host-seeking lxodes scapularis nymphs (Acari: lxodidae) in the United States.J. Med. Entomol. 43: 166-176. Diuk-Wasser, M.A., G. Vourc'h, P. Cislo, A.G. Hoen, F. Melton, S. Hamer, M. Rowland, R. Cortinas, G. J. Hickling, J. I. Tsao, A.G. Barbour, U. Kitron, J. Piesman, and D. Fish. 2010. Field and climate-based model for predicting the density of host-seeking nymphal lxodes scapularis, an important vector of tick-borne disease agents in the eastern United States. Global Ecol. Biogeogr. 19: 504-514. Diuk-Wasser, M.A., A.G. Hoen, P. Cislo, R. Brinkerhoff, S. A. Hamer, M. Rowland, R. Cortinas, G. Vourc'h, F. Melton, G. J. Hickling, J. I. Tsao, J. Bunikis, A. G. Barbour, U. Kitron, J. Piesman, and D. Fish. 2012. Human risk of infection with Borrelia burgdorferi, the Lyme disease agent, in eastern United States. Am. J. Trop. Med. Hyg. 86: 320-327. Dobson, A. D. 2013. Ticks in the wrong boxes: assessing error in blanket-drag studies due to occasional sampling. Parasit. Vectors 6: 344. Eisen, R.J., L. Eisen, and R.S. Lane. 2006. Predicting density of lxodes pacificus nymphs in dense woodland in Mendocino County, California, based on geographic information systems and remote sensing versus field-derived data. A. J. Trop. Med. Hyg. 74: 632-640. Eisen, R.J., R.S. Lane, C.L. Fritz, and L Eisen. 2006. Spatial patterns of Lyme disease risk in California based on disease incidence and modeling of vector-tick exposure. Am. J. Trop. Med. Hyg. 75: 669-676 . ••• 18 TX-DSHS-19-1309-A-000072 Eisen, R.J., L. Eisen, Y.A. Girard, N. Fedorova, J. Mun, B. Slikas, s. Leonhard, U. Kitron, and R.S. Lane. 2010. A spatially- explicit model of acarologica I risk of exposure to Borrelia burgdorfe ri-infected lxodes pacificus nymphs in northwestern California based on woodland type, temperature, and water vapor. Ticks and Tick-Borne Dis. 1: 3543. Eisen, L., and R. J. Eisen. 2016. Critical evaluation of the linkage between tick-based risk measures and the occurrence of Lyme disease cases. J. Med. Entomol. 53: 1050-1062. Eisen, R. J., L. Eisen, and C. B. Beard. 2016. County-scale distribution of lxodes scapularis and lxodes pacificus (Acari: lxodidae) in the Continental United States. J. Med. Entomol. 53: 349-386. Eshoo, M. W., H. E. Carolan, C. Massire, D. M. Chou, C. D. Crowder, M.A. Rounds, C. A. Phillipson, S. E. Schutzer, D. J. Ecker. 2015. Survey of lxodes pacificusticks in California reveals a diversity of microorganisms and a novel and widespread Ana plasmataceae species. PLos One 10(9): e0135828 .. Falco, R. C., and D. Fish. 1992. A comparison of methods for sampling the deer tick, lxodes dammini, in a Lyme disease endemic area. Exp. Appl. Acarol. 14: 165-173. Fedorova, N., J.E. Kleinjan, D. James, L. T. Hui, H. Peeters, R. S. Lane. 2014. Remarkable diversity of tick or mammalianassociated Borreliae in the metropolitan San Francisco Bay Area, California. Ticks Tick Borne Dis. 5: 951-961. French, J.B., Jr., W. L. Schell, J. J. Kazmierczak, and J.P. Davis. 1992. Changes in population density and distr ibution of lxodes dammini (Acari: lxodidae) in Wisconsin during the 1980s. J. Med. Entomol. 29: 723-728. Furman, D. P. and E. C. Loomis. 1984. The ticks of California. Bull. Cal. Insect Survey 25, University of California Press, 239p. Ginsberg, H. S., and C. P. Ewing.1989. Comparison of flagging, walking, trapping, and collecting from hosts as sampling methods for northern deer ticks, lxodes dammini, and lone-star ticks, Amblyomma americanum (Acari: lxodidae). Exp. Appl. Acarol. 7: 313-322. Graham, C. B., S. E. Maes, A. Hojgaard, A. C. Fleshman, S. W. Sheldon, and R. J. Eisen. 2018. A molecular algorithm to detect and differentiate human pathogens infecting lxodes scapularis and lxodes pacificus (Acari: lxodidae). Ticks Tick Borne Dis. 9: 390-403. Johnson, T. L., C. B. Graham, K. A. Boegler, C. C. Cherry, S. E. Maes, M.A. Pilgard, A. Hojgaard, D. E. Buttke, and R. J. Eisen. 2017. Prevalence and diversity of tick-borne pathogens in nymphal lxodesscapularis (Acari: lxodidae) in eastern national parks. J. Med. Entomol. 54: 742-751. Johnson, T. L., K. A. Boegler, R. J. Clark, M. J. Delorey, J. K. H. Bjork, F. M. Dorr, E. K. Schiffman, D. F. Neitzel, A. J. Monaghan, and R. J. Eisen. 2018a. An acarological risk model predicting the density and ditribution of hostseeking lxodesscapularis nymphs in Minnesota. Am. J. Trap. Med. Hyg. 98: 1671-1682. Johnson, T. L., C. B. Graham, S. E. Maes, A. Hojgaard, A. Fleshman, K. A. Boegler, M. J. Delory, K. S. Slater, S. E. Karpathy, J. K. Bjork, D. F. Neitzel, E. K. Schiffman, and R. J. Eisen. 2018b. Prevalence and distribution of seven human pathogens in host-seeking lxodes scapularis (Acari: lxodidae) nymphs in Minnesota, USA. Ticks Tick Borne Dis. Keesing, F., D. J. McHenry, M. Hersh, M. Tibbetts, J. L Brunner, M. Killilea, K. LoGiudice, K. A. Schmidt, and R. S. Ostfeld. 2014. Prevalence of human-active and variant 1 strains of the tick-borne pathogen Anap/asma phagocytophilum in hosts and forests of eastern North America. Am. J. Trop. Med. Hyg. 91: 302-309. Keirans, J.E. and C.M. Clifford. 1978. The genus lxodes in the United States: A scanning electron microscope study and key to the adults. J. Med. Entomol. Suppl. 2: 1-149. Krause, P. J., D. Fish, S. Narasimhan, and A.G. Barbour. 2015. Borrelia miyamotoi infection in nature and in humans. Clin. Microbial. Infect. 21: 631-639. Kurtti, T. J., R. F. Felsheim, N. Y. Burkhardt, J. D. Oliver, C. C. Heu, and U. G. Munderloh. 2015. Rickettsia buchneri sp. nov., a rickettsia I endosymbiont of the blacklegged tick lxodes scapularis. Int. J. Syst. Evol. Microbial. 65: 965-970. Lane, R.S. 1996. Risk of human exposure to vector ticks (Acari: lxodidae) in a heavily used recreational area in northern California. Am. J. Trap. Med. Hyg. 55: 165-173. Lane, R.S., D. B. Steinlein, and J. Mun. 2004. Human behaviors elevating exposure to lxodes pacificus (Acari: lxodidae) nymphs and their associated bacterial zoonotic agents in a hardwood forest. J. Med. Entomol. 41: 239-248. Lee, X., K. Hardy, D. H. Johnson, and S. M. Paskewitz. 2013. Hunter-killed deer surveillance to assess changes in the prevalence and distribution of lxodes scapularis (Acari: lxodidae) in Wisconsin. J. Med. Entomol. 50: 632-639. MacDonald, A.J. and C.J. Briggs. 2016. Truncated seasonal activity patterns of the western blacklegged tick (lxodes pacificus) in cetnral and southern California. Ticks and Tick-Borne Dis. 7: 234-242. Margos, G., R. S. Lane, N. Fedorova, J. Koloczek, J. Piesman, A. Hojgaard, A. Sing, V. Fingerle. 2016. Borrelia bissettiae sp. nov. and Borrelia californiensis sp. nov. prevail in diverse e nzootic transmission cycles. Int. J. Syst. Evol. Microbial. 66: 1447-1452. Margos, G., N. Fedorova, J. E. Kleinjan, C. Hartberger, T. G. Schwan, A. Sing, and V. Fingerle. 2017a. Borrelia lanei sp. nov. extends the diversity of Borrelia species in California. Int. J. Syst. Evol. Microbial. 67: 3872-3876 . ••• 19 TX-DSHS-19-1309-A-000073 Margos, G., D. Marosevic, 5. Cutler, M. Derdakova, M. Diuk-Wasser, 5. Emler, D. Fish, J. Gray, K. P. Hunfeldt, B. Jaulhac, 0. Kahl, 5. Kovalev, P. Kraiczy, R. 5. Lane, R. Lienhard, P. E. Lindgren, N. Ogden, K. Ornstein, T. Rupprecht, I. Schwartz, A. Sing, R. K. Straubinger, F. Strle, M. Voordouw, A. Rizzoli, B. Stevenson, and V. Fingerle. 2017b. There is inadequate evidence to support the division of the genus Borrelia. Int. J. Syst. Evol. Microbiol. 67: 1081-1084. Mather, T. N., M. C. Nicholson, E. F. Donnelly, and B. T. Matyas. 1996. Entomologic index for human risk of Lyme disease. Am. J. Epidemiol. 144: 1066-1069. Oren, A., and G. M. Garrity. 2015. Notification that new names of prokaryotes, new com bi nations, and new taxonomic opinions have appeared in volume 65, part 3, of the IJSEM.Int. J. Syst. Evol. Microbiol. 65: 1701-1702. Padgett, K.A. and R.S.Lane. 2001. Life cycle of lxodespacificus (Acari: lxodidae): timing of developmental processes under field and laboratory conditions. J. Med. Entomol. 38: 684-693. Pepin, K. M., R. J. Eisen, P. 5. Mead, J. Piesman, D. Fish, A.G. Hoen, A.G. Barbour, 5. Hamer, and M.A. Diuk-Wasser. 2012. Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking lxodes scapularis nymphs in the Eastern United States. Am. J. Trap. Med. Hyg. 86: 1062-1071. Pritt, B. 5., M. E. J. Allerdice, L. M. Sloan, C. D. Paddock, U. G. Munderloh, Y. Rikihisa, T. Tajima, 5. M. Paskewitz, D. F. Neitzel, D. K. Hoang Johnson, E. Schiffman, J. P. Davis, C. 5. Goldsmith, C. M. Nelson, and 5. E. Karpathy. 2017. Proposal to reclassify Ehrlichia muris as Ehrlichia muris subsp. muris subsp. nov. and description of Ehrlichia muris subsp. eauc/airensissubsp. nov., a newly recognized tick-borne pathogen of humans. Int. J. Syst. Evol. Microbiol. 67: 2121-2126. Pritt, B. 5., L.B. Respicio-Kingry, L. M. Sloan, M. E. Schriefer, A. J. Replogle, J. Bjork, G. Liu, L. C. Kingry, P. 5. Mead, D. F. Neitzel, E. Schiffman, D. K. Hoang Johnson, J. P. Davis, 5. M. Paskewitz, D. Boxrud, A. Deedon, X. Lee, T. K. Miller, M.A. Feist, C. R. Steward, E. 5. Theel, R. Patel, C. L Irish, and J. M. Petersen. 2016. Borrelia mayonii sp. nov., a member of the Borrelia burgdorferi sensu lato complex, detected in patients and ticks in the upper midwestern United States. Int. J. Syst. Evol. Microbiol. 66: 4878-4880. Raizman, E. A., J. D. Holland, and J. T. Shukle. 2013. White-tailed deer (Odocoileus virginianus) as a potential sentinel for human Lyme disease in Indiana. Zoonoses Publ. Hlth. 60: 227-233. Rejmanek, D., G. Bradburd, and J. Foley. 2011. Molecular characterization reveals distince genospecies of Anap/asma phagocytophilum from diverse North American hots. J. Med. Microbiol. 61: 2014-212. Rounds, M.A., C. D. Crowder, H. E. Matthews, C. A. Philipson, G. A. Scoles, D. J. Ecker, 5. E. Schutzer, M. W. Eshoo. 2012. Identification of Endosymbionts in Ticks by broad-range polymerase chain reaction and electrospray ionization mass spectrometry. J. Med. Entomol. 49: 843-850. Rudenko, N., M. Golovchenko, T. Lin, L. Gao, L. Grubhoffer, J.H. Oliver. 2009. Delineation of a new species of the Borre/ia burgdorferi sensu lato complex, Borrelia americana sp. nov. J. Clin. Microbial. 47: 3875-3880. Schotthoefer, A. M., and H. M. Frost. 2015. Ecology and epidemiology of Lyme borreliosis. Clin. Lab. Med. 35: 723-743. Schulze, T. L, G. 5. Bowen, M. F. Lakat, W. E. Parkin, and J. K. Shisler. 1986. Seasonal abundance and hosts of lxodes dammini (Acari: lxodidae) and other ixodid ticks from an endemic Lyme disease focus in New Jersey, USA.J. Med. Entomol. 23: 105-109. Stafford, K. C., 3rd, M. L Cartter, L.A. Magnarelli, 5. H. Ertel, and P.A. Mshar. 1998. Temporal correlations between tick abundance and prevalence of ticks infected with Borrelia burgdorferi and increasing incidence of Lyme disease. J. Clin. Microbial. 36: 1240-1244. Stromdahl, E. Y., and G. J. Hickling. 2012. Beyond Lyme: aetiology of tick-borne human diseases with emphasis on the south-eastern United States. Zoonoses Publ. Hlth. 59 Suppl 2: 48-64. Talleklint-Eisen, L. and R.S. Lane. 2000. Efficiency of drag sam piing for estimating population sizes of lxodes pacificus (Acari: lxodidae) nymphs in leaf litter. J. Med. Entomol. 37: 484-487. Wang, G., D. Liveris, P. Mukherjee, 5. Jungnick, G. Margos, and I. Schwartz. 2014. Molecular typ i ng of Borrelia burgdorferi. Curr. Protoc. Microbiol. 34: 12C 15 11-31. Wilson, J. G., D. R. Kinzer, J. R. Sauer, and J. A. Hair. 1972. Chemo-attraction in the lone star tick (Acari na: lxodidae). I. Response of different developmental stages to carbon dioxide administered via traps. J. Med. Entomol. 9: 245-252 . ••• 20 TX-DSHS-19-1309-A-000074 Supplemental Material Avoiding Tick Bites The best way to preventtick-borne diseases is to prevent tick bites. To do so, CDC recommends : While You Are Outdoors • Knowwhere to expect I. pacificus ticks. Adultticks are found on the tips of grasses and shrubs, often along trails. Nymphs are found in leaf litter and on rocks, logs, tree trunks or fallen branches under trees in oak woodlands or other shaded natural areas. Thus, spending time, hiking, camping, or hunting could bring you in contact with ticks seeking a host. Some people may find ticks in their own yard or neighborhood, and get bites while gardening or doing yard work. • Use EnvironmentalProtectionAgency(EPA)-registeredtick repellentscontaining DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE), para-menthane-diol {PMD), or 2-undecanone. EPA's helpful search tool can help you find the product that best suits your needs. Always follow product instructions. • o Do not use repellent on babies younger than 2 months old. o Do not use products containing OLE or PMD on children under 3 years old. Treat clothingand gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings. • • Minimize the risk of contactwith I. pacificus ticks o Avoid wooded and brushy areas with high grass and leaf litter when possible. o Walk in the center of trails. Checkyour clothingfor crawlingticks frequently and remove them before they can attach and blood-feed. After You Come Indoors • Checkyour clothingfor ticks.Ticks may be carried into the house on your clothing. Any ticks that are found should be removed. Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed. If the clothes require washing first, hot water is recommended. • Cold and medium temperature water will not kill ticks. Shower soon after being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tick-borne diseases. Showering ensures that you remove (and then presumably change into clean) clothing and also provides an opportunity to spotticks that were crawling or attached under the clothing. Showering may help wash off unattached ticks and it is a good opportunity to do your daily tick check . ••• 21 TX-DSHS-19-1309-A-000075 • Even if not showering, check your body for ticks after being outdoors. Conduct a fu II body check upon return from potentially tick-infested areas, including your own backyard. Use a hand-held or full-length mirror to view all parts of your body. Tick can attach anywhere on the body, but especially check these parts of your body and your child's body for ticks: 0 Under the arms 0 In and around the ears 0 Inside belly button 0 Back of the knees 0 In and around the hair 0 Between the legs 0 Around the waist WHERE TO CHECK FOR TICKS IN ...N'.) A~O UNC;. IN A \ILJ A~O.J\ILJ THE HAIR ~ ~ THE EA~~ UNDER THE ARMS ~IDETHE SELLYBUTTON ' Ar<<.Y JND THEWAIST BETWEE r-- --THELEGS BACK Or n I[ KNEES • Examine gear and pets. Ticks can be transported into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and daypacks. How to Remove a Tick • Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. • Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth-parts easily with clean tweezers, leave it alone and let the skin heal. • After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. • Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the sink or toilet . ••• 22 TX-DSHS-19-1309-A-000076 e • 0 If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick. How to Make Tick Drags Blanket-StyleDrag Su pp lies 1-1/2 yd. rubberized cotton flannel sheeting, 45" wide 2 - zinc-plated screw eyes, size #12 3 - zinc-plated cut washers, 2" outer diameter, 3/4" inner diameter 1 - length of braided polyester clothesline, 3/16" thick 1 - dowel, 3/4" in diameter, 48" long Heavy-duty thread Heavy-duty sewing machine 20 small lead sinkers, used for weighting fishing lines,¼ oz. size Sewing instructions For each flag: Step 1: Preparing the materials From the rubberized cotton flannel material, cut: a. One (1)- 39.5" x 36" rectangle for the main panel of the tick drag. b. One (1)- 39.5" x 4" strip for the pocket that will hold the washers. Step 2: Sewing the loop far the dowel a. Laying the main panel flat so that it measures 39.5" from left to right, fold the top of the panel down approximately 3" toward the front of the panel and pin or clip in place. (Diagram A) b. Sew along the bottom edge of the fabric, leaving the two sides open to form a "loop" for the dowel. (Diagram B) ••• 23 TX-DSHS-19-1309-A-000077 Step 3 {flat drag): Adding the weights a. Flip the panel over so that the seam from Step 2 is facing down. The panel should still be situated so that the loop is across the top ofthe panel. b. Next, pin or clip the 39.5" x 4" rectangle onto the bottom of the panel so that the long edges align. Sew the two pieces together along the bottom edge, using a generous seam allowance. (Diagram C) c. Flip the panel again so that the seam from Step 2 is again facing up. Turn the 39.5" x 4" strip from Step 3b to the front of the panel and pin or clip in place. (Diagram D) d. Following the diagram, sew the strip in place, adding the three washers as you work. (Diagram E) Step 4: Completing the drag a. Affix one screw eye to each end ofthe dowel, and thread the dowel through the dowel loop from Step 2. b. Measure and cut a length of braided cord, and knot each end through the screw eyes to make the drag handle. The length of cord should be long enough for the front ofthe drag to reach the ground as the collector pulls it along the vegetation. •24•• TX-DSHS-19-1309-A-000078 Sewing diagrams B A -------------------------- (front) (front) D C ------------------------(front) (back) ------------------------- - ------------------------- E . .. 1--11"--I •I (front) - - - ,, - ii- - :! . .. •. ---- .. -, .. " I ••• 25 TX-DSHS-19-1309-A-000079 Modified Drag with "Fingers" Su pp lies 1-1/2 yd. rubberized cotton flannel sheeting, 36" wide 2 - zinc-plated screw eyes, size #12 3 - zinc-plated cut washers, 2" outer diameter, 3/4" inner diameter 1 - length of braided polyester clothesline, 3/16" thick 1 - dowel, 3/4" in diameter, 48" long 20 - small lead sinkers,¼ oz. weight Heavy-duty thread Heavy-duty sewing machine Sewing instructions From the rubberized cotton flannel material, cut: a. One (1)- 39.5" x 23" rectangle for the main panel ofthe tick drag. b. Ten (10) -23" x 2" strips for the fingers that will hold the lead weights. Step 2: Sewing the loop for the dowel a. Laying the main panel flat so that it measures 39.5" from left to right, fold the top of the panel down approximately 3" toward the front of the panel and pin or clip in place. (Diagram A) b. Sew along the bottom edge of the fabric, leaving the two sides open to form a "loop" for the dowel. (Diagram B) Step 3 {finger drag): Adding the weights a. Pin or clip the ten 23" x 2" fabric strips at even distances across the bottom of the rectangular piece so that each one overlaps the larger piece by approximately 1". b. Sew a double line of stitches across all ten fingers, securing them to the back of the drag. (Diagram C) c. Fold approximately 2" ofthe bottom of each strip over and sew along two edges to form a pocket with an open side. (Diagram D) d. Insert two of the lead sinkers into this pocket and continue sewing the third side of the pocket to close. Repeat for all ten fingers. (Diagram D) Step 4: Completing the drag a. Affix one screw eye to each end of the dowel, and thread the dowel through the dowel loop from Step 2. b. Measure and cut a length of braided cord, and knot each end through the screw eyes to make the drag handle. The length of cord should be long enough for the front ofthe drag to reach the ground as the collector pulls it along the vegetation. •26•• TX-DSHS-19-1309-A-000080 Sewing diagrams A B ~------------------------- (front) (front) D C ~------------------------ (front) -• -=- =-=1o-'= - =-or=- .::. - - - =- -=-= - =-= --- -c..::. - 11:..: · ..= - 1:.: . ) - - --- ____ 1-- 1 ---- I o : 0 I 1 I ..... •27•• TX-DSHS-19-1309-A-000081 Surveillance for lxodes scapularis andpathogens found inthistickspecies inthe UnitedStates Table of Contents Contributors and Reviewers .......................................................................................... ..................................................... 4 Intended Audience and Objectives ................................................................................ ..................................................... 4 Public Health Importance of lxodes scapularis ................................................................................................................... Life Cycle of lxodes scapularis ........................................................................................ 5 ..................................................... 8 Tick Surveillance Objectives ................................................................................................................................................ Classify County Status for lxodes scapularis ................................................................................................................. 9 10 Identify Presence and Prevalence of Human Pathogens in lxodes scapularis Ticks ..................................................... 10 Estimate the Density of Host-Seeking {Infected) lxodes scapularis Ticks ..................................................................... 11 Document Host-Seeking Phenology of lxodes scapularis Ticks ........... ........... ............ ............... ...... ............................. 12 Tick Collection Methods ................................................................................................ ................................................... 13 Drag Sampling or Flagging ............................................................................................................................................ Background and methods ...................................................................................... 13 ................................................... 13 Acceptable to use to address the following key surveillance objectives: ................................................................ 14 Walking Sampling ......................................................................................................................................................... Background and methods ...................................................................................... 14 ................................................... 14 Acceptable to use to address the following key surveillance objectives: ................................................................ 14 Carbon Dioxide-Baited Tick Traps ............................................................................. ................................................... 14 Background and methods ...................................................................................... ................................................... 14 Acceptable to use to address the following key surveillance objectives: ................................................................ 15 Tick Collection from Deer .......................................................................................... Background and methods ................................................................................. ................................................... 15 ................................ ...... .................. 15 Acceptable to use to address the following key surveillance objectives: ................................................................ 15 Tick Collection from Small- or Medium-Sized Mammals, Birds and Lizards ................................................................. Background and methods ...................................................................................... 15 ................................................... 15 Acceptable to use to address the following key surveillance objectives: ............................. ...... ............................. 15 Ticks Found on People and Pets ................................................................................................................................... Background and methods ...................................................................................... 16 ................................................... 16 Acceptable to use to address the following key surveillance objectives: ............................. ...... ............................. 16 Estimating the Density of Host-seeking {Infected) lxodes scapularis Ticks ...................................................................... 16 Where to Sampie .......................................................................................................................................................... ••• 1 TX-DSHS-19-1309-A-000082 16 Size of Area to Sample ............................................................................................... ................................................... 16 When to Sample ........................................................................................................................................................... How Many Sites to Sample ........................................................................................ 17 ................................................... 17 How to Estimate Infection Prevalence in Host-SeekingTicks ....................................................................................... 17 How to Calculate the Density of Host-Seeking {Infected) Ticks with Confidence Intervals ......................................... 18 Describing Host-Seeking Phenology of lxodes scapularis Ticks ........................................................................................ Where to Sam pie ................ ....................................................................................... ................................................... 18 How to Sample .............................................................................................................................................................. When to Sample ........................................................................................................ 18 18 ................................................... 18 Pathogen Detection .......................................................................................................................................................... 19 Recommended Tick Samples and Preservation for Pathogen Testing ........... .............................................................. 19 Minimum Criteria for Acceptability of Pathogen Detection Assay ............................................................................... 19 Important considerations for Borre/ia testing ................................. ........... .............................................................. 20 Notes on nomenclature: ........................................................................................................................................... 20 Important considerations for Anaplasma phagocytophilum testing ..................................................... .................. 21 Important considerations for Ehrlichia muris eauc/airensis testing ........... ............................................ .................. 21 Important considerations for Babesia microtitesting ................................ .............................................................. Important considerations for Powassan virus testing .............................................................................................. Samples CDC will Test for Pathogens ............................................................................ 22 22 ................................................... 22 In Counties Where the Pathogen of Interest has Never Been Identified ....... .............................................................. 22 In Counties Where the Pathogen of Interest has Been Identified ....... ........... .............................................................. 23 Limitations to Tick Surveillance ..................................................................................... ........................... ........... ............. 23 References .............................. ....................................................................................... ................................................... 24 Supplemental Material ........... ....................................................................................... ................................................... 28 Avoiding Tick Bites ......................................................................................................... ................................................... 28 While You Are Outdoors ......................... ............ ..................................... ...................................... . ................ .............. 28 After You Come Indoors ............................................................................................ ................................................... 28 How to Remove a Tick ................................................................................................... ................................................... 29 How to Make Tick Drags ..................................................................................... ........... ................................................... 30 Blanket-Style Drag ..................................................................................................... ................................................... 30 Supplies ..................................................................................................................................................................... 30 Sewing instructions ......... ....................................................................................... ................................................... 30 Sewing diagrams .................................................................................................... ................................................... 32 Modified Drag with "Fingers" ....................................................................................................................................... 33 Supplies ..................................................................................................................................................................... 33 ••• 2 TX-DSHS-19-1309-A-000083 Sewing instructions ................................................................................................ ................................................... 33 Sewing diagrams ....................................................................................................................................................... ••• 3 TX-DSHS-19-1309-A-000084 34 Contributors and Reviewers The following Centers for Disease Control and Prevention (CDC)staff members formed the technical development group that prepared or reviewed this report: • Rebecca J. Eisen, Ph.D. (Division of Vector-Borne Diseases-Bacterial Diseases Branch) • Lars Eisen, Ph.D. (Division of Vector-Borne Diseases-Bacterial Diseases Branch) • Christine B. Graham, M.S. (Division of Vector-Borne Diseases-Bacterial Diseases Branch) • Andrias Hojgaard, M.S. (Division of Vector-Borne Diseases-Bacterial Diseases Branch) • Paul S. Mead, M.D., M.P.H. (Division of Vector-Borne Diseases-Bacterial Diseases Branch) • Gil Kersh, Ph.D. (Division of Vector-Borne Diseases-Rickettsial Zoonoses Branch) • Sandor Karpathy, Ph.D. (Division of Vector-Borne Diseases-Rickettsial Zoonoses Branch) • Christopher D. Paddock, M.D., M.S. (Division of Vector-Borne Diseases-Rickettsial Zoonoses Branch) • Harry Savage, Ph.D. (Division of Vector-Borne Diseases-Arboviral Diseases Branch) • Barbara L. Herwaldt, M.D., M.P.H. (Division of Parasitic Diseases and Malaria) • Richard Bradbury, Ph.D. (Division of Parasitic Diseases and Malaria) We are grateful to the following state health partners for their thoughtful review and contributions to this document: • Bryon Backenson, M.S. and Melissa Prusinski, M.S., New York Department of Health • David Neitzel, M.S. and Jenna Bjork D.V.M, M.P.H., Minnesota Department of Health Intended Audience and Objectives Public health entomologists/biologists are the intended audience for this document. The geographic distributions of lxodes scapufaris (the blacklegged tick or deer tick) and its associated pathogens are expanding, putting an increasing number of Americans at risk for acquiring Lyme disease, anaplasmosis, babesiosis, Borrefia miyamotoi disease and other, less common/. scapufaris-associated illnesses. The primary objective of this document is to provide guidance for surveillance of/. scapufaris and pathogens found in this tick species in order to provide health care providers and the public with current and accurate information on where this tick occurs, when the different life stages are most active during the year, and which human pathogens are of greatest local concern. Blacklegged t1ckUxodesscapu/arls) ~¥ Adult Adult female male Nymph Figure 1. Active life stages of the blacklegged tick, lxodes scapufaris . ••• 4 TX-DSHS-19-1309-A-000085 Public Health Importance of lxodes scapularis Of the nearly 50,000 cases of locally-acquired vector-borne disease cases reported annually from states and the District of Columbia to the Centers for Disease Control and Prevention, nearly 95% are caused by pathogens spread by ticks ((Adams et al. 2016); Figure 2). The majority are Lyme disease cases, with approximately 30,000 cases reported annually, which is an approximately 10-fold under-estimate of the nearly 300,000 Lyme disease cases diagnosed annually (Hinckley et al. 2014, Nelson et al. 2015). Since becoming a notifiable condition in 1991, the number of Lyme disease cases reported annually has roughly tripled and cases have been reported over an expanding geographical region (Kugeler et al. 2015, Mead 2015) (Figure 3). •Othoer tickborne diseases (25%1 M,;,:;q1,1 il1r 9r tflea-ibo rn ~ ,;jjg-aR:; (ij% J Lyme dLsease 169¾] Cases of Nationally Notifiable Vector-borne Diseases Reported in t he U.S., 20 14 Figure 2. Reported vector-borne diseases, United States, 2014. ,CJICIQ A,t,(10 ~ _, ICJICIO ~ "-'"'' ~ ? ~tbUblllI .193.1 l!f !l!2 151":9'1 .li'i-4 1!995 19.916 l '-g:l' ia9i8 1!:l!f!l! 2:COOiZ.IIOl ZOIIZ 200.J: ii!IJ04 ZQ05 ZDllli '2IXll ii!llilEI Z~ 2910 21111 20 12 2.a13 20L4 ZDl5 Figure 3. Number of Lyme disease cases reported per year . ••• 5 TX-DSHS-19-1309-A-000086 Since 1970, when Babesia microti was first reported to be a human pathogen, six additional I. scapufaris-borne human pathogens have been described (Eisen and Eisen 2018) (Table 1; Figure 4). Moreover, annual case counts have increased over time for notifiable/. scapufaris-associated diseases, including Lyme disease, anaplasmosis and babesiosis (Eisen et al. 2017). In the northern parts of the tick's range,/. scapufaris nymphs are considered the primary vectors ofthe agents causing Lyme disease, anaplasmosis and babesiosis. Table 1. Pathogens transmitted by lxodes scapufaris, life stages that can be infected, and the human diseases caused by infection with these pathogens. Disease Pathogen(s) Life stages infected Anaplasmosis Anapfasma phagocytophifum Nymphs, Adults Babesiosis Babesia microti Nymphs, Adults Borrefia miyamotoi disease Borrefia miyamotoi Larvae, Nymphs, Adults Ehrlichiosis Ehrfichia muris eaucfairensis Nymphs, Adults Lyme disease Borrefia burgdorferi sensu stricto, Borrefia mayonii Nymphs, Adults Powassan virus disease Powassan virus (lineage II/deer tick lineage) Larvae, Nymphs, Adults lxodes s, ,apularis: an increasingpublic health c,oncern .. • 1-970 I l'ow&Sl!ll!lrllriru! 8ilr.r.e.litl' bu~rfeir 1960 f"Mtt:lt/{JIJWl-1!: 8ol'Tt'fil!'i71l'l'fi'/!ll ~~r ~ict. i11eag,_e) I • , I 2000 ••• :2010 8~ !:is-en, RJ,md Els-en, L. Tr~oos In IIW';YNJ1fJ[OI Paraslrnh:ig.o, 201B. 34!:295-3[]9. Figure 4. Time line showing when various/. scapufaris-borne agents were demonstrated to be human pathogens . ••• 6 TX-DSHS-19-1309-A-000087 Tick surveillance is not standardized or routine. Nonetheless, available collection records indicate that the geographic distribution of/. scapufaris has expanded markedly over the past two decades. Specifically, from 1996 through 2015 the number of counties in which/. scapufaris is considered to be established has more than doubled (Eisen et al. 2016) (Figure 5). Moreover, recent models indicate that potentially suitable habitat for the blacklegged tick is wide-spread in the eastern United States, suggesting that either the distribution of the tick is currently under-reported orthere is potential for additional range expansion (Hahn etal. 2016, 2017) (Figure 6). Reported Distribution of,. scapularis has expanded 2015 1996 ■ Reported: Few-er than 6 individualt icks of a sins:lelife staig,e re~orded in a singl,e.,,ear ■ Esta bllshed ; 6 o,r more ticks or nnor,e than 11 lfe st age recorde-din ai :sing le year Figure 5. Distribution of counties with reported or established populations of I. scapufaris in 1996 (Dennis et al. 1998) and 2015 (Eisen et al. 2016). Distribution of suitable habitat, lxodesscapularis Figure 6. Distribution of potentially suitable habitat for I. scapufaris (Hahn et al. 2016 , 2017) . •••7 TX-DSHS-19-1309-A-000088 Because the distributions ofticks and tick-borne pathogens change over time, human risk of exposure to ticks and their associated pathogens also change. Tick surveillance is intended to monitor changes in the distribution and abundance ofticks and the presence and prevalence of tick-borne pathogens in order to provide actionable, evidence-based information to clinicians, the public and public health policy makers. Key questions address when and where humans are at risk for exposure to ticks and tick-borne pathogens. Life Cycle of lxodes sc apu/aris Adult Adult - . ~ lxodes scapularis (; Yes, "'"'"' 1---io st~se-aKn~• BIOO'J11,'.«tn] Figure 6. Genera Iized life cycle of lxodes scapularis. lxodes scapufaris is a primarily woodland-associated tick. It has a 2-3 year life cycle consisting of four life stages: egg, larva, nymph, and adult (Yuval and Spielman 1990). Larval and nymphal ticks each take a single blood meal before molting to the next life stage and may acquire human pathogens through blood-feeding on infectious hosts or by co-feeding transmission (infected and uninfected ticks feeding in close proximity; pathogen transmission can occur in the absence of a systemic host infection). Larvae and nymphs feed primarily on small and medium-sized mammals including, but not limited to, white-footed mice, chipmunks, voles, and shrews. However, they can also infest birds, lizards and larger mammals including deer. Female ticks take a single blood meal (most commonly from deer but also from other medium-sized and large mammals), lay a large batch of eggs and then die. Male ticks do not blood-feed. With the exception of Powassan virus and the relapsing fever spirochete Borrefia miyamotoi, I. scapufaris-borne human pathogens have not been demonstrated to be transmitted transovarially (vertical transmission from infected females to their offspring) (Castera and Grayson 1996, Rollend et al. 2013). The other/. scapufaris-borne pathogens are maintained via horizontal transmission , where infected nymph al or female ticks transmit the agents to vertebrate hosts, and na"ivelarval or nymph al ticks then acquire pathogens while feeding on the infectious hosts. Adults are active mainly in the fall and spring, but can be active also in the winter months in settings where daytime temperatures are above freezing and there is little to no snow cover, allowing for tick activity. Females ••• 8 TX-DSHS-19-1309-A-000089 typically lay eggs in the late spring but hatched larvae do not seek hosts actively until months later, in summer. After blood-feeding, larvae over-winter and molt to nymphs. Nymphs begin host-seeking in the spring with peak activity typically observed from May through July, depending on location. After blood-feeding, nymphs molt to adults and seek hosts in the fall (Figure 6). In some localities, particularly in colder-regions, the life cycle may be extended to 3-4 years (Hamer et al. 2012a). Tick Surveillance Objectives Tick surveillance is intended to monitor changes in the distribution and abundance ofticks and the presence and prevalence oftickborne pathogens in order to provide actionable, evidence-based information to clinicians, the public and public health policy makers. Key questions address when and where humans are at risk for exposure to ticks and tickborne pathogens. Specifically, at the spatial scale of U.S. counties, CDCaims to: 1) classify county status for I. scapufaris: established, reported, or no data available 2) classify county status for presence of specific pathogens in /. scapufaris ticks: present or no data available Additional objectives include the following: (3) generate estimates for local prevalence of specific pathogens in relevant/. scapufaris life stages and local density of host-seeking (infected) nymphs or adults, which then can be aggregated and displayed at county scale; and (4) document host-seeking phenology of all/. scapufaris life stages in strategic locations across the tick's range and display this information at state or regional spatial scales. For more details on tick sampling methods, please see the "Tick Collection Methods" section of this document. Objective 1 provides the most basic information for risk assessment (i.e., is the tick known to be reported or established in the county of interest?). Presence of a vector tick species does not necessarily indicate presence of human pathogens, and therefore, Objective 2 provides additional information about potential exposure to/. scapufaris-borne human pathogens. While documenting the presence of a human pathogen in a county is useful, estimates of infection prevalence in host-seeking ticks (the percentage of ticks tested that are infected) provides a better indication of the likelihood that ticks encountered by humans may be infected with the pathogen of interest. Tick-borne infections in humans arise following the bite of infected ticks. Therefore, a measure that captures the abundance of host-seeking ticks, often referred to as density of host-seeking nymphs (DON) or females (DOF), provides better information on the likelihood of human encounters than simple measures oftick presence or establishment. That is, although human behavior affects the likelihood of human-tick encounters, assuming similar human behavior across tick habitats, human-tick encounters are likely to increase with increasing DON or DOF. Overall, acarological risk measures such as pursued in Objective 3 that combine the density of host-seeking nymphs and local estimates of infection prevalence (often referred to as the density of host-seeking infected nymphs or DIN) provide better estimates of human encounters with infected host-seeking nymphs than simple measures of tick/pathogen presence or abundance (Mather et al. 1996, Pepin et al. 2012, Eisen and Eisen 2016). Similar arguments can be made for the relative value of estimating infection prevalence in and abundance of female ticks, particularly in areas of the eastern United States where host-seeking behavior of nymphs limits human-tick contact and where human encounters with female ticks are more common than nymphal tick encounters (Stromdahl and Hickling 2012, Arsnoe et al. 2015, Hickling et al. 2018) . ••• 9 TX-DSHS-19-1309-A-000090 Finally, recognizing that acarological risk measures often differ by life stage, documenting when each life stage is actively host-seeking aids in identifying when humans are at greatest risk for exposure to tick bites and tickborne pathogens. Therefore, Objective 4 aims to document host-seeking phenology of larval, nymphal and adult I. scapufaris ticks. Criteria for classifying county establishment status for/. scapufaris and estimating infection prevalence, densities of host-seeking (infected) ticks and documenting host-seeking phenology are summarized below. CDCaims to collate tick surveillance data to make county-level data available to the public on national-scale maps that will be displayed on the CDC website. State health departments and other CDC public health partners may submit data through Arbo NET. For additional information on ArboNET submissions, please see https://wwwn.cdc.gov/arbonet or contact us at ticksurveillance@cdc.gov. Additional information can be found in subsequent sections of this document. Classify County Status for lxodes scapularis • Objective: Update the I. scapularis distribution map based on county level establishment criteria (Dennis et al. 1998). Data will be displayed at: https://www.cdc.gov/ticks/surveillance/ • County status classification criteria are as follows: o Established: 2::61. scapufaris of a single life stage or> 1 life stage collected per county within a 12-month period o o • Reported:< 6 /. scapufaris of a single life stage collected per county within a 12-month period No records For this objective and all others, ticks should be identified to species and life stage using published taxonomic keys (e.g., Keirans and Clifford 1978, Durden and Keirans 1996) • For counties reporting new records, voucher specimens supporting the status change should be archived. • Because we have greater confidence in presence than absence data, after a county is classified as "established," it will remain so and will not regress to "reported" or "no records" status. Counties classified as "reported" may progress to "established" and counties classified as "no records" may progress to "reported" or "established" when criteria for those classifications have been met. After a county is classified as "established" surveillance efforts should focus instead on pathogen presence and prevalence and assessments of acarological risk of human exposure to/. scapufaris-borne pathogens. Identify Presence and Prevalence of Human Pathogens in lxodes scapularis Ticks • Objective: Map the county level distribution of human pathogens in I. scapu/aris ticks or in natural hosts for this tick. Data will be displayed at: https://www.cdc.gov/ticks/surveillance/ • Data to be mapped include: o Shading counties where the/. scapufaris-borne pathogen of interest has been detected in/. scapufaris ticks or in natural hosts of/. scapufaris. This is a simple binary response (pathogen detected or not). Pathogen detection assays must meet minimal assay requirements described in "Minimum Criteria for Acceptability of Pathogen Detection Assay." Samples from which potential exposure could have occurred in other counties will not be included (ticks from people or pets are not acceptable unless travel outside of the county within 10 days prior to detection ofthe tick can be ruled out) but infection in ticks collected from the environment (by dragging, flagging, walking, or trapping) or infection in ticks collected from trapped mammals (provided ••• 10 TX-DSHS-19-1309-A-000091 their home ranges are limited enough to infer exposure occurred in the county of interest) are o acceptable for documenting presence of pathogens in a county. For counties where the pathogen of interest already has been detected in/. scapufaris ticks (this information will be updated annually on https://www.cdc.gov/ticks/surveillance/), pathogen prevalence and 95% confidence intervals can be estimated per relevant tick life stage and per collection site in Excel using the Pooled Infection Rate Add-In. Inclusion of confidence intervals is recommended in addition to point estimates in order to convey the level of uncertainty in point estimates. Confidence intervals can be interpreted as "there is a 95% probability that the true infection prevalence is between [insert lower confidence limit] and [insert upper confidence limit]." As sample sizes increase, the width of the confidence intervals decreases. Typically, testing 50 nymph al or adult ticks per site gives reasonable confidence limits for most I. scapufaris-borne pathogens. For example, when 10 of 50 tested ticks are positive, infection prevalence is estimated as 20% (95%CI: 11-33%). Likewise, if no ticks are infected in a sample of 25 or 50 ticks, infection prevalence could be as high as 13% or 7%, respectively. Although infection prevalence can be calculated for smaller sample sizes, uncertainty in estimates is high; pathogen prevalence will not be displayed unless a minimum of 25 ticks have been tested within a given county for a given life stage. Infection prevalence and associated 95% confidence intervals will be calculated by CDCfor data submitted to ArboNET. Estimate the Density of Host-Seeking (Infected) lxodes scapu/aris Ticks For each of the objectives listed below, when sufficient data have been submitted to Arbo NET,CDCwill post annual surveillance reports at https://www.cdc.gov/ticks/surveillance/. • Objective: Map the county level density of host-seeking I. scapularis nymphs. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking nymphs collected per 100 m2 or displayed as the inverse showing the distance covered before expected encounter ■ ■ ■ ■ • with a nymph. Requires at least 750 m 2 drag sampled per site for density estimate; drags should be inspected forticks at least every 10-20 m; sampling should be timed to coincide with the peak in nymphal host-seeking activity; ideally, estimates of nymphal density should be based on at least 2-3 visits to the site within the perceived seasonal peak in host-seeking (Dobson 2013). For more information on sampling, please see: "Estimating the Density of Host-seeking (Infected) lxodes scapufaris ticks." Requires at least 1 site sampled per county, otherwise county will be displayed as "no records." In ecologically diverse counties, sampling at multiple sites representing the range in suitable habitat for the tick is recommended; when multiple sites are sampled per county, average and range will be accessible. Although timed sampling (e.g., dragging for fixed amounts of time, rather than fixed distances) is a valid sampling approach, in the interest of comparability among localities, we will only accept distance-based assessments of DON and DIN for ArboNET. Objective: Map the county level density of host-seeking infected I. scapularis nymphs. o Data display and minimal sampling requirements include: ••• 11 TX-DSHS-19-1309-A-000092 • Displayed in categories based on number of host-seeking infected nymphs collected per 100 m 2 or displayed as the inverse showing the distance covered before expected encounter with an infected nymph. • • Calculated by multiplying the estimated density of nymphs by infection prevalence (both • described above). When multiple sites are sampled per county, average and range will be accessible. Objective: Map the county level density of host-seeking I. scapu/aris females. o Data display and minimal sampling requirements include: • Displayed in categories based on number of host-seeking females collected per 100 m 2 (DOF) or displayed as the inverse showing the distance covered before expected encounter with a female tick. • Requires at least 750 m 2 drag sampled or flagged per site for density estimate; because adults drop off more readily than nymphs, drags or flags should be inspected for ticks every 10 m; sampling should be timed to coincide with the peak in adult host-seeking activity; ideally, estimates of female density should be based on at least 2-3 visits to the site within the perceived seasonal peak in host-seeking. • • • Requires at least 1 site sampled per county, otherwise county will be displayed as "no records." Sampling at three or more sites per county is recommended; when multiple sites are sampled per county, average and range will be accessible. In ecologically diverse counties, sampling at multiple sites representing the range in suitable habitat for the tick is recommended; when multiple sites are sampled per • • county, average and range will be accessible. Although timed sampling (e.g., dragging forfixed amounts of time, rather than fixed distances) is a valid sampling approach, in the interest of comparability among localities, we will only accept distance-based assessments of DOF and DIF for ArboNET. Objective: Map the county level density of infected host-seeking I. scapu/aris females. o Data display and minimal sampling requirements include: ■ Displayed in categories based on number of host-seeking infected females collected per 100 m 2 or displayed as the inverse showing the distance covered before expected encounter with an infected female tick. ■ Calculated by multiplying the estimated density of females by infection prevalence in ■ tested adult ticks (both described above). When multiple sites are sampled per county, average and range will be accessible Document Host-Seeking Phenology of lxodes scapularis Ticks • Objective: Describe when I. scapu/aris ticks are actively host-seeking (phenology). • Data display and minimal sampling requirements include: o o Displayed as state (or neighboring state) records of tick activity by life stage. This will be a categorical response (records of the tick being active for a particular month ofthe year or not, or no records if phenology studies were not reported from a particular state or its neighbor). Based on weekly, bi-weekly, or monthly non-removal sampling over a 12-month period, excluding winter months too cold for tick activity in colder parts ofthe tick's range. For more information, see "Describing Host-Seeking Phenology of lxodes scapufaris Ticks." ••• 12 TX-DSHS-19-1309-A-000093 Tick Collection Methods Several methods can be used to collect I. scapularis ticks, however, some are better suited than others for addressing specific surveillance objectives (Table 2). For example, all of the methods described below can be used to demonstrate the presence of I. scapularis or I. scapularis-borne pathogens in a county of interest. Demonstrating that both the vector and pathogen are present within a county provides fundamental data for assessing the risk of human encounters with infected ticks. However, for Lyme disease, which is most commonly acquired through the bite of infected nymphs, estimates of the density of Borrelia burgdorferi sensu stricto (s.s.)-infected host-seeking nymphs are a better predictor of human Lyme disease occurrence than simple measures of the presence of the tick or pathogen, or quantitative measures of the density of host-seeking nymphs or the infection prevalence in the nymphs alone (Mather et al. 1996, Stafford et al. 1998, Pepin et al. 2012, Eisen and Eisen 2016)) Drag sampling is the single most reliable method for quantifying the density of host-seeking (infected) I. scapularis nymphs (Falco and Fish 1992). Table 2. Summary of tick collection methods that are acceptable or unacceptable for each surveillance objective. Collection Method Objective: Objective: Objective: DON/DIN Objective: Classify county Presence/Prevalence of or DOF/DIF Phenology status pathogens in ticks Dragging/Flagging Acceptable Acceptable Acceptable Acceptable Walking Acceptable Acceptable Not Acceptable Acceptable CO2 traps Acceptable Acceptable for presence, Not Acceptable but not prevalence Ticks collected from deer Acceptable Acceptable for presence, Not Acceptable but not prevalence Ticks collected from small- Acceptable or medium-sized mammals, Acceptable for presence, Not Acceptable Not Acceptable Not Acceptable Acceptable Not Acceptable Not but not prevalence birds, lizards Ticks from people/pets Acceptable, if Acceptable for presence, travel history is but not prevalence Acceptable accounted for Drag Samplingor Flagging Background and methods Drag sampling and flagging are similar methods used to collect host-seeking ticks (Daniels and Fish 1990, Carroll and Schmidtmann 1992, Falco and Fish 1992). Both typically use a 1 m wide by 1 m long flannel, denim or other sturdy white fabric with sufficient texture for ticks to grip. To increase contact between the fabric and vegetation, weights (e.g., metal washers or chains) may be sewn into the trailing edge and/or the trailing edge may be cut into "fingers" or "strips" rather than using a solid cloth. Modified handles (e.g. wooden dowel or rope) may be used to increase maneuverability. For additional details on how to make tick drags, please see the ••• 13 TX-DSHS-19-1309-A-000094 "How to Make Tick Drags" supplemental information. The tick drag or flag is moved horizontally across vegetation or leaf litter (drag) or more vertically (flag). This method of sampling provides good spatial precision for documenting the occurrence and/or abundance of ticks in a county. Acceptable to use to address the following key surveillance objectives: • • Classifying county status for fxodes scapufaris Identifying presence and prevalence of pathogens in ticks (all active life stages) • Estimating the density of host-seeking (infected) nymphs or females; although either dragging or flagging can be used, horizontal distance sampled should be reported to ArboNET • Documenting host-seeking phenology Walking Sampling Background and methods Walking sampling entails an investigator walking through tick habitat and checking his/her clothing and body for crawling ticks (Carey et al. 1980, Schulze et al. 1986). The distance walked and the number of ticks encountered per distance should be recorded. Investigators typically wear light-colored clothing to more easily detect ticks on clothing. Long sleeves and long pants, tucked into socks, are required to reduce the risk for tick bites. This method of collection may be more accurate for assessing human-tick encounters than drag sampling, flagging or collection from hosts or carbon dioxide baited traps, but more so in areas with emergent vegetation for ticks to ascend than in leaf litter where tick exposures more commonly may be related to human behaviors exposing legs or hands/arms directly to the substrate (e.g., when playing or doing yardwork). Walking sampling is similar in efficiency to flagging or dragging for adult ticks, but apparently yields fewer nymphs than drag sampling or flagging (Ginsberg and Ewing 1989). This method of sampling provides good spatial precision for documenting the occurrence and/or abundance ofticks in a county. Acceptable to use to address the following key surveillance objectives: • Classifying county status for fxodes scapufaris • Identifying presence and prevalence of pathogens in ticks (all active life stages) • Documenting host-seeking phenology Carbon Dioxide-Baited Tick Traps Background and methods Carbon dioxide traps work on the premise that ticks have well-developed chemo-receptors and are attracted to carbon dioxide to find a host. Traps consist of a solid base to hold dry ice (a solid form of carbon dioxide) within an insulating material that is surrounded by a sticky tape to capture ticks attracted to the carbon dioxide released as the dry ice sublimates (Wilson et al. 1972). Developed originally for collection of lone starticks (Ambfyomma americanum) which display a more aggressive and mobile host-seeking behavior compared with I. scapufaris, carbon dioxide traps capture I. scapufaris, but appear to be less effective than drag sampling or flagging (Ginsberg and Ewing 1989, Falco and Fish 1992). Carbon dioxide trapping is generally less laborintensive than several other tick collection methods, but because of its inefficiency at collecting I. scapufaris, it is not recommended for assessments of host-seeking densities for this tick species. However, this method of ••• 14 TX-DSHS-19-1309-A-000095 samplingprovides good spatial precisionfor documenting the occurrenceand/or presenceor prevalence of pathogens in a county. Acceptable to use to address the following key surveillance objectives: • Classifyingcounty statusfor lxodesscapufaris • Identifying presenceand prevalenceof pathogens in ticks (all active life stages) Tick Collectionfrom Deer Background and methods White-tailed deer serve as important hostsfor adult/. scapufaristicks. Inspectionof hunter-killed deer brought into check stations is a cost-effective means of detecting changes in the distribution of/_ scapufaris,particularly in areas where the tick is emerging. However, owing to the home range of deer, it is spatially non-specificand may not correlate well with estimates of host-seekingtick densities obtained from drag sampling (French et al. 1992, Bouchardet al. 2013, Lee et al. 2013, Raizman et al. 2013). Becauseinfection rates derived from bloodfed ticks is not representative of infection rates in host-seekingticks, we do not recommend assessinginfection prevalence in ticks collectedfrom deer to infer infection prevalence in host-seekingticks. Acceptable to use to address the following key surveillance objectives: • Classifyingcounty statusfor lxodesscapufaris • Identifying presence but not prevalence of pathogens in ticks (all active life stages) Tick Collectionfrom Small- or Medium-Sized Mammals, Birdsand Lizards Background and methods Small-and medium-sized mammals, birds and lizardsoften serve as hostsof larval and nymphal /. scapufaris ticks. Trapping and inspectingthese animals for ticks can provide useful information on the presenceand abundance ofticks and presenceof associatedpathogens in the collected ticks, as well as data on host-seeking phenologyof immature life stages, in a county of interest. Spatial precisionof estimates is associatedwith the home-range of the target animals, with migratory birds havingthe greatest home-range and providing low spatial precisionin estimating exposure sitesto ticks. Host trapping is generally more labor-intensivethan drag sampling, however, in areas where/_ scapufarisimmatures are seldom collected on drags, host sampling may be an effective means of demonstrating establishment of/. scapufarispopulationsand documenting host-seeking phenology. Acceptable to use to address the following key surveillance objectives: • Classifyingcounty statusfor lxodesscapufaris • Identifying presence but not prevalence of pathogens in ticks (all active life stages) • Documenting host-seekingphenology ••• 15 TX-DSHS-19-1309-A-000096 TicksFound on People and Pets Background and methods Identification ofticks collected from people or pets can be a useful means of assessing human- or pet-tick encounters. However, because people and their pets often travel long distances, ticks collected from these hosts should only be included in assessments of county status when travel history is considered. Specifically, because ticks can remain attached to a host for 7-10 days, samples obtained from persons or pets who traveled outside the county of residence within 10 d oftick encounter should be excluded. Likewise, records with more than one possible exposure site should not be reported. CDCdoes not recommend testing ticks from people for human diagnostic purposes . Acceptable to use to address the following key surveillance objectives: • Classifying county status for lxodes scapufaris (if travel history is considered) • Identifying presence but not prevalence of pathogens in ticks (all active life stages; iftravel history is considered) Estimating the Density of Host-seeking (Infected) lxodes scapularisTicks Where to Sample lxodes scapufaris is primarily a woodland-associated tick. Therefore, sampling will typically focus on forested or wooded settings, including their edges. Specific sampling sites should focus on areas considered to be a public health concern and might include, but not limited to, the following: • novel areas of potential human exposure to/. scapufaris • counties where/. scapufaris is newly established • counties (or counties neighboring areas) where incidence of/. scapufaris-borne overtime • heavily used recreational areas, including those bordering on neighborhoods • areas where novel pathogens are suspected to be circulating • representative habitat types within counties where/. scapufaris-borne illnesses have changed infections are prevalent Size of Area to Sample The density of host-seeking nymphal or female ticks varies spatially and temporally. To get a representative sample of the density of host-seeking (infected) nymphs or females, the sampling area should be expansive (spanning at least 750 m of linear transects, or 50 transects of 15 m dragged with a cloth measuring 1 m wide). Distance sampled can be assessed using several methods including: 1) setting fixed sampling grids where flags, stakes or other objects are used to mark the start and end points of each measured length of the transect, 2) using a measured rope or cable and dragging or flagging its full length, or 3) measuring the collectors stride length and walking a fixed number of strides prior to checking the flag or drag. Because ticks can drop off from the drag or flag easily, inspecting the cloth at regular intervals is important (typically between 10-20 m; adults detach more readily than nymphs and therefore the drag or flag should be checked minimally every 10-15 m) ••• 16 TX-DSHS-19-1309-A-000097 (Diuk-Wasser et al. 2006, Diuk-Wasser et al. 2010, Diuk-Wasser et al. 2012, Johnson et al. 2017, Johnson et al. 2018a, Johnson et al. 2018b}. Drags/Flags should be checked systematically and all parts of the cloth should be examined, including the leading edge, ropes, and seams. Samplers should also inspect their hands at each cloth check and include any ticks recorded on their person. Wearing white or other light-colored clothing is recommended to more easily detect ticks on the tick collector. When to Sample • Sampling should be conducted during the perceived peak of nymphal or adult tick activity. This information could be gleaned from previous phenology studies conducted in the region, timing of onset of human Lyme disease cases or data obtained from passive surveillance (submission ofticks from people or pets, etc.). • Sampling each site 3 or more times within the perceived peak of host-seeking activity provides the most accurate density estimates, but th is may not always be feasible; sampling twice improves precision over a single sample (Dobson 2013). • Sampling should NOT be conducted when it is raining, when the vegetation is wet enough to saturate the tick drag or when it is unseasonably cold or extremely windy. How Many Sites to Sample Sampling numerous sites per county provides better estimates of spatial variation in the density of host-seeking (infected) ticks within a county. Sampling multiple sites is strongly encouraged, particularly within ecologicallydiverse counties. However, data will be displayed if minimum sampling requirements are met for only a single site per county. How to Estimate Infection Prevalence in Host-SeekingTicks In some situations, particularly where the densities of host-seeking ticks are low, it will not be possible to collect a reasonable sample size for pathogen testing within the defined 750 m2 sampling area even when combining ticks collected over multiple sampling sessions. In this case, it is recommended to collect additional ticks through drag sampling or flagging in the area surrounding the sampling plot. These ticks should not be included in estimates of nymphal orfemales densities, but can be included in assessing site-specific estimates of pathogen prevalence. Pathogen detection assays should meet the minimal requirements described above {"Minimum criteria for acceptability of pathogen detection assay"). Pathogen prevalence and 95% confidence intervals can be estimated per tick life stage and per site in Excel using the Pooled Infection Rate Add-In . Inclusion of confidence intervals is recommended in addition to point estimates in order to convey the level of uncertainty in point estimates. Confidence intervals can be interpreted as "there is a 95% probability that the true infection prevalence is between [insert lower confidence limit] and [insert upper confidence limit]." As sample sizes increase, the width ofthe confidence intervals decreases. Typically testing 50 ticks per site gives reasonable confidence limits. However, the number of ticks that need to be tested is dependent on how infection prevalence estimates will translate to public health action. Pathogen prevalence will not be displayed unless a minimum of 25 /. scapufaris ticks of a given life stage have been tested within a given county. NOTE: infection prevalence and confidence intervals will be calculated per site upon submission of data to the ArboNET Tick Module (described below: ArboNETTick Module) . ••• 17 TX-DSHS-19-1309-A-000098 How to Calculate the Density of Host-Seeking(Infected) Tickswith Confidence IntervaIs • • Density of host-seeking nymphs (DON) is estimated as the total number of/. scapu/aris nymphs collected per total area sampled. DON can be scaled per 100 m 2 by multiplying the total number of/. scapu/aris nymphs collected per sampling session by 100 m2,then dividing the product by the total area sampled. Density of host-seeking infected nymphs (DIN) is estimated by multi plying DON by the local infection prevalence (% ofticks infected or the point estimate derived using the Pooled Infection Rate Add-In ). To include a confidence interval, DON should be multiplied by the lower infection prevalence confidence limit and then by the upper infection prevalence confidence limit. • Density of host-seeking females (DOF) is estimated as the total number of/. scapu/aris females collected per total area sampled. DOF can be scaled per 100 m2 by multiplying the total number of/. scapularis females collected per sampling session by 100 m2, then dividing the product by the total area sampled. • Density of host-seeking infected adults (DIF) is estimated by multiplying DOF by the local infection prevalence(% ofticks infected or the point estimate derived using the Pooled Infection Rate Add-In) . To include a confidence interval, DOF should be multiplied by the lower infection prevalence confidence limit and then by the upper infection prevalence confidence limit. DescribingHost-SeekingPhenology of lxodes scapularisTicks Where to Sample Because/. scapularis is a primarily woodland-associated tick, phenology study sites should be situated in woodlands, ideally in an area where the tick is abundant in order to accurately assesstemporal changes in density. Sites with low tick density are susceptible to stochastic variation. Typically, significant differences in host-seeking phenology are not expected over short-distances. Therefore, this labor-intensive sampling should be conducted in strategic locations to identify regional differences in host-seeking phenology, such as in 1-2 sites per State. How to Sample Drag sampling, flagging or collection of ticks from hosts trapped within a fixed area provide suitable samples for documenting when ticks are actively host-seeking. When to Sample Sampling should be conducted at the same site, using the same standardized methods across sampling session. Sites should be sampled weekly or every two weeks to assess either the presence or abundance of ticks collected by life stage per visit. For drag sampling or flagging, ticks should be returned to the transect from which they were collected (non-removal sampling) to avoid artificial depletion of ticks overtime in the study area due to intensive sampling. •18•• TX-DSHS-19-1309-A-000099 Pathogen Detection RecommendedTick Samplesand Preservationfor PathogenTesting Pathogen testing in host-seeking, unfed ticks is recommended for the following surveillance objectives: • Identifying presence and prevalence of pathogens • Calculating DIN and DIF Results from pathogen testing in fed ticks, or from vertebrate host blood or tissue, should be considered with caution because: 1) in some cases ticks can acquire pathogens from hosts while feeding and become infected, but not be able to maintain infection through the molt to the next life stage, and 2) infection rates derived from blood-fed ticks or from hosts is not representative of infection rates in host-seeking ticks. Pathogen testing in fed ticks, or from vertebrate host blood or tissue, is acceptable for the following surveil lanee objectives: • Documenting presence of pathogens in a county Prior to testing, ticks or tissue samples should be preserved in one of the following: • 70-95% ethanol (denatured ethanol should be avoided as it contains additives that may inhibit PCR) • RNALater • Frozen at -80"C without preservatives Minimum Criteria for Acceptability of Pathogen Detection Assay To improve accuracy in estimates of infection prevalence and to enable detection of co-infections, ticks should be tested individually, rather than in pools. However, testing pools ofticks can be useful in some situations, including 1) when prevalence of infection is expected to be very low and testing resources are limited, or 2) when simply noting the presence, rather than prevalence, of pathogens is the goal. In order to report that an/. scapufaris or pool of/. scapufaris is positive for Borrefia burgdorferi s.s., Borrefia mayonii, Borrefia miyamotoi, Anapfasma phagocytophifum, Babesia microti, Ehrfichia muris eaucfairensis, or Powassan virus based on the results of molecular testing of a nucleic acid extract, that testing must include: • A detection assay or assays (e.g., real-time PCRor standard PCR)specific to the target pathogen. To demonstrate that an assay is pathogen species-specific, it should be tested against a panel comprising genetically-similar species, ideally including any genetically-similar species that might also be found in/. scapufaris ticks (see the specific considerations for each pathogen below). A published assay that has previously been shown not to detect genetically-similar species meets this requirement. OR • An assay or assaysthat detect a genus (bacteria and hemoprotozoan parasites) or family (viruses) followed by sequencing to identify the pathogen to species or to at least confirm or rule out the target species. If a molecular target sequence is similar to homologous sequences from multiple species such that it is impossible to confirm or rule out the presence of the target species, testing must incorporate sequencing of at least one additional molecular target . ••• 19 TX-DSHS-19-1309-A-000100 In addition to the minimum requirements listed above, we highly recommend using a molecular testing scheme that has been published in a peer-reviewed journal and includes: • • • Multiple targets for each pathogen. Established limits of detection for each real-time and/or standard PCRtarget in the presence of tick DNA. If the testing scheme includes a multiplex assay designed to detect multiple pathogens, the limit of detection for each pathogen target should also be confirmed in the presence of more abundant DNA from other pathogens targeted by the same assay. An internal control (e.g., a segment ofthe tick actin gene) that can be used to confirm the presence of amplifiable DNA in each specimen. A specimen that does not contain amplifiable DNA should not be included in infection prevalence calculations. See, for example, Graham et al. (2018). All real-time or standard PCRtesting should include no-template controls and, if possible, negative extraction controls (extracts from DNA-free water or buffer taken through the entire DNA extraction process alongside tick specimens). To limit the risk of contaminating field-collected samples with amplicons from previously processed samples, nucleic acid extraction, PCRreaction set-up, and any work with amplicons (e.g., setting up sequencing reactions) should be conducted in separate work areas, ideally with dedicated pipets. Important considerations for Borre/ia testing The 8orrelia genus comprises two major clades: a relapsing fever (RF)group and a distinct 8orrefia burgdorferi sensu lato (s.l.) complex. Phylogenetic analyses place 8. miyamotoiwithin the RF group. To date, 8. miyamotoi is the only RFgroup 8orrefia associated with/. scapufaris (Barbour 2014). 8orrefia miyamotoi is known to cause human disease in the United States (Krause et al. 2015). There are at least 9 recognized (named) species within the 8. burgdorferis.l. complex occurring in the United States (Schotthoefer and Frost 2015, Pritt et al. 2016, Margos et al. 2017a). At least 4 of those have been detected in field- collected /. scapufaris: 8. burgdorferi s.s., 8. mayonii, 8. kurtenbachii, and 8. andersonii (Margos et a I. 2010, Hamer et al. 2012 b, Eisen et a I. 2017). Of the /. scapufaris-associated 8. burgdorferi s.l. species, only 8. burgdorferi s.s. and 8. mayonii have been culture-confirmed as human pathogens in the United States (Stanek and Reiter 2011, Pritt et al. 2016). Notes on nomenclature: • • Publications may use "8orrelia burgdorferi" to refer to 8. burgdorferi s.s. and/or 8. burgdorferi s.l. If you are using a published assay that is reported to be 8. burgdorferi-specific, it is important to determine whether it is truly specific to 8. burgdorferi s.s., which causes human disease, orto 8. burgdorferi s.l., which includes a number of species that are not known to cause human disease. Some have proposed dividing the genus 8orrefia into two genera, with 8orrefia continuing to encompass species in the RFgroup, and a new genus, 8orrelieffa, to encompass species previously included in the 8orrelia burgdorferi s.l. group (Adeolu and Gupta 2014). Investigators continue to debate this proposal (Barbour et al. 2017, Margos et al. 2017b). Those querying databases to identify specimens to species should be aware, however, that 8orrelieffa was included in a validation list (no. 163: list of new names and new combinations previously effectively, but not validly, published (Oren and Garrity 2015)), and that 8. burgdorferi s.l. species in the National Center for Biotechnology (NCBI) nucleotide databases may be identified as 8orrefia species or 8orrelieffa species. ••• 20 TX-DSHS-19-1309-A-000101 To demonstrate that an assay is 8. miyamotoi specific, it should be tested against at least one 8. burgdorferi s.l. species (e.g., 8. burgdorferi s.s.). Ideally, it should also be shown not to detect other RF8orrefia species. To demonstrate that an assay is 8. burgdorferi s.s. specific, it should be tested against a panel including nontarget 8. burgdorferi s.l. species, ideally including 8. kurtenbachii and 8. andersonii. If you will be testing ticks from the upper Midwestern United States, testing should also demonstrate that the assay does not detect 8. mayonii. To demonstrate that an assay is 8. mayonii specific, it should be tested against a panel that includes 8. burgdorferi s.s. and other non-target 8. burgdorferi s.l. species, ideally including 8. kurtenbachii and 8. andersonii. There are a number of published assaysfor amplifying and sequencing 8orrefia targets to identify 8orrefia to species. Assays including nested PCRprotocols are useful for amplifying the often scarce pathogen DNA in ticks. See (Wang et al. 2014) for descriptions of and references to several approaches for molecular typing of 8. burgdorferi s.l. Note that protocols for PCR-basedRFLPcan also be used to generate amplicons for sequencing. Important considerations for Anaplasma phagocytophilum To demonstrate that an assay is specific to A phagocytophifum, phagocytophilum testing it is important to confirm that A. primer and probe target sites are not conserved across Anaplasmataceae or Rickettsiaceae, as I. scapularis can harbor at least one rickettsial endosymbiont and at least one Ehrlichia species (Kumi et al. 2015, Pritt et al. 2017). Assays should be tested for specificity against Rickettsia and Ehrlichia spp. as well as against other Anaplasma spp., ideally including A. bovis and A marginale. Molecular assays designed to detect A phagocytophifum human-active strain (A phagocytophilum-ha), usually cannot differentiate the A phagocytophilum which causes disease in humans, from other variants that are not known to infect humans, including A. phagocytophifum variant 1 (A phagocytophilum-vl) lxodes scapularis may be infected with either A. phagocytophilum-ha, (Keesing et al. 2014). variant 1, or both, but the relative abundance ofthe two strains can vary dramatically between sites and years (Keesing et al. 2014). The relative abundance of A. phagocytophifum-vl also tends to be higher among female ticks that have fed on deer than among males collected from deer, consistent with findings that white-tailed deer are likely a reservoir for A. phagocytophifum-vl but not for A. phagocytophifum-ha (Courtney et al. 2003). You should interpret PCR-based A. phagocytophilum testing results with this in mind. It is possible to differentiate the two strains by amplifying and sequencing select targets (i.e., the msp4 gene (de la Fuenta et al., 2005), the ank gene (Massung et al. 2007), or a segment of the 16S rRNA gene (Massung et al., 2003). This is advisable when reporting an A phagocytophi/um-positive tick from a county that has never reported a human anaplasmosis case and/or has never reported an A. phagoctophilum ha-positive tick. Important considerations for Ehrlichia muris eauc/airensis testing To demonstrate that an assay is specific to Ehrlichia muris eauclairensis: • At a minimum, BLASTanalysis should be used to confirm that primer and probe target sites are not conserved across Anaplasmataceae or Rickettsiacea e, as /. scapularis can harbor A. phagocytophifum and at least one rickettsial endosymbiont (Kumi et al. 2015). • Ideally, the assay should be tested against a panel including other ehrlichial species as well as Rickettsiales. See, for example, (Alie rd ice et al. 2016) . ••• 21 TX-DSHS-19-1309-A-000102 Important considerations for Babesia microti testing In the United States,/. scapufaris is the vector of the parasite 8. microti, which is the most common etiologic agent of human cases of babesiosis in this country. To date,/. scapufaris has not been established to be the vector of any of the other pathogens that have caused documented U.S. zoonotic cases of babesiosis. However, the tick vectors have not been identified for a II such agents, let a lone for a II of the many other 8abesia species that infect non-human animals and that might be found to have zoonotic potential. lxodes scapufaris may be infected with 8. odocoifei, a parasite of white-tailed deer and other cervids, and Theiferia cervi, another parasite in the same order as Babesia spp. (Prioplasmida) (Steiner et al. 2006, Fritzen et al. 2014). Neither of these has been documented to cause infection in humans. To demonstrate that an assay is B. microti-specific, it should be tested -at a minimum- against 8. odocoifei, and ideally against a panel comprising other 8abesia species as well as T. cervi. Important considerations for Powassan virus testing Powassan virus comprises 2 lineages: Powassan virus (POWV) lineage I, for which lxodes cookei serves as the vector, and Powassan virus lineage 11,or deer tick virus (DTV), for which/. scapufaris serves as the vector (Telford et al. 1997, Kuna et al. 2001). Powassan virus is a positive-sense RNA virus. • • Sample preservation, nucleic acid extraction, and nucleic acid storage requirements for RNA are generally more stringent than those for bacterial or protozoan DNA. If you want to include Powassan virus testing in your tick surveillance plan, you may need to collect and store one set ofticks for DNA testing and a second set for RNA testing. Alternatively, you may optimize your sample preservation, nucleic acid extraction, and nucleic acid storage protocols to allow for both DNA and RNAtesting. In this case, it is important to ensure that your preservation, extraction, and storage procedures do not compromise assay sensitivity to any of your RNA or DNA pathogen targets. PCR-basedassays designed to detect or identify this virus must incorporate a reverse transcription step. Samples CDC will Test for Pathogens In support of tick surveillance efforts, CDC has limited resources available to support pathogen detection in ticks submitted by public health partners. Samples will not be accepted for testing from the general public. We offer tick testing for the following pathogens: 8orrefia burgdorferi s.s., 8orrefia mayonii, 8orrefia miyamotoi, Anapfasma phagocytophifum and 8abesia microti. By submitting ticks to CDCfor testing, submitters agree to allow CDCto reserve at least 50 µI of the extraction for our reference collection. In Counties Where the Pathogen of Interest has Never Been Identified In counties where 8orrefia burgdorferi s.s., 8orrefia mayonii, 8orrefia miyamotoi, Anapfasma phagocytophifum or 8abesia microti have not been identified previously in ticks or hosts, CDCwill test the following samples submitted by collaborating public health partners for presence of pathogens: ••• 22 TX-DSHS-19-1309-A-000103 • Host-seeking nymphs (collected from vegetation, walking samples or tick traps); pathogen prevalence will be estimated if sample size is ?_25individuals per site per county. • Host-seeking females (collected from vegetation, walking samples or tick traps); pathogen prevalence will be estimated if sample size is ?_25individuals per site per county. • Ticks collected from hosts; ticks will be tested for pathogen presence only, but prevalence will not be estimated. Blood-fed adults will not be tested due to assaysnot being optimized for that purpose. In Counties Where the Pathogen of Interest has Been Identified In counties where Borrefia burgdorferi s.s., Borrelia mayonii, Borre Ii a miyamotoi, Anapfasma phagocytophifum or Babesia microti have been identified previously in ticks or hosts, CDCwill test the following samples submitted by collaborating public health partners for prevalence of pathogens: • • Host-seeking nymphs (collected from vegetation, walking samples or tick traps) where _2:25individuals are submitted per site per county. Host-seeking females (collected from vegetation, walking samples or tick traps) where ;::25 individuals are submitted per site per county. • In areas where drag sampling/flagging was conducted to assessDIN or DIF, we will test ticks from low density sites, even if the total sample size is less than 25 individuals. Collection of additional ticks from area surrounding the density sampling site should be attempted, but in some cases, collection of 25 individuals will not be feasible. Limitations to Tick Surveillance • Presence of/. scapufaris within a county may be a poor indicator of human disease risk. For example,/. scapufaris has been reported in many counties in the southeastern United States, but Borrelia burgdorferi s.s. infection rates are typically low and nymphs do not commonly ascend vegetation when host-seeking, thus limiting contact between people and nymphs. • Although county estimates of the density of host-seeking infected nymphs is a better predictor of human disease occurrence compared with simple measures of tick presence or density of host-seeking nymphs, DIN and DON do not always accurately estimate risk of tick-borne diseases in humans. This may relate to spatial heterogeneity in where ticks are found and where people spend time outdoors, human behaviors that may increase or decrease risk of exposure to infected ticks, or other factors . ••• 23 TX-DSHS-19-1309-A-000104 References Adams, D. A., K. R. Thomas, R. Jajosky, P. Sharp, D. Onweh, A. 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Piesman. 1998. Reported distribution of lxodes scapularis and lxodes pacificus (Acari: lxodidae) in the United States. J. Med. Entomol. 35: 629-638. de la Fuente, J. R.F. Massung, S. J. Wong, F.K. Chu, H. Lutz, M. Meli, F. D. Loewenich, A. Grzeszczuk, A. Torina, S. Caracappa, A.J. Mangold, V. Naranjo, S. Stuen, and K. M. Kocan. 2005. Sequence analysis of the msp4 gene of Anap/asma phagocytophilum strains. J. Clin. Microbiol. 43: 1309-1317. Diuk-Wasser, M.A., A. G. Gatewood, M. R. Cortinas, S. Yaremych-Hamer, J. Tsao, U. Kitron, G. Hickling, J. S. Brownstein, E. D. Walker, J. Piesman, and D. Fish. 2006. Spatiotemporal patterns of host-seeking lxodes scapularis nymphs (Acari: lxodidae) in the United States. J. Med. Entomol. 43: 166-176. Diuk-Wasser, M.A., G. Vourc'h, P. Cislo, A.G. Hoen, F. Melton, S. Hamer, M. Rowland, R. Cortinas, G. J. Hickling, J. I. Tsao, A.G. Barbour, U. Kitron, J. Piesman, and D. Fish. 2010. Field and climate-based model for predicting the density of host-seeking nymphal lxodes scapularis, an important vector of tick-borne disease agents in the eastern United States. Global Ecol. Biogeogr. 19: 504-514. Diuk-Wasser, M.A., A. G. Hoen, P. Cislo, R. Brinkerhoff, S. A. Hamer, M. Rowland, R. Cortinas, G. Vourc'h, F. Melton, G. J. Hickling, J. I. Tsao, J. Bunikis, A.G. Barbour, U. Kitron, J. Piesman, and D. Fish. 2012. Human risk of infection with Borrelia burgdorferi, the Lyme disease agent, in eastern United States. Am. J. Trop. Med. Hyg. 86: 320-327. Dobson, A. D. 2013. Ticks in the wrong boxes: assessing error in blanket-drag studies due to occasional sampling. Parasit. Vectors 6: 344. Durden, L.A. and J.E. Keirans. 1996. Nymphs of the genus lxodes (Acari: lxodidae) of the United States: Taxonomy, identification key, distribution, hosts, and medical/veterinary importance. Thomas Say Publications in Entomology: Mongraphs, Entomological Society of America, Lanham, MD, 95p . ••• 24 TX-DSHS-19-1309-A-000105 Eisen, L., and R. J. Eisen. 2016. Critical evaluation of the linkage between tick-based risk measures and the occurrence of Lyme disease cases. J. Med. Entomol. 53: 1050-1062. Eisen, R. J., and L Eisen. 2018. The blacklegged tick, lxodes scapularis: An increasing public health concern. Trends Parasitol. 34: 295-309. Eisen, R. J., L. Eisen, and C. B. Beard. 2016. County-scale distribution of lxodes scapularis and lxodes pacificus (Acari: lxodidae) in the Continental United States. J. Med. Entomol. 53: 349-386. Eisen, R. J., K. J. Kugeler, L. Eisen, C. B. Beard, and C. D. Paddock. 2017. Tick-Borne zoonoses in the United States: Persistent and emerging threats to human health. ILARJ.: 1-17. Falco, R. C., and D. Fish. 1992. A comparison of methods for sampling the deer tick, lxodes dammini, in a Lyme disease endemic area. Exp. Appl. Acarol. 14: 165-173. French, J.B., Jr., W. L Schell, J. J. Kazmierczak, and J.P. Davis. 1992. Changes in population density and distribution of lxodes dammini (Acari: lxodidae) in Wisconsin during the 1980s. J. Med. Entomol. 29: 723-728. Fritzen, C., E. Mosites, R. D. Applegate, S. R. Telford, 3rd, J. Huang, M. J. Yabsley, L. R. Carpenter, J. R. Dunn, and A. C. Moncayo. 2014. Environmental investigation following the first human case of babesiosis in Tennessee. J. Parasitol. 100: 106-109. Ginsberg, H. S., and C. P. Ewing.1989. Comparison of flagging, walking, trapping, and collecting from hosts as sampling methods for northern deer ticks, lxodes dammini, and lone-star ticks, Amblyomma americanum (Acari: lxodidae). Exp. Appl. Acarol. 7: 313-322. Goethert, H.K., and S. R. Telford, 3rd. 2003. Enzootic transmission of Babesia divergens among cottontail rabbits on Nantucket Island, Massachusetts. Am. J. Trop. Med. Hyg. 69: 455-460. Graham, C. B., S. E. Maes, A. Hojgaard, A. C. Fleshman, S. W. Sheldon, and R. J. Eisen. 2018. A molecular algorithm to detect and differentiate human pathogens infecting lxodes scapularis and lxodes pacificus (Acari: lxodidae). Ticks Tick Borne Dis. 9: 390-403. Hahn, M. B., C. s. Jarnevich, A. J. Monaghan, and R. J. Eisen. 2016. Modeling the geographic distribution of lxodes scapularis and lxodes pacificus (Acari: lxodidae) in the contiguous United States. J. Med. Entomol. 53: 1176-1191. Hahn, M. B., C. S. Jarnevich, A. J. Monaghan, and R. J. Eisen. 2017. Response: The geographic distribution of lxodes scapularis (Acari: lxodidae) revisited: The importance of assumptions about error balance. J. Med. Entomol. 54: 1104-1106. Hamer, S. A., G. J. Hickling, J. L. Sidge, E. D. Walker, and J. I. Tsao. 2012a. Synchronous phenology of juvenile lxodes scapularis, vertebrate host relationships, and associated patterns of Borrelia burgdorferi ribotypes in the midwestern United States. Ticks Tick Borne Dis. 3: 65-74. Hamer, S. A., G. J. Hickling, R. Keith, J. L. Sidge, E. D. Walker, and J. I. Tsao. 2012b. Associations of passerine birds, rabbits, and ticks with Borrelia miyamotoi and Borrelia andersonii in Michigan, U.S.A. Parasit. Vectors 5: 231. Herwaldt, B. L., G. de Bruyn, N. J. Pieniazek, M. Homer, K. H. Lofy, s. B. Slemenda, T. R. Fritsche, D. H. Persing, and A. P. Limaye. 2004. Babesia divergens-like infection, Washington State. Emerg. Infect. Dis. 10: 622-629. Hickling, G. J., J. R. Kelly, L. D. Auckland, and S. A. Hamer. 2018. Increasing prevalence of Borrelia burgdorferi sensu strictoinfected blacklegged ticks in Tennessee Valley, Tennessee, USA. Emerg. Infect. Dis. 24: in press. Hinckley, A. F., N. P. Connally, J. I. Meek, B. J. Johnson, M. M. Kemperman, K. A. Feldman, J. L. White, and P. S. Mead. 2014. Lyme disease testing by large commercial laboratories in the United States. Clin. Infect. Dis. 59: 676-681. Johnson, T. L., C. B. Graham, K. A. Boegler, C. C. Cherry, S. E. Maes, M.A. Pilgard, A. Hojgaard, D. E. Buttke, and R. J. Eisen. 2017. Prevalence and diversity of tick-borne pathogens in nymphal lxodesscapularis (Acari: lxodidae) in eastern national parks. J. Med. Entomol. 54: 742-751. Johnson, T. L., K. A. Boegler, R. J. Clark, M. J. Delorey, J. K. H. Bjork, F. M. Dorr, E. K. Schiffman, D. F. Neitzel, A. J. Monaghan, and R. J. Eisen. 2018a. An acarological risk model predicting the density and ditribution of hostseeking lxodesscapularis nymphs in Minnesota. Am. J. Trop. Med. Hyg. 98: 1671-1682. Johnson, T. L., C. B. Graham, S. E. Maes, A. Hojgaard, A. Fleshman, K. A. Boegler, M. J. Delory, K. S. Slater, S. E. Karpathy, J. K. Bjork, D. F. Neitzel, E. K. Schiffman, and R. J. Eisen. 2018b. Prevalence and distribution of seven human pathogens in host-seeking lxodes scapularis (Acari: lxodidae) nymphs in Minnesota, USA.Ticks Tick Borne Dis. Keesing, F., D. J. McHenry, M. Hersh, M. Tibbetts, J. L. Brunner, M. Killilea, K. LoGiudice, K. A. Schmidt, and R. S. Ostfeld. 2014. Prevalence of human-active and variant 1 strains of the tick-borne pathogen Anap/asma phagocytophilum in hosts and forests of eastern North America. Am. J. Trop. Med. Hyg. 91: 302-309. Keirans, J.E. and C.M. Clifford. 1978. The genus lxodes in the United States: A scanning electron microscope study and key to the adults. J. Med. Entomol. Suppl. 2: 1-149. Krause, P. J., D. Fish, s. Narasimhan, and A.G. Barbour. 2015. Borrelia miyamotoi infection in nature and in humans. Clin. Microbiol. Infect. 21: 631-639. •25•• TX-DSHS-19-1309-A-000106 Kugeler, K. J., G. M. Farley, J. D. Forrester, and P. s. Mead. 2015. Geographic distribution and expansion of human Lyme disease, United States. Emerg. Infect. Dis. 21: 1455-1457. Kuno, G., H. Artsob, N. Karabatsos, K. R. Tsuchiya, and G. J. Chang. 2001. Genomic sequencing of deer tick virus and phylogeny of Powassan-related vi ruses of North America. Am. J. Trop. Med. Hyg. 65: 671-676. Kurtti, T. J., R. F. Felsheim, N. Y. Burkhardt, J. D. Oliver, C. C. Heu, and U. G. Munderloh. 2015. Rickettsia buchneri sp. nov., a rickettsial endosymbiont of the blacklegged tick lxodes scapularis. Int. J. Syst. Evol. Microbiol. 65: 965-970. Lee, X., K. Hardy, D. H. Johnson, and S. M. Paskewitz. 2013. Hunter-killed deer su rveii lance to assesschanges in the prevalence and distribution of lxodes scapularis (Acari: lxodidae) in Wisconsin. J. Med. Entomol. 50: 632-639. Margos, G., N. Fedorova, J.E. Kleinjan, C. Hartberger, T. G. Schwan, A. Sing, and V. Fingerle. 2017a. Borrelia lanei sp. nov. extends the diversity of Borrelia species in California. Int. J. Syst. Evol. Microbiol. 67: 3872-3876. Margos, G., A. Hojgaard, R. s. Lane, M. Cornet, V. Fingerle, N. Rudenko, N. Ogden, D. M. Aanensen, D. Fish, and J. Piesman. 2010. Mu ltilocus sequence analysis of Borrelia bissettii strains from North America reveals a new Borrelia species, Borrelia kurtenbachii. Ticks Tick Borne Dis. 1: 151-158. Margos, G., D. Marosevic, S. Cutler, M. Derdakova, M. Diuk-Wasser, S. Emler, D. Fish, J. Gray, K. P. Hunfeldt, B. Jaulhac, 0. Kahl, S. Kovalev, P. Kraiczy, R. S. Lane, R. Lienhard, P. E. Lindgren, N. Ogden, K. Ornstein, T. Rupprecht, I. Schwartz, A. Sing, R. K. Straubinger, F. Strle, M. Voordouw, A. Rizzoli, B. Stevenson, and V. Fingerle. 2017b. There is inadequate evide nee to support the division of the genus Borrelia. Int. J. Syst. Evol. Microbiol. 67: 1081-1084. Massung, R. F., R. A. Priestley, N. J. Miller, T. N. Mather, and M.L. Levin. 2003. Inability of a variant strain of Anap/asma phagocytophilum to infect mice.J. Infect. Dis.188: 1757-1763. Massung, R. F., M. L. Levin, U. G. Munderloh, D. J. Silverman, M. J. Lynch, J. K. Gaywee, and T. J. Kurtti. 2007. Isolation and propapation of the Ap-variant 1 strain of Anap/asma phagocytophilum in a tick cell line. J. Clin. Microbiol. 45: 2138-2143. Mather, T. N., M. C. Nicholson, E. F. Donnelly, and B. T. Matyas. 1996. Entomologic index for human risk of Lyme disease. Am. J. Epidemiol. 144: 1066-1069. Mead, P. S. 2015. Epidemiology of Lyme disease. Infect. Dis. Clin. North Am. 29: 187-210. Nelson, C. A., S. Saha, K. J. Kugeler, M. J. Delorey, M. B. Shankar, A. F. Hinckley, and P. S. Mead. 2015. Incidence of clinician-diagnosed Lyme disease, United States, 2005-2010. Emerg. Infect. Dis. 21: 1625-1631. Oren, A., and G. M. Garrity. 2015. Notification that new names of prokaryotes, new combinations, and new taxonomic opinions have appeared in volume 65, part 3, of the IJSEM. Int. J. Syst. Evol. Microbiol. 65: 1701-1702. Pepin, K. M., R. J. Eisen, P. S. Mead, J. Piesman, D. Fish, A.G. Hoen, A. G. Barbour, S. Hamer, and M. A. Diuk-Wasser. 2012. Geographic variation in the relationship between human Lyme disease incidence and density of infected host-seeking lxodes scapularis nymphs in the Eastern United States. Am. J. Trop. Med. Hyg. 86: 1062-1071. Pritt, B. S., M. E. J. Allerdice, L. M. Sloan, C. D. Paddock, U. G. Munderloh, Y. Rikihisa, T. Tajima, S. M. Paskewitz, D. F. Neitzel, D. K. Hoang Johnson, E. Schiffman, J. P. Davis, C. s. Goldsmith, C. M. Nelson, ands. E. Karpathy. 2017. Proposal to reclassify Ehrlichia muris as Ehrlichia muris subsp. muris subsp. nov. and description of Ehrlichia muris subsp. eauc/airensis subsp. nov., a newly recognized tick-borne pathogen of humans. Int. J. Syst. Evol. Microbiol. 67: 2121-2126. Pritt, B. S., L.B. Respicio-Kingry, L. M. Sloan, M. E. Schriefer, A. J. Replogle, J. Bjork, G. Liu, L. C. Kingry, P. S. Mead, D. F. Neitzel, E. Schiffman, D. K. Hoang Johnson, J. P. Davis, S. M. Paskewitz, D. Boxrud, A. Deedon, X. Lee, T. K. Miller, M.A. Feist, C. R. Steward, E. S. Theel, R. Patel, C. L. Irish, and J. M. Petersen. 2016. Borrelia mayonii sp. nov ., a member of the Borre/ia burgdorferi sensu lato complex, detected in patients and ticks in the upper midwestern United States. Int. J. Syst. Evol. Microbiol. 66: 4878-4880. Raizman, E. A., J. D. Holland, and J. T. Shukle. 2013. White-tailed deer (Odocoileus virginianus) as a potential sentinel for human Lyme disease in Indiana. Zoonoses Publ. Hlth. 60: 227-233. Rollend, L., D. Fish, and J.E. Childs. 2013. Transovarial transmission of Borrelia spirochetes by lxodes scapularis: a summary of the literature and recent observations. Ticks Tick Borne Dis. 4: 46-51. Schotthoefer, A. M., and H. M. Frost. 2015. Ecology and epidemiology of Lyme borreliosis. Clin. Lab. Med. 35: 723-743. Schulze, T. L., G. S. Bowen, M. F. Lakat, W. E. Parkin, and J. K. Shisler. 1986. Seasonal abundance and hosts of lxodes dammini (Acari: lxodidae) and other ixodid ticks from an endemic Lyme disease focus in New Jersey, USA.J. Med. Entomol. 23: 105-109. Stafford, K. C., 3rd, M. L Cartter, L.A. Magnarelli, S. H. Ertel, and P.A. Mshar. 1998. Temporal correlations between tick abundance and prevalence of ticks infected with Borrelia burgdorferi and increasing incidence of Lyme disease. J. Clin. Microbiol. 36: 1240-1244. Stanek, G., and M. Reiter. 2011. The expanding Lyme Borrelia complex--clinical significance of genomic species? Clin. Microbiol. Infect. 17: 487-493. •26•• TX-DSHS-19-1309-A-000107 Steiner, F. E., R. R. Pinger, C. N. Vann, M. J. Abley, B. Sullivan, N. Grindle, K. Clay, and C. Fuqua. 2006. Detection of Anap/asma phagocytophilum and Babesia odocoi/ei DNA in lxodes scapularis (Acari: lxodidae) collected in Indiana. J. Med. Entomol. 43: 437-442. Stromdahl, E. Y., and G. J. Hickling. 2012. Beyond Lyme: aetiology of tick-borne human diseases with emphasis on the south-eastern United States. Zoonoses Publ. Hlth. 59 Suppl 2: 48-64. Telford, S. R., 3rd, P. M. Armstrong, P. Katavolos, I. Foppa, A. S. Garcia, M. L Wilson, and A. Spielman. 1997. A new tickborne encephalitis-like virus infecting New England deer ticks, lxodes dammini. Emerg. Infect. Dis. 3: 165-170. Wang, G., D. Liveris, P. Mukherjee, S. Jungnick, G. Margos, and I. Schwartz. 2014. Molecular typ i ng of Borre/ia burgdorferi. Curr. Protoc. Microbial. 34: 12C 15 11-31. Wilson, J. G., D. R. Kinzer, J. R. Sauer, and J. A. Hair. 1972. Chemo-attraction in the lone star tick (Acari na: lxodidae). I. Response of different developmental stages to carbon dioxide administered via traps. J. Med. Entomol. 9: 245-252. Yuval, B., and A. Spielman. 1990. Duration and regulation of the developmental cycle of lxodes dammini (Acari: lxodidae). J. Med. Entomol. 27: 196-201. ••• 27 TX-DSHS-19-1309-A-000108 Supplemental Material Avoiding Tick Bites The best way to preventtick-borne diseases is to prevent tick bites. To do so, CDC recommends : While You Are Outdoors • Knowwhere to expect I. scapularisticks. Spending time outside playing in the yard, gardening or doing yard work, walking your dog in the neighborhood, camping, or hunting could bring you in contact with ticks seeking a host. Many people get bites by/. scapularis ticks in their own yard or neighborhood, where the ticks occur commonly in wooded portions and along wooded ecotones in yards or greenbelts (shaded, moister microhabitats), but less commonly on open, sunny and drier lawns. • Use EnvironmentalProtectionAgency(EPA)-registeredtick repellentscontaining DEET, picaridin, IR3535, Oil of Lemon Eucalyptus {OLE), para-menthane-diol {PMD), or 2-undecanone. EPA's helpful search tool can help you find the product that best suits your needs. Always follow product instructions. • o Do not use repellent on babies younger than 2 months old. o Do not use products containing OLE or PMD on children under 3 years old. Treat clothingand gear with products containing 0.5% permethrin. Permethrin can be used to treat boots, clothing and camping gear and remain protective through several washings. • • Minimize the risk of contactwith I. scapularisticks o Avoid wooded and brushy areas with high grass and leaf litter when possible. o Walk in the center of trails. Checkyour clothingfor crawlingticks frequently and remove them before they can attach and blood-feed. After You Come Indoors • Checkyour clothingfor ticks.Ticks may be carried into the house on your clothing. Any ticks that are found should be removed. Tumble dry clothes in a dryer on high heat for 10 minutes to kill ticks on dry clothing after you come indoors. If the clothes are damp, additional time may be needed. If the clothes require washing first, hot water is recommended. • Cold and medium temperature water will not kill ticks. Shower soonafter being outdoors. Showering within two hours of coming indoors has been shown to reduce your risk of getting Lyme disease and may be effective in reducing the risk of other tick-borne diseases. Showering ensures that you remove (and then presumably change into clean) clothing and also provides an opportunity to spotticks that were crawling or attached under the clothing. Showering may help wash off unattached ticks and it is a good opportunity to do your daily tick check . ••• 28 TX-DSHS-19-1309-A-000109 • Even if not showering, check your body for ticks after being outdoors. Conduct a f u 11body check upon return from potentially tick-infested areas, including your own backyard. Use a hand-held or full-length mirror to view all parts of your body. Tick can attach anywhere on the body, but especially check these parts of your body and your child's body for ticks: 0 Under the arms 0 In and around the ears 0 Inside belly button 0 Back of the knees 0 In and around the hair 0 Between the legs 0 Around the waist WHERE TO CHECK FOR TICKS IN ...N'.) A~O UNC;. IN A \ILJ A~O.J\ILJ THE HAIR ~ ~ THE EA~~ UNDER THE ARMS ~IDETHE SELLYBUTTON ' Ar<<.Y JND THEWAIST BETWEE r-- --THELEGS BACK Or n I[ KNEES • Examine gear and pets. Ticks can be transported into the home on clothing and pets, then attach to a person later, so carefully examine pets, coats, and daypacks. How to Remove a Tick • Use fine-tipped tweezers to grasp the tick as close to the skin's surface as possible. • Pull upward with steady, even pressure. Don't twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with tweezers. If you are unable to remove the mouth-parts easily with clean tweezers, leave it alone and let the skin heal. • After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. • Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the sink or toilet . ••• 29 TX-DSHS-19-1309-A-000110 e • 0 If you develop a rash or fever within several weeks of removing a tick, see your doctor. Be sure to tell the doctor about your recent tick bite, when the bite occurred, and where you most likely acquired the tick. How to Make Tick Drags Blanket-StyleDrag Supplies 1-1/2 yd. rubberized cotton flannel sheeting, 45" wide 2 - zinc-plated screw eyes, size #12 3 - zinc-plated cut washers, 2" outer diameter, 3/4" inner diameter 1- length of braided polyester clothesline, 3/16" thick 1 - dowel, 3/4" in diameter, 48" long Heavy-duty thread Heavy-duty sewing machine 20 small lead sinkers, used for weighting fishing lines,¼ oz. size Sewing instructions For each flag: Step 1: Preparing the materials From the rubberized cotton flannel material, cut: a. One (1) - 39.5" x 36" rectangle for the main panel of the tick drag. b. One (1) - 39.5" x 4" strip for the pocket that will hold the washers. Step 2: Sewing the loop far the dowel a. Laying the main panel flat so that it measures 39.5" from left to right, fold the top of the panel down approximately 3" toward the front of the panel and pin or clip in place. (Diagram A) b. Sew along the bottom edge of the fabric, leaving the two sides open to form a "loop" for the dowel. (Diagram B) ••• 30 TX-DSHS-19-1309-A-000111 Step 3 {flat drag): Adding the weights a. Flip the panel over so that the seam from Step 2 is facing down. The panel should still be situated so that the loop is across the top ofthe panel. b. Next, pin or clip the 39.5" x 4" rectangle onto the bottom of the panel so that the long edges align. Sew the two pieces together along the bottom edge, using a generous seam allowance. (Diagram C) c. Flip the panel again so that the seam from Step 2 is again facing up. Turn the 39.5" x 4" strip from Step 3b to the front of the panel and pin or clip in place. (Diagram D) d. Following the diagram, sew the strip in place, adding the three washers as you work. (Diagram E) Step 4: Completing the drag a. Affix one screw eye to each end ofthe dowel, and thread the dowel through the dowel loop from Step 2. b. Measure and cut a length of braided cord, and knot each end through the screw eyes to make the drag handle. The length of cord should be long enough for the front of the drag to reach the ground as the collector pulls it along the vegetation. •31•• TX-DSHS-19-1309-A-000112 Sewi ng diagrams B A -------------------------- (front) (front) D C ------------------------(front) (back) ------------------------- - ------------------------- E . .. 1--11"--I •I (front) - - - ,, - ii- - :! . .. •. ---- .. -, .. " I ••32 • TX-DSHS-19-1309-A-000113 Modified Drag with "Fingers" Supplies 1-1/2 yd. rubberized cotton flannel sheeting, 36" wide 2 - zinc-plated screw eyes, size #12 3 - zinc-plated cut washers, 2" outer diameter, 3/4" inner diameter 1 - length of braided polyester clothesline, 3/16" thick 1 - dowel, 3/4" in diameter, 48" long 20 - small lead sinkers,¼ oz. weight Heavy-duty thread Heavy-duty sewing machine Sewing instructions From the rubberized cotton flannel material, cut: a. One (1)-39.5" x 23" rectangle for the main panel ofthe tick drag. b. Ten (10) - 23" x 2" strips for the fingers that will hold the lead weights. Step 2: Sewing the loop for the dowel a. Laying the main panel flat so that it measures 39.5" from left to right, fold the top of the panel down approximately 3" toward the front of the panel and pin or clip in place. (Diagram A) b. Sew along the bottom edge of the fabric, leaving the two sides open to form a "loop" for the dowel. (Diagram B) Step 3 {finger drag): Adding the weights a. Pin or clip the ten 23" x 2" fabric strips at even distances across the bottom of the rectangular piece so that each one overlaps the larger piece by approximately 1". b. Sew a double line of stitches across all ten fingers, securing them to the back ofthe drag. (Diagram C) c. Fold approximately 2" of the bottom of each strip over and sew along two edges to form a pocket with an open side. (Diagram D) d. Insert two of the lead sinkers into this pocket and continue sewing the third side of the pocket to close. Repeat for all ten fingers. (Diagram D) Step 4: Completing the drag a. Affix one screw eye to each end of the dowel, and thread the dowel through the dowel loop from Step 2. b. Measure and cut a length of braided cord, and knot each end through the screw eyes to make the drag handle. The length of cord should be long enough for the front of the drag to reach the ground as the collector pulls it along the vegetation. •33•• TX-DSHS-19-1309-A-000114 Sewi ng diagrams A B ~------------------------- (front) (front) D C ~------------------------ (front) -• -=- =-=1o-'= - =-or=- .::. - - - =- -=-= - =-= --- -c..::. - 11:..: · ..= - 1:.: . ) - - --- ____ 1-- 1 ---- I o : 0 I 1 I ..... •34•• TX-DSHS-19-1309-A-000115 From: Aldridge,Tiffany (DSHS) Sent: Tuesday, November 13, 2018 10:39 AM EST To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) CC: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call Attachment(s): "Evaluation Summary - DIN - 2018.docx","Comments Summary_Survey Monkey_DIN 2017.xls" Nga, I’m sending this to you so you will have it to view during the call for strategy 1.1. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) [mailto:ypg2@cdc.gov] Sent: Tuesday, November 13, 2018 8:35 AM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call Okay – no rush. Thank you! Talk with you all soon. Nga From: Aldridge,Tiffany (DSHS) Sent: Tuesday, November 13, 2018 7:33 AM To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call I found them last night. I am prepping for responses. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) [mailto:ypg2@cdc.gov] Sent: Tuesday, November 13, 2018 8:30 AM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call Great – thank you, Tiffany. I have a few notes and questions for our call later today. You’ll see all of it on the ELC Project Officer Notes section. Thanks! Nga From: Aldridge,Tiffany (DSHS) Sent: Tuesday, November 13, 2018 7:27 AM To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call TX-DSHS-19-1309-A-000116 Good Morning Nga, The report for Texas is marked completed in REDCap. Please let me know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID) [mailto:ypg2@cdc.gov] Sent: Friday, November 9, 2018 1:35 PM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call Great – thanks for the update, Tiffany! Please go ahead and use the comment bubbles if you all have any updates related to the specific activities or milestones. Unfortunately, I was informed by our REDCap team that the programs will be unable to enter our own comments on the strategy pages unless there’s a comment bubble already populated by the grantee. I’ll have some notes and questions populated on the ELC Project Officer Notes page of REDCap. You all will be able to access the questions and keep track of our discussion there after the call as well. Speak with you all soon! Nga From: Aldridge,Tiffany (DSHS) Sent: Friday, November 9, 2018 12:29 PM To: Vuong, Nga (CDC/DDID/NCEZID) Cc: Garcia,Imelda M (DSHS) Subject: RE: TX - CDC ELC M1 Quarterly Check-in Call Hi Nga, We are working to add this information and get it submitted by Monday. The Lab has been working on loading their information and should be close to complete at this point. We will have it completed on Monday. Thank you for checking in with us. Please let us know if you have any questions. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID) [mailto:ypg2@cdc.gov] Sent: Friday, November 9, 2018 1:23 PM To: Aldridge,Tiffany (DSHS) ; Garcia,Imelda M (DSHS) Subject: Re: TX - CDC ELC M1 Quarterly Check-in Call TX-DSHS-19-1309-A-000117 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Tiffany and ImeldaI just wanted to check in with the two of you. I haven’t seen the information on the funding status and the progress status populated in REDCap. Has the team been able to access this? Thank you! We’d need to have this entered prior to our call on Tuesday. Nga From: Vuong, Nga (CDC/DDID/NCEZID) When: November 13, 2018 at 11:00:00 AM EST Required: Sidwa,Tom (DSHS) , Aldridge,Tiffany (DSHS) , Bonny.mayes@dshs.texas.gov , Imelda Garcia – , Simpson, De'Lisa D. (CDC/DDID/NCEZID) Optional: Gamez,Monica (DSHS) , Qualls,Whitney (DSHS) , Fonken,Eric (DSHS) , Thompson,Martha (DSHS) , Robinson,Laura (DSHS) , Newlin,Lisa (DSHS) , Bolling,Bethany (DSHS) , VanCleave,Crystal (DSHS) , Sidwa,Tom (DSHS) Subject: TX - CDC ELC M1 Quarterly Check-in Call Location: Skype Meeting - (855) 348-8390 / 2855050 In preparation for our first quarterly call, I’d like to walk your team through a few steps that should be completed within the REDCap portal for the ELC M1 monitoring tool prior to the call. The REDCap monitoring portal has been populated with your jurisdiction’s strategies and activities for BP5. Within each strategy applicable to your jurisdiction, you’ll notice that the “Activity Name”, “Implementation Plan”, and relevant “Milestones” has been populated. Please complete the following tasks for each applicable section in the monitoring tool: 1. Funding Status – Fully funded / Partially Funded / Not Funded 2. Progress Status – 0% - 100% in quarter intervals a. If this is a year-long activity with projects that are on-going, we’d recommend clicking on the 1%-25% for the first quarter call to report that the activity/milestone is 25% complete. We will continue with the ¼ trend and choose 50% for the quarter 2 call and so on. You’re welcome to add in a comment bubble for activities that require additional explanation. 3. Please use the “comment bubble” located to the left of the implementation plan or milestone box to provide notable updates or comments as well for the respective activity or milestone. You may also see it “highlighted” and populated with a question from CDC to respond to. Our agenda for the call will be as followed: 1. Review the final FFR 2. Discuss goals to spend down remaining funds 3. Address initial needs for redirection of funds or change in scope of activities 4. Review monitoring tool on REDCap and address activities/areas of concerns Please let me know if you have any questions on this REDCap process or if your team would like to add other agenda items. Thank you! Nga Vuong, MAT Public Health Advisor CDC/NCEZID/DVBD/ADB 3156 Rampart Road, MS P-02, Fort Collins, CO 80521 Cubicle Location: 2-305.30 Phone: 970-494-6682 ypg2@cdc.gov ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (970) 221-6403 (Ft. Collins Dial-in Conference Region) (404) 553-8912 (Ft. Collins Dial-in Conference Region) (855) 348-8390 (Ft. Collins Dial-in Conference Region) English (United States) English (United States) English (United States) Find a local number Conference ID: 2855050 Forgot your dial-in PIN? Help TX-DSHS-19-1309-A-000118 [!OC([1033])!] ......................................................................................................................................... *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000119 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 A How would you rate the online registration process? Smooth operation. Very straightforward, thanks! Super easy to use. I had so much difficulty in the registration that I had to call the contacts indicated who actually effected the registration for me. The system was requesting for a discount code which to the best of my knowledg The payment options were a little confusing.  How would you rate your experience at the conference registration desk when checking in? However, they were not able to provide me information on parking. They referred me to the hotel reception desk. Brittany is the BEST!!! Somewhat confusing. It might be helpful if there was signage for the hours when DIN Registration will start or if a brochure with such information is given to participants at Check-In. Registration happened later The staff are always so very pleasant! Brittany and Dan are great! Well organized and easy to get materials The guys checking us in during registration were: engaging, funny, knowledgeable and pleasant; a great group... My nametag did not have a ticket inserted, so I had to go back to the table later on to get a ticket.  How would you rate your experience at the registration desk when obtaining your CE certificate? Usually have to stand in line due to the number of veterinarians at the conference. I didn't get a CE certificate, but I'm sure it was handled very well. Does not apply. Did not take CE Long line. The veterinary certificates took longer at the end of the conference, but it was explained that this was due to having to fulfill requirements from the state board. I am pending a General/Attendance Certificate. Thank you. Not applicable A bit more organization could be added (line formation, something); I realize the location of the desk plays a role in the line formation but I stood in line a good 10 minutes with it not moving before realizing t Efficient and quick. With the rush to depart and the number of CE seakers the people at the table were very efficient.  Did the conference website provide the information you needed about the conference? The conference schedule was posted very late.  The website was very helpful and addressed all pertinent questions. Very helpful. It would be nice to get out information earlier.  How would you rate the printed conference program? It was essentially abstracts.  The agenda list is great.  I think the abstracts could be more professional.  There are at least half that give no useful information and indicate: this will be discussed later...  I am glad the presenters emails are av Very detailed. I really like the one page abstract for each talk in combination with the schedule format for each day. Session highlight figures were awesome. Plenty of room to take notes on each presentation. Loved the program. Great job. Overall, how would you rate the amount and quality of food and beverage provided by the conference? I do not partake.  Very pleased. Best of any conference I have attended. The breakfast buffet did not have a wide variety of options  The breakfasts were well planned and provided a hardy selection. It was nice to have some hot-food options, like the eggs. The assortment of juices and teas were appreciated. The breakfasts on Thursday and Friday seemed smaller. The amount of food was adequate but the quality of food was not consistent or good.   It was great, thank you. If possible, oatmeal at every breakfast would be greatly appreciated. Excellent to keep us going through the day. I am amazed with budget restrictions ( I am sure) what all we are provided.  It is appreciated!!! Important to provide a protein at BKFST and you did- thank you Full breakfasts are stellar whereas continental aren't the best. Wish we could have had another hot breakfast/protien item Thursday and Friday, but stil very good Needed a beef entree for this beefeater.  TX-DSHS-19-1309-A-000120 comments summary 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 A Thank you for providing vegetarian options at the Keynote luncheon and at the breakfast buffets. The meal with the keynote was great, the rest was fair at best.  Wish you all provided snacks on Wednesday as well. It appears the snacks were only on Thursday and Friday. Also, the breakfast eggs were not good, but the muffins were excellent! The Continuing Education (CE) process is complex and determined by the accreditation agencies, rather than the conference organizers. Were the instructions given at the conference regarding the CE process suffi You made it simple and painless. Very well done!! It was beneficial that the CE information was provided and available in a variety of formats (oral announcements, conference program and reoccurring PowerPoint). There was always a reference available to answ I am not there for Continuing Education credits. EXCELLENT!!! Hard to comment as I have yet to receive my CEUs.  Signing in each day was easy once I understood the instructions but I would have liked to have known the process earlier Pam did an excellent job on this. As always. The conference organizers often pass over excellent meeting sites because they do not have a separate space for the keynote lecture and luncheon.  How would you feel about having an evening keynote lecture a I guess it will depend on the location. At the 2017 conference I did not stay as a guest in the hotel and it would have been extremely difficult for me to come back for a dinner/lecture.  I would actually prefer this format rather than in the middle of the conference.  This is a very good idea. It might be helpful, if this was necessary, to push the starting hour back or to end early that day, ie for lunch or just after. Only because of work time and the complexities associated with that... But really I do not care that much I would prefer it stay during business hours and not take away from any after hours time. I had to travel into the conference each day, so a luncheon would be preferred.  It would work fine either way.  The poster session cannot be approved for CE and adds an additional significant expense.  Do you find the poster session is worthwhile? Not sure. I enjoyed the ability to talk to the posters presenters, but I'm not sure I walked away with much more information.  This really gives a lot of students an opportunity to present materials that they have been working on and allows them interactions with professional peers.  I think it is worth the extra expense. I did like it and see its worth. Not really, it is far to rushed using the present system.  It would be much more effective to have a poster session and then leave the posters up for the duration of the meeting so people have a chance to get sp I think it 's a good opportunity for younger scientists to explain their valuable work, and for older people (like me) to see the new work that's being done. I do not feel the poster session was worthwhile primarily due to time restraints; ie. I did not have enough time to talk with each presenter and gather the information each had to offer.  I like the poster presenta I enjoyed speaking with those who had posters, hearing about their projects and experiences. I actually spent quite a lot of time in the poster session just chatting.  The poster session does provide a break from sitting all day.  It also allows for dissemination of additional information, but it isn't necessarily critical to a successful conference.  Perhaps if the poster session is eli I did not attend. This time could be better spent providing additional CEs through presentations. That might also allow for slightly earlier dismissal at the end of the day and/or longer lunch periods while maintaining or increasing  Would it be possible to display the posters in the main conference room for several days with the "session" including presenters on one particular day? Maybe - it depends on the cost to the conference. It is a good break and an excellent opportunity to get newer people involved in zoonotic diseases and DIN. However the quality of the information provide is on The poster session provides something extra that other conferences do not offer. I think it is a special characteristic of the DIN. It is great to be able to speak to the researchers and help network and communicat I think it is a great first step for junior researchers to present their findings. But did not realize the expense.  I could do without the sweets!  Those are extraordinary and I am sure cost a pretty penny.  Could the posters not be seat up along the walls in the main room?  I am sure renti Great opportunity to learn more, plus gives more epis a chance to present.  I find the poster sessions especially worthwhile and would be disappointed if future conferences removed this session from the agenda. Enables some participants opportunity to attend.  Enables some early career individuals to display their work.  Keep it.  Why not CE credit - other conferences do...   Opportunity to network and learn about new initiatives. Not criticizing it.  It is just difficult to visit and each get the story of each, especially when there old friends and are refreshments in the room. I found the posters and discussion very worthwhile and thought serving dessert during and at the session was s stroke of genius.  Though CE may not be offered, it afford a good opportunity for additional disucs The poster session was one of the highlights of the conference for me -- it allowed me time to speak with researchers and other professionals whom I otherwise would likely not have had the chance to meet. It p I think it is good to offer the poster session, but I personally did not take away much from it.   Also, although the desserts were a nice touch, if you want to save money, I recommend choosing less expensive o Yes it adds opportunities for added information exchange & networking.  Neutral YES! Keep it!!! i would rather sacrifice something else, rather than this. My two cents worth.    Overall, how organized was the conference? Everything was superb. Having the moderators be slightly more stringent about questions staying on-topic and useful would be helpful. Excellent organization, thank you for your hard work. Well-oiled machine, thank you!! Eric, Bonny and the crew did a fantastic job! Eric Fonken and Bonnie Mays ran a conference that was punctual, very organized and low key. They should be applauded.  TX-DSHS-19-1309-A-000121 comments summary 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 A Great experience! What do you think are the strong points of the conference? The format. 30 minutes per speaker allows for a better reception from the audience rather than 1 hour speaker that losses its audience after 30-45 minutes into the presentation. The diversity of topics covered, the organization of timing (nothing is too rushed or takes too long). The strongest draw is the ability to pull presenters from many different areas that may not otherwise be accessible to local jurisdictions or to the state of Texas. It is also great to hear speakers whose life-work h Diversity and relevance of topics; excellent organization; welcoming audience. Information presented. the keynote speaker, poster sessions, presentations with strong clinical relevance, public health presentations Variety of topics and speaker backgrounds What do you think are the weak points of the conference? Boring nighttime entertainment in the area around the hotel. I would prefer a downtown location near restaurants, theaters, museums, etc. As a veterinarian in practice, not all the topics were relevant to me. Some of the speakers were obviously new to public speaking. One presenter in particular was talking about a study that he wasn't present on.  I'm not sure there is a weak point though I really like the DINs that emphasis international exchange. I did not find any weak points. The time of year is the weakest point.  There are just to many competing things in late may.  It would be better for both potential speakers and attendees if the conference was done in early June as it had been n/a cant think of anything None, really.  The length of the talks is fine for me, but I think some find them too long. Also, for less engaging presenters, it can be harder to follow and stay interested for the hour talk. Several of the presenters were difficult for me to understand and hear. Too small  I have trouble sitting through more than 3 half hour presentations in a row.  The final day always seems rushed. NA None Hrm...lack of after lunch activity. Maybe a workshop or breakout session would be beneficial. Everyone gets sleepy after lunch and it makes it hard to concentrate. There were lags in assistance when speakers had AV difficulties. The tables were a little tight in the meeting room. All in one room makes it hard to be comfortable The mid-day keynote. None The dual presentation screens. It is difficult to watch the speaker and the speaker during the presentation.   It also promotes the speaker to just present to one part of the audience.   Audience correcting speakers in front of the whole group.  It is unprofessional, and seems to be a select few that continually do this. Sometimes there is a repeat from year to year.  N/A The only complaint (and it's minimal) was the quality of food. It might be difficult to find an open venue for the posters. It might have been helpful if poster boards were oriented perpendicular to the wall rather than parallel. Not applicable It appeared to have turned into the Kristy Murray and sidekick show.  I realize that recruiting a variety of speakers has to be tough. Not enough representation by other disciplines. Sitting in a freezing room, lecture after lecture tires you out, lack of audience interaction None this year None- great job, thank you! The  set up of tables are always to close together. it should be in june not may Session lengths Excessively long break times. Fifteen minutes should be sufficient. Focus on one state only (for the most part). Lack of human healthcare professionals in the audience, a lot of the presentations mentioned engaging human health professionals is key to managing these diseases, wo None n/a Many of the talks are mostly academic, it'd be nice to have a balance with application.  can;t think of any Many of the research presentations were probably not appropriate for the large/diverse audience that was in attendance.  Some presentations seemed repetitive. None. All interesting.  Difficult to hear and understand many speakers.  Several presentations appeared to be presentations of a masters or PhD thesis.  They are full of techniques and charts, many of which had print too small to be s TX-DSHS-19-1309-A-000122 comments summary 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 A More information in the packet would have been better. none No weaknesses Sometimes the breaks seemed really long when speakers presentation were shortened.  (minor points) Lack of breakout sessions. Limited time for the poster session. The weak point of this conference was the location. I have no desire to spend almost a week in Irving.  Some of the presenters did not fully explain their acronyms, making it hard for some of us to follow them.  It was a very nice conference! none to mention with this past conference Would benefit from more outreach earlier in the year I honestly cannot think of a weak point. What changes would you recommend for future conferences? Do not have it scheduled on the last days of school.  Only impacts parents with young children but was an issue.     Also, need a larger room.  Use a hotel that provides free breakfast to guests. Then, only provide snacks in the morning. That should save a lot of money. Let the participants know how they can help. No changes. It is just fine as it is. Arranging to have it in early June rather than late May  (see the above comment). more food! (just kidding) Just make sure to keep the coffee hot and available :) I think I'd like to see more presentations from physicians. Right now the conference is pretty veterinarian-centric. Slightly shorter talks (maybe 45 minutes?) and potentially increasing the diversity of the research groups represented in the talks. There seemed to be a couple of research groups who were over-represented. This conference was very good and I find it hard to make recommendations as to how to improve future conferences. Expanding to allow more attendees  It was very cold in the meeting room but I do not know what can be done about that No I'm grateful for the breakfast, but I also liked the outing options we had in San Antonio. It was a great way to encourage networking outside of breaks or posters. No suggestions for change in the conference. Keep the basic format; it works! Maybe pick a more interesting location. Have breakout sessions An evening keynote and the removal of the poster sessions to accommodate more oral presentations. For research given poster presentations, maybe someone can create a new session of 15 minute talks instead of  None Ask the moderators to not make comments after the talks.  That time should be given for questions from the audience.   Every two years.  N/A More options for breakfast for all days of the event.  Second and third days had no meat and hashbrown.  It might be helpful to request that posters be turned in at the registration desk and then have a team set them up the night before or first thing in the morning day of the presentation. No changes, really like it as it is. Having agenda available sooner. more of a interactive environment, not as cold None cannot think of any Personally, I would like to see more talks on less common zoonoses, more on parasitic/vector-borne diseases, and more on rabies in the future. Talks from more out-of-state individuals/groups would also be a welco If possible, to have a full breakfast every day. There are so many carbs with continental breakfast. Just being mindful of the folks who maybe diabetic or pre-diabetic. month of may sucks I don't know Provide gift bags. Try to engage other states, maybe make the conference more regional, a lot of the topics and main points are applicable to other states as well. Engage human healthcare professionals. An increase in the medical component of the presentations is desirable ie the challenges which zoonotic diseases pose to medical providers (just as veterenarians) n/a Missed opportunity for "no-host" social on Wednesday - what happened ? Conference in a border city and invite Mexican counterparts.   None  Assure a good sound system and a dependable laser pointer.  Also, try to have presentations that are more aimed at a general audiences than ones that focus on statistics and lab techniques. Keep in DFW None.  Excellent conference. TX-DSHS-19-1309-A-000123 comments summary 217 218 219 220 221 222 223 224 225 226 227 228 229 230 A none More snacks throughout the day None  Make it less expensive. I understand that some of the cost is due to the CE credits, but I think that with a tighter budget you could lower the cost, especially for non-vets. Although I like Omni, if you choose a  I liked it as it was. Not much. I think its excellent really.  Different cities... Overall, do you think this conference is a good value? Extremely good value and enabled me to obtain the needed CE hours for licensure requirements. Thanks for all the work that went into making this conference possible! My favorite conference!! Everyone does a great job planning, organizing and executing. Way to go, Zoo!! This conference is a great value. I think it is especially helpful to new Epidemiologists as it helps them network, meet counterparts, and put their new training to practice and into perspective. Thank you for hosti I really liked the conference, but don't think it was worth the hefty $350-400 price tag. Cut off $100, and that would be a very great value. So due to the price, I am also less likely to recommend it to a friend most definitely! Thanks! TX-DSHS-19-1309-A-000124 comments summary A B C CollectorID StartDate 1 RespondentID 2 5.38E+09 97912742 ######## 3 5.38E+09 97912742 ######## 4 5.38E+09 97912742 ######## 5 5.38E+09 97912742 ######## 6 5.38E+09 97912742 ######## 7 5.38E+09 97912742 ######## 8 5.38E+09 97912742 ######## 9 10 5.38E+09 97912742 ######## 11 5.38E+09 97912742 ######## 12 5.38E+09 97912742 ######## 13 5.38E+09 97912742 ######## 14 5.38E+09 97912742 ######## 15 5.38E+09 97912742 ######## 16 5.38E+09 97912742 ######## 17 5.38E+09 97912742 ######## 18 5.38E+09 97912742 ######## 19 5.38E+09 97912742 ######## 20 5.38E+09 97912742 ######## 21 5.38E+09 97912742 ######## 22 5.38E+09 97912742 ######## 23 5.38E+09 97912742 ######## 24 5.38E+09 97912742 ######## 25 5.38E+09 97912742 ######## 26 5.38E+09 97912742 ######## 27 5.38E+09 97912742 ######## 28 5.38E+09 97912742 ######## 29 5.38E+09 97912742 ######## 30 5.38E+09 97912742 ######## 31 5.38E+09 97912742 ######## 32 5.38E+09 97912742 ######## 33 5.38E+09 97912742 ######## 34 5.38E+09 97912742 ######## 35 5.38E+09 97912742 ######## 36 5.38E+09 97912742 ######## 37 5.38E+09 97912742 ######## 38 5.38E+09 97912742 ######## 39 5.38E+09 97912742 ######## 40 5.38E+09 97912742 ######## 41 5.38E+09 97912742 ######## 42 5.38E+09 97912742 ######## 43 5.38E+09 97912742 ######## 44 5.38E+09 97912742 ######## 45 5.38E+09 97912742 ######## 46 5.38E+09 97912742 ######## 47 5.38E+09 97912742 ######## 48 5.37E+09 97912742 ######## 49 5.37E+09 97912742 ######## 50 5.37E+09 97912742 ######## 51 5.37E+09 97912742 ######## 52 5.37E+09 97912742 ######## 53 5.37E+09 97912742 ######## 54 5.37E+09 97912742 ######## D EndDate ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## I E F G H I J K L M N O P Q IP Address Email Address First Name LastName Custom Data How would you rate the online registration process? How would you rate your experience at the conference registration desk wh How would you rate your experience at the registrati Did the conference website pro Response Comments Response Comments Response Comments Response IComment 98.196.162.145 Very Good Very Good Very good All of the information 108.209.1.145 Excellent Excellent Excellent All of the information 76.1.112.51 Excellent Excellent Excellent All of the information 99.57.23.128 Very Good Excellent Excellent All of the information 107.77.221.182 Excellent Excellent Excellent All of the information 151.121.153.20 Very Good Very Good Very good All of the information 50.24.57.165 Excellent Very Good Very good All of the information 67.11.30.50 Very Good Excellent Excellent All of the information 129.130.18.67 Very Good Excellent Very good All of the information 216.139.72.36 Very Good Excellent Good Usually have to stand in line due to the n All of the information 72.183.131.193 Very Good Very Good Very good Most of the information 70.128.162.250 Excellent Smooth operation. Very Good However, they were not able to provide me information on park Very good All of the information 167.137.1.14 Very Good Excellent Excellent All of the information 147.26.87.150 Excellent Excellent n/a All of the information 76.185.153.66 Excellent Excellent Excellent All of the information 160.42.85.9 Excellent Excellent N/A Some of the information 139.232.92.116 Excellent Excellent I didn't get a CE certificate, but I'm sure All of the information 160.42.85.9 Excellent Excellent N/A All of the information 160.42.85.9 Excellent Excellent Excellent All of the information 165.91.24.67 Excellent Excellent Excellent All of the information 160.42.85.9 Very Good Excellent Good All of the information 160.42.85.9 Excellent Excellent Does not apply. Most of the information 128.249.96.26 Excellent Excellent Very good All of the information 50.24.111.72 Excellent Very Good Poor Did not take CE All of the information 128.194.30.22 Excellent Excellent Excellent All of the information 172.58.109.16 Excellent Excellent Excellent All of the information 216.60.33.220 Good Very Good Very good All of the information 161.226.134.140 Excellent Excellent Very good Some of the information IThe conference sch 216.60.33.220 Very Good Excellent N/A All of the information 209.40.169.18 Very Good Very Good Good All of the information 24.149.192.5 Fair Very Good Very good All of the information 160.42.85.9 Excellent Excellent Good Long line. All of the information 71.41.252.94 Good Excellent N/A Most of the information 160.42.85.9 Excellent Excellent Excellent The veterinary certificates took longer at  All of the information 74.124.47.10 Very Good Excellent Very good Some of the information 128.249.96.26 Excellent Excellent Excellent Most of the information 160.42.85.9 Excellent Excellent Excellent All of the information 160.42.85.9 Excellent Excellent All of the information 128.194.28.81 Very Good Excellent Brittany is the BEST!!! Very good All of the information 160.42.85.9 Very Good Excellent Excellent All of the information 160.42.85.9 Very Good Excellent Very good Most of the information 216.194.176.129 Excellent Excellent Excellent All of the information 160.42.85.9 Excellent Excellent N/A Most of the information 71.40.50.202 Excellent Good Somewhat confusing. It might be helpful if there was signage fo Excellent I am pending a General/Attendance Certif All of the information IThe website was ve 128.249.96.26 Excellent Very straightforward, thanks! Excellent Not applicable All of the information 160.42.85.9 Excellent Excellent The staff are always so very pleasant! Very good A bit more organization could be added ( All of the information 160.42.85.9 Very Good Very Good Excellent Most of the information 162.89.0.58 Excellent Excellent Excellent N/A didn't apply for CE Most of the information 160.42.85.9 Excellent Excellent Excellent All of the information 162.89.0.59 Excellent Excellent Excellent All of the information 160.42.85.9 Good N/A N/A All of the information 160.42.85.9 Very Good Very Good Very good I TX-DSHS-19-1309-A-000125 full 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 I I R S T U V W X Y Z AA AB AC How would you rate the printed conference program? Overall, how would you rate the amount and quality of food and beverage provided by the conference? The Continuing Education (CE) process is complex and determined by the accreditation agencies, rather than the conference organizers. Were the instructions given at t The conference organizers often pass over excellent meeting sites because they do not have a separate space for the keynote lecture and luncheo The poster session cannot be approved for CE and adds an additional significant expense.  Do you find the poster session Overall, how organized was the conference? Response Comments Response Comments Response Comments or suggestions Response IComment Response Comments Response IComment Excellent Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Very Good Very Good Yes I would prefer to keep it as a luncheon No Extremely organized Excellent Excellent Yes Neutral Yes  Extremely organized I Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Good It was essentially abstracts.  Good Yes Neutral Not sure. I enjoyed the ability to talk to the posters presenters, but I'm not sure I walked away with much m Very organized I Very Good I do not partake.  Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Excellent Very Good Yes Neutral Yes  Very organized I Very Good Very Good Yes I would prefer to keep it as a luncheon No Extremely organized Very Good Excellent Yes I would prefer to keep it as a luncheon Yes  Very organized Fair The agenda list is great.  I think the abstracts could be more professional.  There are at least half that give no useful information and indicate: this will be discussed later...  I am glad the presenters em Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  This really gives a lot of students an opportunity to present materials that they have been working on and allo Very organized Very Good Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Very organized Excellent Very detailed. Excellent Very pleased. Best of any conference I have attended. Yes You made it simple and painless. I would prefer to keep it as a luncheon Yes  I did like it and see its worth. Extremely organized II guess it will depend on the location. At the 2017 conference I did not stay as a guest in the hotel and it would have been extreme IEverything was superb. Excellent Excellent Yes Very well done!! I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Not really, it is far to rushed using the present system.  It would be much more effective to have a poster se Very organized II would actually prefer this format rather than in the middle of the conference.  This is a very good idea. Excellent n/a I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would prefer to keep it as a luncheon Yes  Extremely organized Good Good N/A Neutral No Very organized I Excellent Excellent No I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  I think it 's a good opportunity for younger scientists to explain their valuable work, and for older people (lik Extremely organized Excellent I really like the one page abstract for each talk in combination with the schedule format for each day. Very Good N/A Neutral Yes  Very organized I IHaving the moderators be slightly more stringent about questions staying on-topic and u Excellent Excellent Yes I would prefer to keep it as a luncheon No I do not feel the poster session was worthwhile primarily due to time restraints; ie. I did not have enough tim Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Very Good Neutral Very organized I Excellent Excellent Does not apply. I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  I enjoyed speaking with those who had posters, hearing about their projects and experiences. I actually spent q Extremely organized Excellent Excellent Yes Yes  Very organized I Excellent Good No No CE taken I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  The poster session does provide a break from sitting all day.  It also allows for dissemination of additional info Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Very Good Very Good Yes I would prefer to keep it as a luncheon No Very organized Very Good Fair The breakfast buffet did not have a wide variety of options  Yes I would prefer to keep it as a luncheon Yes  Very organized Excellent Fair No I did not attend. Very organized I Excellent Very Good Yes I would prefer to keep it as a luncheon Yes  Extremely organized Good Fair Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent No I would prefer to keep it as a luncheon Yes  Extremely organized Very Good Very Good No I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Excellent The breakfasts were well planned and provided a hardy selection. It was nice to have some hot-food options, like the eggs. The assortment of juices and teas were appreciated. Yes It was beneficial that the CE information was provided and available in a variety of formats (oral announcements, conference program and reoccurring Pow Neutral No This time could be better spent providing additional CEs through presentations. That might also allow for sligh Extremely organized I Good Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Excellent Very Good The breakfasts on Thursday and Friday seemed smaller. Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Would it be possible to display the posters in the main conference room for several days with the "session" inc Extremely organized Excellent Excellent No I am not there for Continuing Education credits. I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Very Good Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Maybe - it depends on the cost to the conference. It is a good break and an excellent opportunity to get new Extremely organized Excellent Good Yes I would prefer to keep it as a luncheon No Very organized Very Good Very Good Yes I would prefer to keep it as a luncheon Yes  Very organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Very Good Fair The amount of food was adequate but the quality of food was not consistent or good.   Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Excellent It was great, thank you. If possible, oatmeal at every breakfast would be greatly appreciated. Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  The poster session provides something extra that other conferences do not offer. I think it is a special characte Extremely organized IIt might be helpful, if this was necessary, to push the starting hour back or to end early that day, ie for lunch or just after. IExcellent organization, thank you for your hard work. Excellent Session highlight figures were awesome. Excellent Excellent to keep us going through the day. Not applicable I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  I think it is a great first step for junior researchers to present their findings. Extremely organized IWell-oiled machine, thank you!! Excellent Excellent I am amazed with budget restrictions ( I am sure) what all we are provided.  It is appreciated!!! Yes EXCELLENT!!! I would prefer to keep it as a luncheon Yes  But did not realize the expense.  I could do without the sweets!  Those are extraordinary and I am sure cost  Extremely organized IOnly because of work time and the complexities associated with that... Excellent Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Very Good Yes Neutral Yes  Extremely organized I Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Important to provide a protein at BKFST and you did- thank you Yes Hard to comment as I have yet to receive my CEUs.  Signing in each day was easy once I understood the instructions but I would have liked to have kno I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Great opportunity to learn more, plus gives more epis a chance to present.  Extremely organized IBut really I do not care that much Very Good Good N/A I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  I find the poster sessions especially worthwhile and would be disappointed if future conferences removed this s Extremely organized Excellent Very Good No Neutral Yes  Very organized I TX-DSHS-19-1309-A-000126 full 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 AD AE AF AG AH AI AJ AK AL AM AN AO AP AQ What do you think are the strong points of the conference? What do you think are the weak points of the conference? What changes would you recommend for future conferences? Overall, do you think this conference is a good value? Overall, how would you rate this conference? How likely is it that you would recommend this conference to a friend or colleague? Open-Ended Response Open-Ended Response Open-Ended Response Response Comments Response Great speakers nd a strong sense of community Yes Excellent 9 Yes Very good 10 topics and communication Do not have it scheduled on the last days of school.  Only impacts parents with young children but was an issue.     Also, need a larger room Yes Excellent 10 Meeting people from different professions. Boring nighttime entertainment in the area around the hotel. I would prefer a downtown location near restaurants, theaters, museums, etc. Use a hotel that provides free breakfast to guests. Then, only provide snacks in the morning. That should save a lot of money. Yes Excellent 10 Stayed on time. Had an alternate presentation ready when one presenter was absent.  As a veterinarian in practice, not all the topics were relevant to me. Some of the speakers were obviously new to public speaking. One presenter in partic Yes Very good 7 The speakers even though at this year's conference there seemed to be more MS than PhD or DVM, it was still worthwhile. I'm not sure there is a weak point though I really like the DINs that emphasis international exchange. Let the participants know how they can help. Yes Excellent Yes Very good 9 Yes Excellent 10 Yes Very good 8 The variety of topics that are presented. Yes Very good 8 Yes Very good 9 The format. 30 minutes per speaker allows for a better reception from the audience rather than 1 hour speaker that losses its audience after 30-45 minutes into the presentation. I did not find any weak points. No changes. It is just fine as it is. Yes Excellent 10 The time of year is the weakest point.  There are just to many competing things in late may.  It would be better for both potential speakers and attende Arranging to have it in early June rather than late May  (see the above comment). Yes Excellent 10 relaxed atmosphere n/a more food! (just kidding) Yes Excellent 10 The speakers and their stories cant think of anything Just make sure to keep the coffee hot and available :) Yes Excellent 10 Yes Very good 8 I think the scope of the subjects presented is very wide, and that's the strength of the conference. It alerts public health officials to new threats. None, really.  I think I'd like to see more presentations from physicians. Right now the conference is pretty veterinarian-centric. Yes Excellent 9 The diversity of topics covered, the organization of timing (nothing is too rushed or takes too long). The length of the talks is fine for me, but I think some find them too long. Also, for less engaging presenters, it can be harder to follow and stay intere Slightly shorter talks (maybe 45 minutes?) and potentially increasing the diversity of the research groups represented in the talks. There seeme Yes Very good 9 Good variation of topics.  Most were very interesting and informative. Several of the presenters were difficult for me to understand and hear. This conference was very good and I find it hard to make recommendations as to how to improve future conferences. Yes Extremely good value and enabled me to obtain the needed CE hours for licensure requirements. Excellent 10 Yes Excellent 8 Yes Excellent 10 Yes Excellent 8 Yes Excellent 9 Diversity of attendees  Too small  Expanding to allow more attendees  Yes Excellent 10 A significant amount of information on a variety of relevant topics is presented. I have trouble sitting through more than 3 half hour presentations in a row.  The final day always seems rushed. Yes Excellent 10 Back up presenters    Diversity of presenters NA It was very cold in the meeting room but I do not know what can be done about that Yes Excellent 10 Yes Very good 6 Yes Excellent 10 Good articles as far as I attended. None No Yes Very good 10 The scientific content and diversity of presentations despite the unifying theme of "diseases in nature". You all work very hard to keep all of the presentations unique. Hrm...lack of after lunch activity. Maybe a workshop or breakout session would be beneficial. Everyone gets sleepy after lunch and it makes it hard to c I'm grateful for the breakfast, but I also liked the outing options we had in San Antonio. It was a great way to encourage networking outside Yes Excellent 10 Yes Very good 9 Diverse content Yes Excellent 10 Very good 8 This year seemed to have a larger volume of case studies, which are always intriguing and beneficial to hear; they are more interesting than most of the research-oriented presentations. As always, the format of h There were lags in assistance when speakers had AV difficulties. The tables were a little tight in the meeting room. No suggestions for change in the conference. Keep the basic format; it works! Maybe pick a more interesting location. Yes Thanks for all the work that went into making this conference possible! Excellent 10 Good topics and sessions All in one room makes it hard to be comfortable Have breakout sessions Yes Very good 7 Organization, content, variety of talks, and length of talks. The mid-day keynote. An evening keynote and the removal of the poster sessions to accommodate more oral presentations. For research given poster presentations, m Yes Excellent 10 Yes Excellent 10 Topics and speakers None None Yes My favorite conference!! Everyone does a great job planning, organizing and executing. Way to go, Zoo!! Excellent 10 Meeting with colleagues working in this area and the contacts made.  Learning about which diseases are occurring throughout Texas and what may be on the horizon. The dual presentation screens. It is difficult to watch the speaker and the speaker during the presentation.   It also promotes the speaker to just present t Yes Excellent 10 The format of the presentations.  Really like the presentations of cases. Audience correcting speakers in front of the whole group.  It is unprofessional, and seems to be a select few that continually do this. Ask the moderators to not make comments after the talks.  That time should be given for questions from the audience.   Yes Very good 10 The people who host it.  Sometimes there is a repeat from year to year.  Every two years.  Yes Good 7 Everything N/A N/A Yes Excellent 10 The presentations  Networking  Meeting people that you normally only communicate via phone/email The only complaint (and it's minimal) was the quality of food. More options for breakfast for all days of the event.  Second and third days had no meat and hashbrown. Yes Excellent 10 The strongest draw is the ability to pull presenters from many different areas that may not otherwise be accessible to local jurisdictions or to the state of Texas. It is also great to hear speakers whose life-work ha It might be difficult to find an open venue for the posters. It might have been helpful if poster boards were oriented perpendicular to the wall rather tha  It might be helpful to request that posters be turned in at the registration desk and then have a team set them up the night before or first t Yes This conference is a great value. I think it is especially helpful to new Epidemiologists as it helps them network, meet c Excellent 10 Diversity and relevance of topics; excellent organization; welcoming audience. Not applicable No changes, really like it as it is. Yes Excellent 10 The format, the organization of it, the distribution of locations (not a fan of the San Luis in Galveston and the rats running on top of the roof). It appeared to have turned into the Kristy Murray and sidekick show.  I realize that recruiting a variety of speakers has to be tough. Yes Very good 8 Quality of speakers and content of presentations. Not enough representation by other disciplines. Having agenda available sooner. Yes Excellent 10 The speakers/topics, organization, timeliness, friendly environment Sitting in a freezing room, lecture after lecture tires you out, lack of audience interaction more of a interactive environment, not as cold Yes Excellent 10 A good variety of topics/subjects None this year None Yes Excellent 10 Great info in 30 min segments- LOVE the format!  Great opportunity to network and make professional connections. None- great job, thank you! cannot think of any Yes Excellent 10 Overall I enjoyed many of the oral and poster presentations and found the conference to be well-organized. Talks presenting original scientific research and human/animal case studies were especially interesting and Personally, I would like to see more talks on less common zoonoses, more on parasitic/vector-borne diseases, and more on rabies in the future.  Yes Very good 8 Yes Very good 10 TX-DSHS-19-1309-A-000127 full 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 A 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 5.37E+09 B 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 97912742 C ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## D ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## ######## E F 160.42.85.9 167.137.1.13 167.137.1.15 64.57.225.21 74.124.47.10 199.134.80.3 160.42.85.9 156.98.136.92 107.77.198.97 50.24.135.164 70.112.113.132 70.115.137.159 173.123.40.21 155.220.248.90 107.223.137.33 108.95.36.32 23.127.245.156 70.196.82.199 68.93.67.222 66.76.223.211 207.193.242.50 40.134.128.14 160.42.85.9 67.135.243.206 173.173.44.22 67.135.243.207 142.147.51.27 160.42.85.9 167.137.1.14 160.42.85.9 107.77.208.194 128.194.74.159 160.42.85.9 209.55.126.2 165.91.26.218 160.42.85.9 160.42.85.9 160.42.85.9 160.42.85.9 G H I I J K L M N O P Q Very Good Excellent N/A All of the information Fair Fair Fair A little of the information Very Good Excellent Very good Some of the information Excellent Excellent Excellent All of the information Excellent Excellent Excellent Most of the information Excellent Super easy to use. Excellent Brittany and Dan are great! Excellent Efficient and quick. All of the information IVery helpful. Excellent Excellent N/A All of the information Very Good Excellent All of the information Excellent Excellent Excellent All of the information Fair I had so much difficulty in the registration that I had to call the contacts indicated who actually ef Excellent Excellent All of the information Excellent Excellent n/a All of the information Very Good Excellent Very good Most of the information Excellent Excellent All of the information Excellent Excellent Excellent All of the information Excellent Excellent N/A All of the information Excellent Excellent Excellent Some of the information Excellent Very Good Good Most of the information Excellent Excellent Excellent Most of the information Excellent Excellent Excellent With the rush to depart and the number  All of the information Excellent Excellent Excellent All of the information Excellent Excellent Good Most of the information Excellent Excellent Excellent All of the information Very Good Very Good N/A All of the information Very Good Excellent Well organized and easy to get materials Very good All of the information Very Good Excellent Excellent Most of the information Excellent Excellent The guys checking us in during registration were: engaging, funn Excellent All of the information Excellent Excellent Very good Most of the information Very Good Excellent N/A Most of the information Excellent Excellent Very good All of the information Good The payment options were a little confusing.  Very Good My nametag did not have a ticket inserted, so I had to go back Excellent Some of the information Excellent Excellent Very good All of the information IIt would be nice to Excellent Excellent N/A All of the information Excellent Excellent Excellent All of the information Very Good Very Good Very good All of the information Excellent Excellent Very good All of the information Very Good Very Good Very good Most of the information Excellent Excellent Excellent All of the information Very Good Very Good Very good All of the information Excellent Excellent Excellent All of the information TX-DSHS-19-1309-A-000128 full 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 I I R S T U V W X Y Z AA AB AC Excellent Very Good N/A I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Fair Excellent No I would prefer to keep it as a luncheon No Not so organized Very Good Fair Yes Neutral Yes  Very organized I Very Good Very Good Yes I would prefer to keep it as a luncheon No Extremely organized Excellent Excellent Yes I would prefer to keep it as a luncheon Yes  Extremely organized Excellent Plenty of room to take notes on each presentation. Good Full breakfasts are stellar whereas continental aren't the best. Yes Pam did an excellent job on this. As always. I would prefer to keep it as a luncheon No Extremely organized II would prefer it stay during business hours and not take away from any after hours time. IEric, Bonny and the crew did a fantastic job! Very Good Good N/A I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Very organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Very organized Excellent Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Good n/a I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Good Good No I would prefer to keep it as a luncheon Yes  Extremely organized IEric Fonken and Bonnie Mays ran a conference that was punctual, very organized and  Excellent Good Wish we could have had another hot breakfast/protien item Thursday and Friday, but stil very good N/A I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Good Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Enables some participants opportunity to attend.  Enables some early career individuals to display their work.   Very organized Excellent Very Good No Neutral Yes  Opportunity to network and learn about new initiatives. Very organized I Excellent Good Yes I would prefer to keep it as a luncheon Yes  Extremely organized Good Good Needed a beef entree for this beefeater.  Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Not criticizing it.  It is just difficult to visit and each get the story of each, especially when there old friends  Extremely organized Very Good Excellent No I would prefer to keep it as a luncheon No Very organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Very Good Fair No I would prefer to keep it as a luncheon Yes  Very organized Very Good Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  I found the posters and discussion very worthwhile and thought serving dessert during and at the session was s Very organized Excellent Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent No I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Extremely organized Very Good Very Good Thank you for providing vegetarian options at the Keynote luncheon and at the breakfast buffets. N/A I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  The poster session was one of the highlights of the conference for me -- it allowed me time to speak with re Very organized IGreat experience! Good Fair The meal with the keynote was great, the rest was fair at best.  Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. No Very organized Excellent Loved the program. Great job. Very Good Wish you all provided snacks on Wednesday as well. It appears the snacks were only on Thursday and Friday. Also, the breakfast eggs were not good, but the muffins were exce Yes I would prefer to keep it as a luncheon No I think it is good to offer the poster session, but I personally did not take away much from it.   Also, althou Extremely organized II had to travel into the conference each day, so a luncheon would be preferred.  Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Yes it adds opportunities for added information exchange & networking.  Very organized IIt would work fine either way.  Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Neutral Extremely organized Excellent Excellent Yes I would prefer to keep it as a luncheon Yes  YES! Keep it!!! i would rather sacrifice something else, rather than this. My two cents worth.    Extremely organized Very Good Excellent Yes I would prefer to keep it as a luncheon Yes  Very organized Very Good Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Very Good Very Good Yes Neutral Yes  Very organized I Excellent Very Good Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Extremely organized Excellent Excellent Yes I would have no objection to attending an evening dinner lecture if an excellent meeting space necessitated it. Yes  Very organized Excellent Excellent Yes Neutral Yes  Extremely organized I TX-DSHS-19-1309-A-000129 full 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 AD AE AF AG AH AI AJ AK AL AM AN AO AP AQ The amount of experience in the room is awesome and the sessions and how they are divided are strong points The  set up of tables are always to close together. If possible, to have a full breakfast every day. There are so many carbs with continental breakfast. Just being mindful of the folks who mayb Yes Very good 10 it should be in june not may month of may sucks Yes Fair 3 Excellent speakers Session lengths I don't know Yes Excellent 10 Yes Excellent 10 Yes Very good 7 Information presented. Excessively long break times. Fifteen minutes should be sufficient. Provide gift bags. Yes Excellent 10 Yes Very good 7 Local perspectives and applicable take aways for epidemiologists, healthcare professionals, animal health. Wide variety of topics, yet easily fit into categories. Focus on zoonoses, which is hard to find in large nation Focus on one state only (for the most part). Lack of human healthcare professionals in the audience, a lot of the presentations mentioned engaging huma Try to engage other states, maybe make the conference more regional, a lot of the topics and main points are applicable to other states as we Yes Excellent 10 Professional presenters Yes Very good 9 1. The choice of subject experts as presenters  2. The variety of fields covered  3. The strict adherence to time schedules None An increase in the medical component of the presentations is desirable ie the challenges which zoonotic diseases pose to medical providers (just Yes Excellent 10 it's relaxed, fun environment n/a n/a Yes Excellent 10 The interactions, classroom set up, as well as dessert during poster session Many of the talks are mostly academic, it'd be nice to have a balance with application.  Yes Very good 8 smooth consistent array of presentations on pertinent topics can;t think of any Yes Excellent 10 the keynote speaker, poster sessions, presentations with strong clinical relevance, public health presentations Many of the research presentations were probably not appropriate for the large/diverse audience that was in attendance.  Yes Very good 7 Great networking and opportunity to present/learn current research. Always look forward to this conference. Yes Excellent 9 Missed opportunity for "no-host" social on Wednesday - what happened ? Yes Excellent 10 Very interesting case studies. Some presentations seemed repetitive. Conference in a border city and invite Mexican counterparts. Yes Excellent 9 I really enjoyed all of the presentations; I especially enjoyed the keynote speaker's presentation as well. Yes Excellent 9 Some speakers needed to be reminded to speak up.  None. All interesting.    None  Yes Excellent 9 Well organized, chance to see old friends.  Some presentations are easy to follow. Difficult to hear and understand many speakers.  Several presentations appeared to be presentations of a masters or PhD thesis.  They are full of techniq Assure a good sound system and a dependable laser pointer.  Also, try to have presentations that are more aimed at a general audiences than  Yes Very good 10 Speakers and topics were excellent.  The 30 minute format is great. More information in the packet would have been better. Keep in DFW Yes Excellent 10 Yes Excellent 10 Yes Good 7 Variety of subjects.   Outside of medical conferences in the state, this conference is the best for infectious disease and public health impact. Yes Very good 8 Variety of topics and presenters. none None.  Excellent conference. Yes Excellent 10 The conference was excellent.... No weaknesses none Yes Excellent 10 Having a variety of topics from different professions(research, medical, veterinary and public health)  Sometimes the breaks seemed really long when speakers presentation were shortened.  More snacks throughout the day Yes Excellent 10 Variety of topics and speaker backgrounds (minor points) Lack of breakout sessions. Limited time for the poster session. Yes Very good 8 Speakers, amount of CE  The weak point of this conference was the location. I have no desire to spend almost a week in Irving.  None  Yes Excellent 10 The variety of speakers and the various topics discussed. I also liked that you all alternated the person introducing the speakers.  Some of the presenters did not fully explain their acronyms, making it hard for some of us to follow them.  Make it less expensive. I understand that some of the cost is due to the CE credits, but I think that with a tighter budget you could lower th No I really liked the conference, but don't think it was worth the hefty $350-400 price tag. Cut off $100, and that would  Excellent 7 Knowledge gained & networking.  It was a very nice conference! I liked it as it was. Yes Excellent 10 subject matter offered in efficient manner none to mention with this past conference Yes Excellent 10 Diversity of presentations and attendees  Would benefit from more outreach earlier in the year Not much. I think its excellent really.  Yes most definitely! Thanks! Excellent 10 Excellent information. Enjoyed all the case studies. Yes Very good 9 Yes 10 This conference is superb at addressing zoonotic disease issues. I honestly cannot think of a weak point. Different cities... Yes Very good 9 Very well organized and run. Yes Excellent 10 Yes Excellent 10 Yes Excellent 10 TX-DSHS-19-1309-A-000130 full Evaluation Summary Event Title: James Steele Conference on Diseases in Nature Transmissible to Man Event Number: 807 Location: Houston, TX Event Date: May 23-25, 2018 Achievement of Learning Objectives 1. The data entered below should indicate the number of learners marking each response as well as average rating. Upon completion of this event, participants should be able to: Event Objectives Poor 1 Fair 2 Good 3 Very Good 4 Excellent 5 Average rating for all participants 3 15 52 53 4.3 1 16 40 62 4.7 1 14 45 69 4.4 3 18 50 54 4.2 Session 1. Evaluate the epidemiological characteristics and assess geographical distribution trends of murine typhus cases; identify lab and clinical characteristics of hospitalized patients associated with intensive care admission due to murine typhus; and describe the epidemiology and clinical presentation of tickborne relapsing fever. Session 2. Describe components of and assess the success of kissing bug and tick surveillance programs as well as some of the diseases with which they are associated; surveillance, control, and testing techniques and insecticide resistance testing methods; and principles of remote sensing and how these can be applied to vector-borne disease public health interventions. Session 3. Demonstrate the risks of zoonotic diseases associated with nature-based tourism; describe the agents responsible for meningitis and encephalitis in a pediatric population; and critically evaluate a proposed preventative strategy to decrease transmission of skunk rabies. Session 4. Identify how to request state assistance for mosquito control during an emergency event and describe mosquito-population dynamics and the process of vector-borne disease TX-DSHS-19-1309-A-000131 information distribution in response to a flood event. Session 5. Identify information in a patient’s history that indicates risk for Brucella suis; describe the public health investigation of a human case of Brucella abortus RB 51 infection; and assess the risk of RB51 vaccine exposure to humans. Session 6. Describe the evidence in support of bats being a reservoir host for zoonotic Leptospira species; illustrate the epidemiology of tularemia and tularemic syndromes; evaluate appropriate diagnostic studies and therapy for tularemia; describe the epidemiology and surveillance of Vibrio infection in Texas; and appraise potential infectious disease hazards associated with folk medicine. JV Irons Keynote Lecture Describe the public health elements that constitute a One Health framework. Session 7. Demonstrate knowledge of the electrocardiographic and echocardiographic abnormalities observed in dogs seropositive for T. cruzi; compare epidemiological trends of Chagas disease in South America; describe the basic epidemiology of Chagas disease transmission; compare potentially high-risk groups for Chagas disease; appraise available diagnostic tools for Chagas disease; and evaluate the use of skunks as sentinels for and dilutors of arthropod-borne infectious diseases in Texas. Session 8. Interpret lessons learned from the public health response to Zika and apply them to future public health emergencies; interpret results of a therapeutic treatment for West Nile virus in a rodent model; and describe a local Zika response and understand how CDC Zika guidelines might be applied to a local jurisdiction. Session 9. Distinguish the clinical manifestations of Chagas disease in its various forms; assess clinical parameters and apply treatment options for Chagas-infected dogs; and 1 1 1 11 46 66 4.4 14 43 65 4.4 1 4 23 93 4.7 2 10 49 59 4.4 12 51 50 4.3 7 32 67 4.6 TX-DSHS-19-1309-A-000132 describe the 2011 Chagas in Transplant Working Group recommendations for posttransplant testing of patients who have received organs from seropositive donors. Session 10. Describe two epidemiological investigation steps for a possible transfusion-related malaria case and describe a confirmed autochthonous case of leishmaniasis. 1 5 26 61 4.6 Presenter’s Competence and Effectiveness 2. The data entered below should indicate the number of learners marking each response as well as average rating. Fair 2 Good 3 Very Good 4 Excellent 5 Ana Zangeneh 3 16 47 50 4.2 Anna Klioueva 2 26 43 47 4.1 Kristopher Koch 3 18 42 57 4.3 19 48 53 4.3 Presenter Names Poor 1 Mustapha Debboun Average rating for all participants Kyndall Dye-Braumuller 1 20 42 57 4.3 Elaine Chu 1 23 47 49 4.2 Melissa Nolan 18 43 60 4.3 Michael P. Muehlenbein 10 36 74 4.5 1 13 39 74 4.5 1 17 42 58 4.3 13 46 60 4.4 8 35 46 29 3.8 2 15 47 51 4.3 Kit Darling 2 12 50 51 4.3 Shelley D. Stonecipher 1 14 33 71 4.5 Susan N. Rollo 16 41 60 4.4 Diana M. Stone 20 37 70 4.5 10 40 70 4.5 13 51 51 4.2 Timothy Erickson Carson R. Phillips Whitney A. Qualls Martin Reyna Nava Rebecca Riley 1 Lucila (Lucy) Marquez Irina Cody 6 TX-DSHS-19-1309-A-000133 15 42 61 4.4 1 5 16 96 4.7 Derek Matthews 2 17 54 41 4.2 Micaela Sandoval 4 17 49 46 4.2 Sarah M. Gunter 13 36 66 4.5 Bonnie E. GulasWroblewski 11 34 65 4.5 17 46 47 4 2 18 36 50 4.3 7 34 38 27 3.8 13 45 52 4.4 Roy Madigan 5 22 81 4.7 Bob Garrison 8 31 67 4.6 Thi Dang 10 31 62 4.5 Vaidehi Shah 12 26 58 4.5 Gregory M. Anstead Umair Shah 1 Benjamin D. Hornstein Shannon E. Ronca Lauren Wilkerson 2 Nicolas A. Melgarejo Please list responses to each question. 3. As a result of attending this event, what new skill or idea will you implement into your job or practice within the next six months? Responses to Question #3: Do better on protecting myself when I’m cleaning the shelters; Be more cautious with animals because of disease; In my work, I will implement more public awareness about insect borne diseases; Wear DEET insect repellent more consistently; Thinking of how to implement One Health locally; Using more PPE when handling; PPE; Just helps to be more aware of things to look for w/patients – also being award of the latest info on diseases; Finally some benefit to having skunks in a suburban environment, even if the public isn’t yet full appreciative; Pay more attention to risk factors of zoonoses; Epidemiology & diagnosis of rare disease occurrences; I’m a vet student, so I will continue to look into this field of work; Additional collaboration; I will be bringing concepts from Dr. Muehlenbein’s presentation into some of the conservation research projects on which I’m collaborating through TAMU’s Applied Biodiversity Science program; Presentations on Brucellosis, awareness for Tularemia vectors, hosts, risks to children; Looking at sickle cell and clinical outcomes; Chagas awareness; I have additional information to present while teaching Microbiology and Parasitology laboratories; Better able to identify reduvids; Treatment recommendations for Chagas in dogs; Education on disease risks to humans in a slaughter house environment to state regulatory personnel; Hurricane response related information may be applicable during next event (or planning for it); To be more open minded regarding etiologies; More education about mosquito control, more awareness about certain zoonotic diseases, and importance of vaccination prior to traveling to some countries; Always help me keep current for medical micro lectures. Like the excursions TX-DSHS-19-1309-A-000134 into natural history of animals – both bugs and mammals. Want to get a skunk for my backyard! There is never a dull topic; Better travel medicine risk communication for zoonotic/anthroponosis potential diseases/exposures; Aspects of prevention will be integrated into teaching veterinary students; RB51 in Brucellosis cattle; Better surveillance for viruses and protozoans in animals; I am retired from lab animal practice – but this conference provided new insights into the current state of zoonotic disease research; Brucellosis RB51 risk and raw milk – fascinating, great info; Positive lyme labs – take a harder look: could it be TBRF? Look more at travel clinics & the education they are providing patients. Increase ACO presentations on animal ID. Ask better questions during Chagas interviews. Increase education to wildlife management groups; Promote skunk surveys; Basic knowledge; More discussion of Vibrio vulnificans in class. Inclusion of Brucellosis in Brucellosis discussion & risk of RB51 or B. abortus in soft cheeses. Augment current infor on Chagas disease in class discussion; Lectures on One Health, skunk habitat; Not sure – better mosquito control maybe; Education for trapping methods on mosquitoes; PPE use when handling carcasses; New ideas for vector borne disease projects; Improve working relationships with Texas Baylor Trop Med & Regional Zoonosis Veterinarians; Canine Chagas diagnosis & treatment; Be more aware of kissing bugs in my environment, think more broadly when considering Brucella; Be more aware; None, but will discuss several topics/issues with human medicine counterparts in hopes of increasing awareness of some of these diseases discussed; Brucellosis information; Nothing – I’m in food safety and there weren’t any presentations that applied to my field (meat & poultry) – but I enjoyed the presentations and learned a lot; I’m going into research this summer so the lecture on RB51 Brucelaa Abortus cases were very interesting. I’m not sure if the lab I’m working in will be able to support a research project with this agent but it is exciting to hear there are a lot of unknowns with this vaccine; Wearing gloves with patients. Talk to my transplant center about Chagas disease screening; Try and use the free mapping websites to hopefully help our trapping efforts or see if it would be beneficial for our county to invest in such software (given if someone is trained to use it). Also would like to look for raw grants so we can also benefit like Harris Co. There are many ideas I would like to implement but we don’t have the funds, or manpower, and training. So that’s why I will start small and FREE; mapping; Networking and collaboration across different discipline & associations when it comes to infectious diseases (open mind); Became aware of variety of cases/research going on zoonotic infections; current status of public health in Texas regarding zoonotic disease investigations; Incorporating One Health philosophy into our work, looking to collaborate more with env. Health and animal management; Try to apply the One Health approach more often; Look into satellites to find more trapping locations efficiently; I would like to get in touch with kit to learn more about infection control for vet hospitals; Mosquito resistance testing; Cook your food; Incorporate more One Health concepts into our programs; One Health concept, review literature on murine typhus and empiric treatment for sepsis. Does empiric therapy and doxycycline for unknown cause of sepsis and risk of zoonoses cause conflict with current guidelines/campaign to reduce production of selection and spread of antimicrobial resistant organisms?; Always excellent information! Will use the content to continue to update and inform staff back at my facility; Chagas surveillance in animal shelters, typhus GIS; May consider collaborating to screen feral cats for Chagas. Consider other differentials with cases besides rabies; Generally the most valuable take aways for implementation into practice were found in the “challenges” sections of the investigation reports; We will be looking at ways to screen for T. Cruzi without having cross reactivity to leshmanises, try to find a more specific test; Research ideas/gaps for potential PhD; Consider looking at safety TX-DSHS-19-1309-A-000135 precautions used for samples with unknowns; More awareness of client exposure to more organisms in nature that cause infection and needed education to protect people; I’m interested in modifying our murine typhus message to providers; Implement new information in vector borne disease prevention education program; Working toward more of a One Health concept with my job; I teach emerging infectious disease course to graduate students. The presentations on lepto in bats in Granada and ethanopharmacology have provided 2 new subjects for me to cover in class; Presentation, do more research & abstract, need to do more update with Harris and DSHS to improve our public health; I’ve learned about zoonotic diseases; New procedures and processes to provide information to the DOD. Possibly able to streamline operations/missions with information provided in sessions; The knowledge of testing and symptoms and treatments will assist with surveillance interviews; Learn more about Chagas in humans, more importantly in domestic animals – is vaccine being developed?; Greater understanding of several diseases which will lead me to include them in my differential – Letospirosis, Tryponosomiaris, Vibrio, Salmonella, Typhus; One Health – will communicate and work with other departments more efficiently; I am going to look at how my programs are structured using a One Health lens; Educate public and health care provider; Remote sensory technology to detect better mosquito breeding sites as we have currently just been driving around to find locations; One Health; Focus on networking with local blood bank in data reporting; After discussion with my team, we may reach out to the pediatric providers in hospitals to inform them of zoonotic findings as it relates to encephalitis and meningitis; Encouraging students to build & foster relationships with those outside their immediate fields of work; Consideration of holistic “folk” medicine in exposure possibilities re: snakes, etc.; I wouldn’t say I learned a specific skill directly relating to my job, but more like a deeper understanding of how to approach public health and scientific research as a whole; I loved to see the collaboration, so I have taken away the concept of collaboration and working together – really enjoyed the One Health talk; Observed needs for new testing that be used by PH/state labs (development of new test); Hopefully more involvement in sampling/surveillance (mosquito/tick); The value of personal protective equipment (per Kit Darling’s presentation). I have an increased awareness of Chagas disease in dogs (Roy Madigan’s presentation); Rebecca Riley’s presentation reminded me of the importance of forgetting our research and interventions to at-risk communities & populations that need it most. 4. What topics would you like to see presented at future events? More info on vet/wildlife topics; Everything was great; Vaccinating personnel for rabies; I would like to see more studies on wildlife; Being that hunting is a multibillion dollar industry in the state of Texas alone, you never see any public awareness about diseases transmittable from wildlife to hunters; Speakers were passionate and intelligent, but it became difficult to stay awake when many had the same topic (Chagas) – I’d love a balance of topics – I love learning new things; Cat scratch fever; Would like to see at least one talk about rabies; Continue with the various/variety of topics currently covered, plus new topics as they emerge or become relevant; I can’t think of any – all the topics, including ones I haven’t thought about, were covered; Rare cases – collaboration & presence of physicians; More Chagas disease topics; Methodology & basic science; Fungal pathogens, tick-borne pathogens, anything incorporating conservation medicine in a One Health framework; Recruit speakers from Russia, China, Middle East to determine One Health concerns in those parts of the world; Same – these are great; Cutting edge emerging disease awareness; Human to animal transmission of diseases, environmental diseases, TX-DSHS-19-1309-A-000136 emerging veterinary diseases, strengths/weaknesses of various tests offered/where they are offered (commercial labs, specialty labs, restricted labs); All of the topics were great; Incidence of zoonotic disease transmission potential in the meat industry and its effects on regulators; More case studies; More clinical cases; Always enjoy topics covered – even if I don’t expect some of the things that come up in the program. Always my favorite conference of the year; More practical integrated pest management for departments 2 – 3 people deep with basic resources (no skeeter van or novel Microsoft traps). There were a lot of report topics – would be nice to get more variety; Interactions with and potential for live bird (animal) markets on aspects of zoonotic diseases; Food safety; Presentations on how lab tests are done; Vectors, Rickettsia, Borrellia; I’m always interested in emergent diseases. This year’s conference didn’t present much in the way of “new” diseases. Perhaps it’s been a quiet year; More tick presentations. More presentations from clinicians. Evan Kipps Caldwell County locally acquired Leish case; Delusory Parasitosis; Pocket pets, zoonotic diseases; Activities of local health departments and agencies, the participation of Harris County PH Dept. has really added the local “boots on the ground” perspective; Anything new, case studies are always interesting; Health care associated infections – zoonotic agents; TB in Texas, food borne diseases, a little less Chagas; Late breakers – public health events in the news; More on rabies, less on Zika & Chagas; Disease outbreak reports; Pocket pets – public health; Food safety issues; Information with practical use in clinic or classroom; Chronic Wasting disease, Brucellosis in feral swine, & implications of hunting & field dressing; Antibiotic resistance; Case presentations are usually interesting and always enlightening to hear the physician point of view; More scientific talks please; It seems like we need a CE session on interstate health certificate requirements and reporting requirements for non-compliance. Nobody in the audience was able to answer interstate animal travel regulations for the case of canine contracted Brucella. The animal went from Texas to Florida exposing many people without repercussion; Lots of zoonoses – what we need to push our politicians for; Increased awareness/surveillance in hog & cattle for zoonotic diseases; It is not so much the topics, it’s the presenters themselves. Have a more variety (different counties/institutions). Many oral and poster presentations were from Harris Co. I know it also depends on who submits presentations, but it would be nice to have variety; Antimicrobial resistance, microbial products/treatments that are being used in practice; It would be interesting to see representation of African American community – I know some people in different fields that are involved in climate change projects, etc., and will encourage them to submit abstracts; Consider need of establishing Chagas screening at our public health lab if at risk; More highlights on differentiation between lyme disease and tick borne conditions, prognosis of tick borne diseases; More case investigations; Chikungunya; More physicians speaking on cases and how they’re dealing with patients affected by these diseases; The Strongy organ transplant transmitted case investigated by DSHS 2018; More case studies; New and emerging diseases; EPM; Occupational health for laboratorians and field staff investigating zoonotic diseases; Antimicrobial resistance trends for zoonotic diseases in the US, Texas, and internationally; Murray Valley fever; Zoonotic brain infections, plague; More on Leishmaniasis; Pythiosis; More common misdiagnoses, chronic wasting disease, prion disease; Updates on research presented – case studies always appreciated; Studies on Hanta virus; Cat scratch fever; Current training and new ways to train public health/One Health professions; VZV or West Nile virus; Hep C, E, Ebola, lassa fever, etc; Avian influenza; Emerging diseases; More on Zika testing, use of the media during big events, cross reactivity on mosquito born testing, in general – the case studies are very interesting; Legionella in the environment, mad cow disease; Case study outbreaks; Zoonotic case study TX-DSHS-19-1309-A-000137 from a dermatologist or neurologist, clinicians in general were great between public health presentations; Zoo animals, zoo veterinarians, exotic animals, human to animal transmission; Blood bank rep. on their tracking system, Zika update; More tick borne disease; Due to the nature of my job, I would like a lot more presentations about rabies; I enjoyed the rare/different topics: skunks, malaria, etc. I would like to see anthrax; Other vector borne infections/exotic parasites, infectious diseases; More clinical lab development; Keep up the good work with variety of topics. Panel discussions?; More rabies-related presentations; Cat scratch fever; Less Chagas, outbreak investigations, rare investigations, rabies. 5. Did you perceive any conflict of interest (i.e. commercial support, product endorsement, or unannounced off-label product use) during the presentation? No Yes 113 Unsure 5 4 If so, please describe conflict of interest perceived: Should wear protective gloves when handling bats!; Exxon Mobile; There seemed to be some underlying support for Harris County and their One Health conference; the only thing that came to mind was Exxon’s partnership with one of the projects involved. It wasn’t necessarily a bad thing, but it definitely raised a couple questions for me personally regarding sincerity and motive behind the partnership. Analysis of Evaluation Findings Event Planner, please answer the following questions: 1. Overall, what did these participant evaluations indicate? The evaluation results indicate that the conference objectives were met very well with all average scores rating 4.2 or above. Similarly, the presenters had outstanding ratings with 31 out of 33 receiving an average score of 4.0 or above (the other two speakers each scored a 3.8). Based on the evaluation ratings and comments, the conference was successful, plus was appreciated by attendees. 2. As a result of these evaluations, what would you choose to do differently, or the same, for future events? We will continue to locate excellent speakers on a wide plethora of zoonotic diseases and will review evaluation comments for topics of particular interest and for speakers who attendees would like to have present again. TX-DSHS-19-1309-A-000138 Miscellaneous responses: Great conference! Food was good; This was one of the better conferences that I have attended. The speakers were good and kept my attention. Great job to Brittany and Dan at registration. Great job to Bonny and Eric. Really enjoyed it; Thank you so much for having the conference in a hotel that provides internet access in the conference room; Martin Nava’s slides were way too busy and too small to read; Lauren Wilkerson did not face forward – only looked at slides; Roy Madigan was best speaker; J V Irons Lecture – best ever next to Jeanna Giese & Dr. Willoughby; Kristopher Koch – Please ask him back; Michael Muehlenbein – Please ask him back; Timothy Erickson – Please ask him back again – the best; Susan Rollo – Always an excellent presenter; Lucia Marquez – Excellent presentation; Umair Shah – Amazing – Dr. Shah for President; Derek Matthews – Needs to come back again; Bonnie Gulas-Wroblewski – Need to hear more from her; Vaidehl Shah – Great speaker to end the conference; Lighting was too bright over screens. This made it difficult to read many slides and to see details in photos, eg. Skunk types in ppt slides. Better if can dim lights near screens; Screen set up and lighting were not very good for presenting material; Acoustics of room and background noise made it difficult to hear and concentrate; Poster set up in hallway was not very effective; Melissa Nolan – Very good; Carson Phillips – Great; Shelley Stonecipher – Very good; Irina Cody – great; Umair Shah – Excellent; Shannon Ronca – Awesome; Lauren Wilkerson – Awesome topic, well done; Session 1 – Interesting; Ana Zangeneh – Interesting; Anna Klioueva – Good info on ticks; Mustapha Debboun – Brought up interesting points to consider; Timothy Erickson – Great energy & enthusiasm; Kathleen Darling – Always has good cases; Lucia Marquez – Good to have clinical perspective; Bonnie Gulas-Wroblewski – need more public health, not background info; Many slides were hard to read – size of lettering & some colors were difficult to visualize; Martin Nava – Good knowledge but too many graphs & hard to follow/difficult to see; Irina Cody – Excellent presentation material, but very difficult to understand this presenter; Lauren Wilkerson – Sometimes inaudible; Nicolas Melgarejo – Sometimes difficult to understand with heavy accent; It would be nice to expedite the CE at the end if there were more people to help – split the lines; Session 1 was fair, but thought provoking for project ideas; Kristopher Koch – Slides hard to read; Martin Nava – Could have been better if images on separate slides; Sessions 2 & 5 were great, Keynote Lecture was outstanding; Thanks for asking the conflict of interest question; Thank you for all the space in our sitting area during the conference; Bonnie Gulas-Wroblewski was great; Shannon Ronca needs to enunciate – too fast; Martin Nava – I couldn’t read any of the data; Mustapha Debboun – very broad, many topics; Martin Nava – too much info on slides; Lauren Wilkerson – interesting presentation but presenter needs better speaking skills – her voice drones on and lowers at end of sentences; Nicolas Melgarejo – too fast – I missed a lot of words; Need to know about background of presenters if possible – build a website for attendants to review or see back all presentation documents to learn or can question presenters; A presenter was unable to show a video and there were microphone issues – I recommend you improve AV infrastructure; Great conference – thank you; Thank you for a wonderful conference; Timothy Erickson and Benjamin Hornstein had great enthusiasm and positive energy that added to the quality of their presentations. Thanks for all the good food choices, plus hot tea! Always an excellent conference! TX-DSHS-19-1309-A-000139 From: Vanyo,Jodie (DSHS) Sent: Tuesday, November 27, 2018 5:28 PM EST To: Perkins, Kiran Mayi (CDC/DDID/NCEZID/DHQP) CC: Marquez,Cynthia S (DSHS) ; Garcia,Imelda M (DSHS) ; Shuford,Jennifer (DSHS) ; Gamez,Monica (DSHS) ; Rodriguez,Gretchen (DSHS) ; Powell, Krista (CDC/DDID/NCEZID/DHQP) ; Garcia,Bobbiejean (DSHS) Subject: RE: MMWR update - Texas Attachment(s): "MMWR Stem Cells_Draft_11_14_2018_cleared DSHS edits.docx" Hello Ms. Perkins, Apologies; attached is the full document with edits shown in track changes. Cynthia will be in touch to set up a conference call. Thank you! Jodie Vanyo, MGPS Integrated Policy and Operations Team Lead Infectious Disease Prevention Section Texas Department of State Health Services (512) 776-2194 www.dshs.texas.gov TEXAS HealthandHuman Services TexasDepartment ofState HealthServices From: Perkins, Kiran Mayi (CDC/DDID/NCEZID/DHQP) [mailto:guu9@cdc.gov] Sent: Tuesday, November 27, 2018 2:38 PM To: Garcia,Bobbiejean (DSHS) Cc: Marquez,Cynthia S (DSHS) ; Garcia,Imelda M (DSHS) ; Shuford,Jennifer (DSHS) ; Gamez,Monica (DSHS) ; Vanyo,Jodie (DSHS) ; Rodriguez,Gretchen (DSHS) ; Powell, Krista (CDC/DDID/NCEZID/DHQP) Subject: RE: MMWR update - Texas WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi Bobbiejean, I only received 2 pages of edits (the title page and the acknowledgments page). Just want to make sure that was intentional and that there are not additional pages that I am missing? Yes, the number below is my office line. ThanksKiran From: Garcia,Bobbiejean (DSHS) Sent: Tuesday, November 27, 2018 3:31 PM To: Perkins, Kiran Mayi (CDC/DDID/NCEZID/DHQP) Cc: Marquez,Cynthia S (DSHS) ; Garcia,Imelda M (DSHS) ; Shuford,Jennifer (DSHS) ; Gamez,Monica (DSHS) ; Vanyo,Jodie (DSHS) ; Rodriguez,Gretchen (DSHS) Subject: MMWR update - Texas Hi Kiran, Please see the attach edits from Texas. Leadership would like to discuss some concerns DSHS has with the article. Cynthia Marquez will be in contact to schedule a conference call with you, Associate Commissioner Imelda Garcia, and DSHS Infectious Disease Medical Officer Dr. Jennifer Shuford. Is this the best contact information for you: P: 404-639-1161 KPerkins@cdc.gov TX-DSHS-19-1309-A-000140 Thank you, Bobbiejean ********** Bobbiejean Garcia MPH, CIC, FAPIC HAI Epidemiologist Region 6/5 South Texas Department of State Health Services 5425 Polk Street Mail Code: 1906 Houston, Texas 77023 O: 713-767-3404 F: 713-767-3006 C: 832-728-4741 Office Hours: 7:30am-4:00pm *Telework Wednesdays* CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code § 81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000141 1 Notes from the Field: Bloodstream and Joint Infections in Patients After Receiving Bacterially 2 Contaminated Umbilical Cord Blood-derived Stern Cell Products for Non-hernatopoietic Conditions - 3 United States, 2018 4 Authors: 5 Kiran M. Perkins, MD 1 6 BobbiejeanGarcia, MP~-2 7 Gretchen~odriguez, MP~-2 8 Samantha Spoto, MSPH ~l 9 Danielle A. Rankin, MPH-3l o Nychie Q. Dotson, MPH-31 1 Mary Malarkey, BS4§. 2 Melissa Mendoza, JD41 3 Lorrie McNeil!, BA41. 14 Paige Gable, BS 1 15 Krista M. Powell, MD 1 16 17 18 Affiliations: 19 20 1 Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, CDC 1 -2rexas Department of State ~ealth Services 2 ..::~ Florida Department of Health 3 14U.S. Food and Drug Administration 24 Corresponding author: Kiran Perkins, KPerkins@cdc.gov , 404-639-1161. 25 Word count (excluding tables and references): 627 1 TX-DSHS-19-1309-A-000142 26 The only U.S. Food and Drug Administration (FDA)-approved stem cell products are derived 27 from umbilical cord blood, and their only approved use is hematopoietic and immunologic reconstitution 28 (1). On September 17, 2018, the Texas Department of State Health Services received notification of 29 Enterobacter cloacae and Citrobacterfreundii 30 received injections or infusions of non-FDA-approved umbilical cord blood-derived stem cell products 31 (processed by Genetech, Inc. ["Genetech"), distributed by Liveyon, LLC ["Liveyon"]) at an outpatient 32 clinic on September 12 for non-hematopoietic conditions. Patient isolates of E. cloacae had identical 33 pulsed-field gel electrophoresis patterns, suggesting a common source. On September 22, the Florida 34 Department of Health received notification of Escherichia coli, Enterococcus faecalis, and Proteus 35 mirabilis joint infections in four patients who had received injections of these same products at an 36 orthopedic clinic during February 15-August 30, also for non-hematopoietic conditions. Cultures of 37 unopened products from the clinic by a Florida hospital identified contamination with E. coli and E. 38 faecalis. In response, on September 28, Liveyon issued a voluntary recall and immediately 39 discontinued purchase of the Genetech-processed stem cell products (2, 3). On October 4, CDC issued 40 a nationwide call for culture-confirmed infections in patients after receiving Liveyon's product. 41 bloodstream infections in three patients who had As of November 8, CDC has received reports of infections in ten patients from three states 42 (Texas [5), Florida [4), Arizona [1]), including the initial four in Florida and three in Texas. All ten 43 patients received infusions or injections of Liveyon's product before the recall. Of nine patients for 44 whom conditions prompting product administration were known, all had non-hematopoietic conditions 45 (Table) such as pain or orthopedic conditions. 46 CDC tested unopened vials of product obtained from the Texas and Florida clinics where 47 patients had received product. The six vials from Texas had the same cord-blood donor and processing 48 day as the vials that had been administered to patients with infections. E. cloacae was isolated from all 49 six vials; c. freundii was also isolated from five. The four vials from Florida were from different donors 50 and processing days than those from Texas. E. coli was isolated from one of two vials from the same 2 TX-DSHS-19-1309-A-000143 51 cord-blood donor and processing day; E.coli and E. faecalis were isolated from one of two vials from 52 unique donors and processing days. 53 Ongoing investigations include active case finding, additional laboratory testing to compare 54 clinical and product isolates, onsite assessments of healthcare facility infection control and injection 55 safety practices, and investigation of manufacturing (including distribution) practices, but initial 56 investigation suggests the possibility of bacterial contamination of the product at some point before 57 distribution. Umbilical cord blood cannot be decontaminated after collection, so manufacture of derived 58 products must be highly controlled to prevent distribution of contaminated products. The Genetech- 59 processed, Liveyon-distributed product is not FDA-approved. Both Genetech and Liveyon are 60 registered with FDA, however registration is not a form of FDA approval. Registration alone does not 61 demonstrate that the firms or their products comply with the law. 62 Regardless of when contamination occurred, this investigation underscores that stern cell 63 therapies can pose potential serious risks to patients when administered for unapproved and unproven 64 uses to treat non-hernatopoietic conditions (4). Although the safety and efficacy of stern cells derived 65 from sources other than peripheral blood or bone marrow for procedures unrelated to hernatopoietic 66 reconstitution have not been well established, many companies, clinics, and clinicians continue to 67 market stern cell products from various sources as treatment for conditions without FDA's approval 68 (e.g., orthopedic, neurologic, and rheurnatologic conditions). such clinics and providers operate in 69 outpatient settings, which oftentimes have less robust oversight of infection control measures , including 70 injection safety and medication preparation (5), potentially amplifying risk to patients. Therefore, FDA 71 has recommended patients avoid receiving such products outside of controlled clinical studies under an 72 investigational new drug application (1). 3 TX-DSHS-19-1309-A-000144 73 Acknowledgments 74 Florida Department of Health: Scott Pritchard, MPH, Virginia Warren, MPH, Bureau of Public Health 75 Laboratories. Texas Department of State Health Services: Linda K. Gaul, PhD, MPl=l, ~tate epidemiolo§!ist for Texas f6 77 Arizona Department of Health Services: Kara Tarter, MPH, Rachana Bhattarai, BVSc&AH, MS, PhD, 78 CIC 79 California Department of Public Health: Robert Hunter, MS, Jon Rosenberg, MD 80 CDC: Kathleen Hartnett, PhD, MPH, Ana Cecilia Bardossy, MD, Heather Moulton-Meissner, PhD, 81 Gregory Eckert-Raczniak, MD, PhD, MPhil, MPH 4 TX-DSHS-19-1309-A-000145 82 References 83 1. U.S. Food and Drug Administration. "FDA Warns About Stem Cell Therapies." Consumer Updates, 84 November 17, 2017, https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm286155.htm 85 2. U.S. Food and Drug Administration. "Recall Notification to Clients with Possible Product On-Hand, 86 Effective 9/28/18." Vaccines, Blood & Biologics, October 1, 2018, 87 https://www .fda.qov/Biologi csBloodVaccines/SafetyAvailability/Recal ls/ucm622190. htm . 88 3. U.S. Food and Drug Administration. "Liveyon, LLC Issues a Voluntary Nationwide Recall of the 89 Regen series® Product, Manufactured by Genetech, Inc." Recalls, Market Withdrawals, & Safety 90 Alerts, October 10, 2018, https://www .fda.qov/Safety/Recalls/ucm623039.htm . 91 4. Mat1; Ruiz,Mauro (DSHS) ; Boneta,Otto (DSHS) Attachment(s): "US Southern Border Region Infectious Disease Prioritization_Workshop Sum....pdf" -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Tuesday, December 11, 2018 9:38 AM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Morris,Sandra (DSHS); Rocha,Felipe (DSHS); Poe,Jonathon D (DSHS); Rodriguez,Tomas R (DSHS Contractor); iom5@cdc.gov; Foy,Elizabeth (DSHS); Martinez,Angelica (DSHS Contractor); Vaaler,Margaret (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: FW: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting Here is the call-in information. I am not sure when the bulk of the TB discussion will occur, but I am happy to have y’all on the call with me! Jennifer -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Thursday, November 15, 2018 3:52 PM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, this date was the clear winner out of the three that we had proposed and sent out. Our apologies to anyone who is not able to participate. Reminder about the purpose of this call: the next step in the disease prioritization process that we began at September’s Infectious Disease Prioritization for Multijurisdictional Engagement at the US Southern Land Border Workshop (workshop summary is attached) is to finalize the general recommendations for the four prioritized diseases/disease category’s and develop disease specific recommendations/action items. We hope to develop a draft of those recommendations over two conference calls to be held in December and January. On this call we will discuss the general recommendations, as well as TB and enteric diseases. Please forward this invite to any TB or enteric disease subject matter experts in your state that you would like to join the call. On the January call we discuss Aedes-transmitted diseases and rickettsioses. TX-DSHS-19-1309-A-000150 Within the next week you will receive: · A draft of the general recommendations that were developed at the workshop. · Additional questions about the general recommendations (~8-10) to review and answer as a state prior to the conference call. o This is a great opportunity for those on your team who cannot participate on this call to provide input. CONFERNCE CALL INFORMATION ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 8059272 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... Thank you, Tom Gray Public Health Specialist Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 619.692.5625 office; 404.594.0908 cell ; 619.692.8821 fax To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html Confidentiality Notice: This message and the accompanying documents may contain information that is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this e-mail is not the intended recipient, you are hereby notified that you are strictly prohibited from reading, disseminating, distributing, or copying this communication. If you have received this e-mail in error, please notify the sender immediately and destroy the original transmission. Thank you. TX-DSHS-19-1309-A-000151 Infectious Disease Prioritization for Multijurisdictional Engagement at the United States Southern Border Region San Diego1 California September 27-28 1 2018 Workshop Summary Infectious Disease Prioritization for the United States Southern Border Region • The Centers for Disease Control and Prevention (CDC)United States-Mexico Unit worked with CDC'sOne Health Office to host an infectious disease prioritization workshop for the US southern border region in San Diego, California September 27-28, 2018. • This workshop was the first time CDC's One Health Zoonotic Disease Prioritization (OHZDP)tool was used to prioritize infectious diseases beyond zoonoses and for a regional approach to prioritization. Workshop Goals: • • 1 To prioritize endemic and emerging infectious diseases of particular concern in the US southern border region,1 identify common USfederal and state priorities, and determine how to jointly address them. These include diseases that can be introduced and amplified, or cause an outbreak, due to the movement of people, products, or animals between the US and Mexico. To develop plans to address gaps in surveillance, response, or other relevant activities for the prioritized diseases. The 44 US counties with the majoritv of their area within the 100 km line, as established bv the 1983 La Paz agreement 1 TX-DSHS-19-1309-A-000152 Workshop Participants: The workshop was attended by 32 participants from federal and state agencies. There were 12 voting members (4 federal and 8 state representatives) and many advisors providing subject matter expertise (see Appendix A). Workshop Outcomes: Federal and state health officials agreed upon a prioritized list of four infectious disease groups: 1. Tuberculosis 2. Aedes-transmitted arboviral diseases (dengue, chikungunya, Zika) 3. Enteric diseases (Vibrio spp., Listeria monocytogenes, non-typhoidal Salmonella, and Brucella spp.) 4. Rickettsioses (R. rickettsiae, R. typhi, R. parkeri) Workshop Methods The prioritization process used a semi-quantitative tool developed by CDC’s One Health Office2. During a pre-workshop webinar, a preliminary list of 20 infectious diseases (see Appendix B) based on recent border health initiatives was reviewed, discussed, and finalized in collaboration with voting participants and advisors. During the workshop, participants jointly identified five criteria for quantitative ranking of these infectious diseases. Participants then worked in groups to develop one categorical question for each criterion (see Appendix C). All questions had ordinal multinomial answers, as required for the OHZDP tool. Once the five criteria and questions were agreed upon by the broader group of participants, each voting member determined the relative importance of each criterion from their agency’s perspective. These individual rankings were used to generate a final group of weights for each criterion. The questions were then answered for each disease using data from available literature and subject matter expertise, generating a score for each disease. The scores for all five questions were weighted, summed, and then normalized, yielding a prioritized list with the highest final score being 1.0. The ranked list of 20 infectious diseases was presented to the workshop participants on Day 2 for general discussion (see Appendix D). The twelve voting members from federal and state agencies determined a final prioritized list of four infectious disease groups. After the disease list was finalized, workshop participants discussed potential actions and next steps regarding the prioritized infectious disease groupings. 2 Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. One Health Zoonotic Disease Prioritization [Internet]. Available at: https://www.cdc.gov/onehealth/globalactivities/prioritization.html 2 TX-DSHS-19-1309-A-000153 VOTING MEMBERS DISCUSSING THE DISEASE LIST APPENDIX A: List of Participating Agencies            Arizona Department of Health Services California Department of Public Health New Mexico Department of Health Texas Department of State Health Services Imperial County Public Health Department San Diego Country Health and Human Services Agency, Office of Border Health US Department of Health and Human Services, Office of Global Affairs Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, US-Mexico Unit (CDC–USMU) Centers for Disease Control and Prevention, Division of Vector-borne Diseases (CDC– DVBD) Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response (CDC–OPHPR) Centers for Disease Control and Prevention, One Health Office 3 TX-DSHS-19-1309-A-000154 APPENDIX B: Infectious Disease List Table 1. This list of infectious diseases was used for the US Southern Border Region Infectious Disease Prioritization workshop. Infectious Disease Brucellosis Campylobacteriosis Chagas disease Chikungunya Dengue Hepatitis A Hepatitis B HIV infection Influenza Listeria Pertussis Rickettsioses Salmonellosis (non-typhoidal) Shigella Shiga toxin-producing Escherichia coli (STEC) Syphilis Tuberculosis Varicella Vibrio infection Zika Etiological Agent Brucella species Campylobacter species Trypanosoma cruzi Chikungunya virus Dengue viruses Hepatitis A virus Hepatitis B virus Human immunodeficiency virus Influenza A and Influenza B viruses Listeria monocytogenes Bordetella species R. rickettsiae, R. parkeri, R. typhi Salmonella species Shigella species Escherichia coli species Treponema pallidum Mycobacterium tuberculosis complex Varicella-zoster virus Vibrio species Zika virus 4 TX-DSHS-19-1309-A-000155 APPENDIX C: Numerical Weights for the Criteria Selected for Ranking Infectious Diseases at the U.S. Southern Border Region 1. Epidemic / Pandemic Potential (criterion weight=0.307)  What is the number of outbreaks (defined as using the CDC case definition) in the US southern border states in the past 10 years? o (4) Multiple outbreaks (>1) and at least one outbreak has occurred in all 4 US southern border states o (3) Multiple outbreaks (>1), but outbreaks have not occurred in all 4 US southern border states o (2) Only one outbreak in any US southern border state o (1) No outbreaks in the US southern border states but at least one outbreak has occurred in Mexico (country) OR no outbreaks have occurred in US southern border states nor Mexico (country) but there is potential for an outbreak 2. Presence and rate of disease (criterion weight=0.249)  Is the highest reported incidence rate (2017, or most recent available data) from the United States southern border state county with the population >100,000 persons (within a single state) greater than the national incidence rate? o (3) Yes, all for states have a higher incidence rate o (2) Yes, <4 states have a higher incidence rate o (1) No states have a higher incidence rate 3. Impact on human health (criterion weight=0.230)  Does the disease have a significant case fatality rate (untreated, ≥5%), and does it have significant DALYs—Daily Adjusted Life Years, (at least one per 100,000 population/year or 0.1 log-scale per case/year) or a significant hospitalization rate (≥10%) for the disease? o (3) CFR ≥5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (2) CFR ≥5% but DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% o (2) CFR <5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (1) CFR <5% AND DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% 5 TX-DSHS-19-1309-A-000156 4. Capacity (criterion weight=0.115)  Is there an unmet need in a given state in the border region (unmet need is defined as no or poor lab capacity (from collection of samples to reporting) including use of available technology) OR insufficient staffing OR other substantial gap that is generally available outside the border region)? o (5) Four states have an unmet need o (4) Three states have an unmet need o (3) Two states have an unmet need o (2) One state has an unmet need o (1) No states have an unmet need 5. Effective prevention and control measures (criterion weight=0.099)  Are recognized effective surveillance systems in place in the state OR effective prevention and control measures (vaccine, treatment – but not supportive care) available in the state OR there is a potential intervention (beyond vaccine or treatment, such as case management, vector control, infection control, etc.) available in the state for this disease in all 4 southern border states? o (3) + Surveillance AND + Prevention/control measures AND + Potential intervention o OR + Prevention/control measures AND + Potential intervention o OR + Surveillance AND + Prevention/control measures o OR + Surveillance AND + Potential intervention o (2) + Surveillance only OR + Prevention/control measures only OR + Potential intervention only o (1) No surveillance, prevention/control measures, or potential interventions 6 TX-DSHS-19-1309-A-000157 APPENDIX D: Final Results of Infectious Disease Prioritization Workshop for the US Southern Border Region Table 2. Infectious diseases considered for prioritization: Final results of prioritization and normalized weights for 20 infectious diseases. The top prioritized infectious diseases selected by the voting members are shown in bold. Rank Infectious Disease Raw Score Normalized Final Score 1 Tuberculosis 1.266686081 1 2 Vibrio infection 1.237911983 0.977283955 3 Hepatitis A 1.218692442 0.962110866 4 Dengue 1.193208165 0.941992008 5 Syphilis 1.164434067 0.919275963 6 Listeria 1.159788977 0.915608843 7 Pertussis 1.151600921 0.909144688 8 Varicella 1.151600921 0.909144688 9 Influenza 1.142046364 0.901601732 10 Rickettsioses 1.115085159 0.880316896 11 Campylobacteriosis 1.102252014 0.870185621 12 Salmonellosis (non-typhoidal) 1.102252014 0.870185621 13 STEC 1.102252014 0.870185621 14 Zika 1.090956151 0.861267971 15 Shigella 1.007741664 0.795573331 16 Hepatitis B 0.991800712 0.782988561 17 HIV infection 0.959930039 0.75782789 18 Chikungunya 0.947096894 0.747696614 19 Brucellosis 0.918322796 0.724980569 20 Chagas disease 0.707818409 0.558795443 7 TX-DSHS-19-1309-A-000158 Subject: FW: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST Location: Skype Meeting Start: Wednesday, December 12, 2018 11:30 AM EST End: Wednesday, December 12, 2018 1:30 PM EST Show Time As: Busy Recurrence: None Meeting Status: Not yet responded Organizer: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) Required Attendees: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) ; Prot,Emilie (DSHS) ; Ruiz,Mauro (DSHS) ; Boneta,Otto (DSHS) ; Morris,Sandra (DSHS) ; Rocha,Felipe (DSHS) ; Poe,Jonathon D (DSHS) ; Rodriguez,Tomas R (DSHS Contractor) ; iom5@cdc.gov ; Foy,Elizabeth (DSHS) ; Martinez,Angelica (DSHS Contractor) ; Vaaler,Margaret (DSHS) ; Komatsu, Kenneth (CDC azdhs.gov) ; Brady, Shane (CDC azdhs.gov) ; Santibanez, Margarita@CDPH ; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov) ; Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us) ; DOH ; Shuford,Jennifer (DSHS) ; Banicki,Allison (DSHS) ; Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD) ; Mcconnell, Michelle (HHS/OS/OGA) ; Waterman, Steve (CDC/DDID/NCEZID/DVBD) ; Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR) ; Tyler,Carla (DSHS) ; Sidwa,Tom (DSHS) ; Frieda Adams (Freida.Adams@state.nm.us) ; Olivia.Arizmendi@cdph.ca.gov ; Torres,David (DSHS) ; Delossantos,Rosy (DSHS) ; April Fernandez (april.fernandez@cdph.ca.gov) ; Kozo, Justine ; Paula Kriner ; Maria Fierro ; Robert Guerrero (robert.guerrero@azdhs.gov) ; Mariana Casal (mariana.casal@azdhs.gov) ; Corona Luevanos,Adriana (DSHS) ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Eugene Livar Attachment(s): "US Southern Border Region Infectious Disease Prioritization_Workshop Sum....pdf" -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Tuesday, December 11, 2018 9:38 AM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Morris,Sandra (DSHS); Rocha,Felipe (DSHS); Poe,Jonathon D (DSHS); Rodriguez,Tomas R (DSHS Contractor); iom5@cdc.gov; Foy,Elizabeth (DSHS); Martinez,Angelica (DSHS Contractor); Vaaler,Margaret (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: FW: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting Here is the call-in information. I am not sure when the bulk of the TB discussion will occur, but I am happy to have y’all on the call with me! Jennifer -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Thursday, November 15, 2018 3:52 PM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); TX-DSHS-19-1309-A-000159 Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, this date was the clear winner out of the three that we had proposed and sent out. Our apologies to anyone who is not able to participate. Reminder about the purpose of this call: the next step in the disease prioritization process that we began at September’s Infectious Disease Prioritization for Multijurisdictional Engagement at the US Southern Land Border Workshop (workshop summary is attached) is to finalize the general recommendations for the four prioritized diseases/disease category’s and develop disease specific recommendations/action items. We hope to develop a draft of those recommendations over two conference calls to be held in December and January. On this call we will discuss the general recommendations, as well as TB and enteric diseases. Please forward this invite to any TB or enteric disease subject matter experts in your state that you would like to join the call. On the January call we discuss Aedes-transmitted diseases and rickettsioses. Within the next week you will receive: · A draft of the general recommendations that were developed at the workshop. · Additional questions about the general recommendations (~8-10) to review and answer as a state prior to the conference call. o This is a great opportunity for those on your team who cannot participate on this call to provide input. CONFERNCE CALL INFORMATION ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 8059272 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... Thank you, Tom Gray Public Health Specialist Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 619.692.5625 office; 404.594.0908 cell ; 619.692.8821 fax To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html Confidentiality Notice: This message and the accompanying documents may contain information that is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this e-mail is not the intended recipient, you are hereby notified that you are strictly prohibited from reading, disseminating, distributing, or copying this communication. If you have received this e-mail in error, please notify the sender immediately and destroy the original transmission. Thank you. TX-DSHS-19-1309-A-000160 Infectious Disease Prioritization for Multijurisdictional Engagement at the United States Southern Border Region San Diego1 California September 27-28 1 2018 Workshop Summary Infectious Disease Prioritization for the United States Southern Border Region • The Centers for Disease Control and Prevention (CDC)United States-Mexico Unit worked with CDC'sOne Health Office to host an infectious disease prioritization workshop for the US southern border region in San Diego, California September 27-28, 2018. • This workshop was the first time CDC's One Health Zoonotic Disease Prioritization (OHZDP)tool was used to prioritize infectious diseases beyond zoonoses and for a regional approach to prioritization. Workshop Goals: • • 1 To prioritize endemic and emerging infectious diseases of particular concern in the US southern border region,1 identify common USfederal and state priorities, and determine how to jointly address them. These include diseases that can be introduced and amplified, or cause an outbreak, due to the movement of people, products, or animals between the US and Mexico. To develop plans to address gaps in surveillance, response, or other relevant activities for the prioritized diseases. The 44 US counties with the majoritv of their area within the 100 km line, as established bv the 1983 La Paz agreement 1 TX-DSHS-19-1309-A-000161 Workshop Participants: The workshop was attended by 32 participants from federal and state agencies. There were 12 voting members (4 federal and 8 state representatives) and many advisors providing subject matter expertise (see Appendix A). Workshop Outcomes: Federal and state health officials agreed upon a prioritized list of four infectious disease groups: 1. Tuberculosis 2. Aedes-transmitted arboviral diseases (dengue, chikungunya, Zika) 3. Enteric diseases (Vibrio spp., Listeria monocytogenes, non-typhoidal Salmonella, and Brucella spp.) 4. Rickettsioses (R. rickettsiae, R. typhi, R. parkeri) Workshop Methods The prioritization process used a semi-quantitative tool developed by CDC’s One Health Office2. During a pre-workshop webinar, a preliminary list of 20 infectious diseases (see Appendix B) based on recent border health initiatives was reviewed, discussed, and finalized in collaboration with voting participants and advisors. During the workshop, participants jointly identified five criteria for quantitative ranking of these infectious diseases. Participants then worked in groups to develop one categorical question for each criterion (see Appendix C). All questions had ordinal multinomial answers, as required for the OHZDP tool. Once the five criteria and questions were agreed upon by the broader group of participants, each voting member determined the relative importance of each criterion from their agency’s perspective. These individual rankings were used to generate a final group of weights for each criterion. The questions were then answered for each disease using data from available literature and subject matter expertise, generating a score for each disease. The scores for all five questions were weighted, summed, and then normalized, yielding a prioritized list with the highest final score being 1.0. The ranked list of 20 infectious diseases was presented to the workshop participants on Day 2 for general discussion (see Appendix D). The twelve voting members from federal and state agencies determined a final prioritized list of four infectious disease groups. After the disease list was finalized, workshop participants discussed potential actions and next steps regarding the prioritized infectious disease groupings. 2 Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. One Health Zoonotic Disease Prioritization [Internet]. Available at: https://www.cdc.gov/onehealth/globalactivities/prioritization.html 2 TX-DSHS-19-1309-A-000162 VOTING MEMBERS DISCUSSING THE DISEASE LIST APPENDIX A: List of Participating Agencies            Arizona Department of Health Services California Department of Public Health New Mexico Department of Health Texas Department of State Health Services Imperial County Public Health Department San Diego Country Health and Human Services Agency, Office of Border Health US Department of Health and Human Services, Office of Global Affairs Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, US-Mexico Unit (CDC–USMU) Centers for Disease Control and Prevention, Division of Vector-borne Diseases (CDC– DVBD) Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response (CDC–OPHPR) Centers for Disease Control and Prevention, One Health Office 3 TX-DSHS-19-1309-A-000163 APPENDIX B: Infectious Disease List Table 1. This list of infectious diseases was used for the US Southern Border Region Infectious Disease Prioritization workshop. Infectious Disease Brucellosis Campylobacteriosis Chagas disease Chikungunya Dengue Hepatitis A Hepatitis B HIV infection Influenza Listeria Pertussis Rickettsioses Salmonellosis (non-typhoidal) Shigella Shiga toxin-producing Escherichia coli (STEC) Syphilis Tuberculosis Varicella Vibrio infection Zika Etiological Agent Brucella species Campylobacter species Trypanosoma cruzi Chikungunya virus Dengue viruses Hepatitis A virus Hepatitis B virus Human immunodeficiency virus Influenza A and Influenza B viruses Listeria monocytogenes Bordetella species R. rickettsiae, R. parkeri, R. typhi Salmonella species Shigella species Escherichia coli species Treponema pallidum Mycobacterium tuberculosis complex Varicella-zoster virus Vibrio species Zika virus 4 TX-DSHS-19-1309-A-000164 APPENDIX C: Numerical Weights for the Criteria Selected for Ranking Infectious Diseases at the U.S. Southern Border Region 1. Epidemic / Pandemic Potential (criterion weight=0.307)  What is the number of outbreaks (defined as using the CDC case definition) in the US southern border states in the past 10 years? o (4) Multiple outbreaks (>1) and at least one outbreak has occurred in all 4 US southern border states o (3) Multiple outbreaks (>1), but outbreaks have not occurred in all 4 US southern border states o (2) Only one outbreak in any US southern border state o (1) No outbreaks in the US southern border states but at least one outbreak has occurred in Mexico (country) OR no outbreaks have occurred in US southern border states nor Mexico (country) but there is potential for an outbreak 2. Presence and rate of disease (criterion weight=0.249)  Is the highest reported incidence rate (2017, or most recent available data) from the United States southern border state county with the population >100,000 persons (within a single state) greater than the national incidence rate? o (3) Yes, all for states have a higher incidence rate o (2) Yes, <4 states have a higher incidence rate o (1) No states have a higher incidence rate 3. Impact on human health (criterion weight=0.230)  Does the disease have a significant case fatality rate (untreated, ≥5%), and does it have significant DALYs—Daily Adjusted Life Years, (at least one per 100,000 population/year or 0.1 log-scale per case/year) or a significant hospitalization rate (≥10%) for the disease? o (3) CFR ≥5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (2) CFR ≥5% but DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% o (2) CFR <5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (1) CFR <5% AND DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% 5 TX-DSHS-19-1309-A-000165 4. Capacity (criterion weight=0.115)  Is there an unmet need in a given state in the border region (unmet need is defined as no or poor lab capacity (from collection of samples to reporting) including use of available technology) OR insufficient staffing OR other substantial gap that is generally available outside the border region)? o (5) Four states have an unmet need o (4) Three states have an unmet need o (3) Two states have an unmet need o (2) One state has an unmet need o (1) No states have an unmet need 5. Effective prevention and control measures (criterion weight=0.099)  Are recognized effective surveillance systems in place in the state OR effective prevention and control measures (vaccine, treatment – but not supportive care) available in the state OR there is a potential intervention (beyond vaccine or treatment, such as case management, vector control, infection control, etc.) available in the state for this disease in all 4 southern border states? o (3) + Surveillance AND + Prevention/control measures AND + Potential intervention o OR + Prevention/control measures AND + Potential intervention o OR + Surveillance AND + Prevention/control measures o OR + Surveillance AND + Potential intervention o (2) + Surveillance only OR + Prevention/control measures only OR + Potential intervention only o (1) No surveillance, prevention/control measures, or potential interventions 6 TX-DSHS-19-1309-A-000166 APPENDIX D: Final Results of Infectious Disease Prioritization Workshop for the US Southern Border Region Table 2. Infectious diseases considered for prioritization: Final results of prioritization and normalized weights for 20 infectious diseases. The top prioritized infectious diseases selected by the voting members are shown in bold. Rank Infectious Disease Raw Score Normalized Final Score 1 Tuberculosis 1.266686081 1 2 Vibrio infection 1.237911983 0.977283955 3 Hepatitis A 1.218692442 0.962110866 4 Dengue 1.193208165 0.941992008 5 Syphilis 1.164434067 0.919275963 6 Listeria 1.159788977 0.915608843 7 Pertussis 1.151600921 0.909144688 8 Varicella 1.151600921 0.909144688 9 Influenza 1.142046364 0.901601732 10 Rickettsioses 1.115085159 0.880316896 11 Campylobacteriosis 1.102252014 0.870185621 12 Salmonellosis (non-typhoidal) 1.102252014 0.870185621 13 STEC 1.102252014 0.870185621 14 Zika 1.090956151 0.861267971 15 Shigella 1.007741664 0.795573331 16 Hepatitis B 0.991800712 0.782988561 17 HIV infection 0.959930039 0.75782789 18 Chikungunya 0.947096894 0.747696614 19 Brucellosis 0.918322796 0.724980569 20 Chagas disease 0.707818409 0.558795443 7 TX-DSHS-19-1309-A-000167 Subject: FW: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST Location: Skype Meeting Start: Wednesday, December 12, 2018 11:30 AM EST End: Wednesday, December 12, 2018 1:30 PM EST Show Time As: Busy Recurrence: None Meeting Status: Not yet responded Organizer: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) Required Attendees: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) ; Prot,Emilie (DSHS) ; Ruiz,Mauro (DSHS) ; Boneta,Otto (DSHS) ; Morris,Sandra (DSHS) ; Rocha,Felipe (DSHS) ; Poe,Jonathon D (DSHS) ; Rodriguez,Tomas R (DSHS Contractor) ; iom5@cdc.gov ; Foy,Elizabeth (DSHS) ; Martinez,Angelica (DSHS Contractor) ; Vaaler,Margaret (DSHS) ; Komatsu, Kenneth (CDC azdhs.gov) ; Brady, Shane (CDC azdhs.gov) ; Santibanez, Margarita@CDPH ; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov) ; Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us) ; DOH ; Shuford,Jennifer (DSHS) ; Banicki,Allison (DSHS) ; Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD) ; Mcconnell, Michelle (HHS/OS/OGA) ; Waterman, Steve (CDC/DDID/NCEZID/DVBD) ; Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR) ; Tyler,Carla (DSHS) ; Sidwa,Tom (DSHS) ; Frieda Adams (Freida.Adams@state.nm.us) ; Olivia.Arizmendi@cdph.ca.gov ; Torres,David (DSHS) ; Delossantos,Rosy (DSHS) ; April Fernandez (april.fernandez@cdph.ca.gov) ; Kozo, Justine ; Paula Kriner ; Maria Fierro ; Robert Guerrero (robert.guerrero@azdhs.gov) ; Mariana Casal (mariana.casal@azdhs.gov) ; Corona Luevanos,Adriana (DSHS) ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Eugene Livar Attachment(s): "US Southern Border Region Infectious Disease Prioritization_Workshop Sum....pdf" -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Tuesday, December 11, 2018 9:38 AM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Morris,Sandra (DSHS); Rocha,Felipe (DSHS); Poe,Jonathon D (DSHS); Rodriguez,Tomas R (DSHS Contractor); iom5@cdc.gov; Foy,Elizabeth (DSHS); Martinez,Angelica (DSHS Contractor); Vaaler,Margaret (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: FW: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting Here is the call-in information. I am not sure when the bulk of the TB discussion will occur, but I am happy to have y’all on the call with me! Jennifer -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) [mailto:mze3@cdc.gov] Sent: Thursday, November 15, 2018 3:52 PM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Tyler,Carla (DSHS); Sidwa,Tom (DSHS); Frieda Adams (Freida.Adams@state.nm.us); TX-DSHS-19-1309-A-000168 Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar Subject: Infectious Disease Prioritization for the U.S. Southern Land Border: Conference Call to Discuss General/Disease Specific Recommendations; 8:30 am PST - 10:30 am PST When: Wednesday, December 12, 2018 8:30 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, this date was the clear winner out of the three that we had proposed and sent out. Our apologies to anyone who is not able to participate. Reminder about the purpose of this call: the next step in the disease prioritization process that we began at September’s Infectious Disease Prioritization for Multijurisdictional Engagement at the US Southern Land Border Workshop (workshop summary is attached) is to finalize the general recommendations for the four prioritized diseases/disease category’s and develop disease specific recommendations/action items. We hope to develop a draft of those recommendations over two conference calls to be held in December and January. On this call we will discuss the general recommendations, as well as TB and enteric diseases. Please forward this invite to any TB or enteric disease subject matter experts in your state that you would like to join the call. On the January call we discuss Aedes-transmitted diseases and rickettsioses. Within the next week you will receive: · A draft of the general recommendations that were developed at the workshop. · Additional questions about the general recommendations (~8-10) to review and answer as a state prior to the conference call. o This is a great opportunity for those on your team who cannot participate on this call to provide input. CONFERNCE CALL INFORMATION ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 8059272 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... Thank you, Tom Gray Public Health Specialist Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 619.692.5625 office; 404.594.0908 cell ; 619.692.8821 fax To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html Confidentiality Notice: This message and the accompanying documents may contain information that is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this e-mail is not the intended recipient, you are hereby notified that you are strictly prohibited from reading, disseminating, distributing, or copying this communication. If you have received this e-mail in error, please notify the sender immediately and destroy the original transmission. Thank you. TX-DSHS-19-1309-A-000169 Infectious Disease Prioritization for Multijurisdictional Engagement at the United States Southern Border Region San Diego1 California September 27-28 1 2018 Workshop Summary Infectious Disease Prioritization for the United States Southern Border Region • The Centers for Disease Control and Prevention (CDC)United States-Mexico Unit worked with CDC'sOne Health Office to host an infectious disease prioritization workshop for the US southern border region in San Diego, California September 27-28, 2018. • This workshop was the first time CDC's One Health Zoonotic Disease Prioritization (OHZDP)tool was used to prioritize infectious diseases beyond zoonoses and for a regional approach to prioritization. Workshop Goals: • • 1 To prioritize endemic and emerging infectious diseases of particular concern in the US southern border region,1 identify common USfederal and state priorities, and determine how to jointly address them. These include diseases that can be introduced and amplified, or cause an outbreak, due to the movement of people, products, or animals between the US and Mexico. To develop plans to address gaps in surveillance, response, or other relevant activities for the prioritized diseases. The 44 US counties with the majoritv of their area within the 100 km line, as established bv the 1983 La Paz agreement 1 TX-DSHS-19-1309-A-000170 Workshop Participants: The workshop was attended by 32 participants from federal and state agencies. There were 12 voting members (4 federal and 8 state representatives) and many advisors providing subject matter expertise (see Appendix A). Workshop Outcomes: Federal and state health officials agreed upon a prioritized list of four infectious disease groups: 1. Tuberculosis 2. Aedes-transmitted arboviral diseases (dengue, chikungunya, Zika) 3. Enteric diseases (Vibrio spp., Listeria monocytogenes, non-typhoidal Salmonella, and Brucella spp.) 4. Rickettsioses (R. rickettsiae, R. typhi, R. parkeri) Workshop Methods The prioritization process used a semi-quantitative tool developed by CDC’s One Health Office2. During a pre-workshop webinar, a preliminary list of 20 infectious diseases (see Appendix B) based on recent border health initiatives was reviewed, discussed, and finalized in collaboration with voting participants and advisors. During the workshop, participants jointly identified five criteria for quantitative ranking of these infectious diseases. Participants then worked in groups to develop one categorical question for each criterion (see Appendix C). All questions had ordinal multinomial answers, as required for the OHZDP tool. Once the five criteria and questions were agreed upon by the broader group of participants, each voting member determined the relative importance of each criterion from their agency’s perspective. These individual rankings were used to generate a final group of weights for each criterion. The questions were then answered for each disease using data from available literature and subject matter expertise, generating a score for each disease. The scores for all five questions were weighted, summed, and then normalized, yielding a prioritized list with the highest final score being 1.0. The ranked list of 20 infectious diseases was presented to the workshop participants on Day 2 for general discussion (see Appendix D). The twelve voting members from federal and state agencies determined a final prioritized list of four infectious disease groups. After the disease list was finalized, workshop participants discussed potential actions and next steps regarding the prioritized infectious disease groupings. 2 Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. One Health Zoonotic Disease Prioritization [Internet]. Available at: https://www.cdc.gov/onehealth/globalactivities/prioritization.html 2 TX-DSHS-19-1309-A-000171 VOTING MEMBERS DISCUSSING THE DISEASE LIST APPENDIX A: List of Participating Agencies            Arizona Department of Health Services California Department of Public Health New Mexico Department of Health Texas Department of State Health Services Imperial County Public Health Department San Diego Country Health and Human Services Agency, Office of Border Health US Department of Health and Human Services, Office of Global Affairs Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, US-Mexico Unit (CDC–USMU) Centers for Disease Control and Prevention, Division of Vector-borne Diseases (CDC– DVBD) Centers for Disease Control and Prevention, Office of Public Health Preparedness and Response (CDC–OPHPR) Centers for Disease Control and Prevention, One Health Office 3 TX-DSHS-19-1309-A-000172 APPENDIX B: Infectious Disease List Table 1. This list of infectious diseases was used for the US Southern Border Region Infectious Disease Prioritization workshop. Infectious Disease Brucellosis Campylobacteriosis Chagas disease Chikungunya Dengue Hepatitis A Hepatitis B HIV infection Influenza Listeria Pertussis Rickettsioses Salmonellosis (non-typhoidal) Shigella Shiga toxin-producing Escherichia coli (STEC) Syphilis Tuberculosis Varicella Vibrio infection Zika Etiological Agent Brucella species Campylobacter species Trypanosoma cruzi Chikungunya virus Dengue viruses Hepatitis A virus Hepatitis B virus Human immunodeficiency virus Influenza A and Influenza B viruses Listeria monocytogenes Bordetella species R. rickettsiae, R. parkeri, R. typhi Salmonella species Shigella species Escherichia coli species Treponema pallidum Mycobacterium tuberculosis complex Varicella-zoster virus Vibrio species Zika virus 4 TX-DSHS-19-1309-A-000173 APPENDIX C: Numerical Weights for the Criteria Selected for Ranking Infectious Diseases at the U.S. Southern Border Region 1. Epidemic / Pandemic Potential (criterion weight=0.307)  What is the number of outbreaks (defined as using the CDC case definition) in the US southern border states in the past 10 years? o (4) Multiple outbreaks (>1) and at least one outbreak has occurred in all 4 US southern border states o (3) Multiple outbreaks (>1), but outbreaks have not occurred in all 4 US southern border states o (2) Only one outbreak in any US southern border state o (1) No outbreaks in the US southern border states but at least one outbreak has occurred in Mexico (country) OR no outbreaks have occurred in US southern border states nor Mexico (country) but there is potential for an outbreak 2. Presence and rate of disease (criterion weight=0.249)  Is the highest reported incidence rate (2017, or most recent available data) from the United States southern border state county with the population >100,000 persons (within a single state) greater than the national incidence rate? o (3) Yes, all for states have a higher incidence rate o (2) Yes, <4 states have a higher incidence rate o (1) No states have a higher incidence rate 3. Impact on human health (criterion weight=0.230)  Does the disease have a significant case fatality rate (untreated, ≥5%), and does it have significant DALYs—Daily Adjusted Life Years, (at least one per 100,000 population/year or 0.1 log-scale per case/year) or a significant hospitalization rate (≥10%) for the disease? o (3) CFR ≥5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (2) CFR ≥5% but DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% o (2) CFR <5% AND DALY at least one per 100,000 population/year or 0.1 log-scale per case/year OR hospitalization rate ≥10% o (1) CFR <5% AND DALY at <1 per 100,000 population/year or < 0.1 logscale per case/year OR hospitalization rate < 10% 5 TX-DSHS-19-1309-A-000174 4. Capacity (criterion weight=0.115)  Is there an unmet need in a given state in the border region (unmet need is defined as no or poor lab capacity (from collection of samples to reporting) including use of available technology) OR insufficient staffing OR other substantial gap that is generally available outside the border region)? o (5) Four states have an unmet need o (4) Three states have an unmet need o (3) Two states have an unmet need o (2) One state has an unmet need o (1) No states have an unmet need 5. Effective prevention and control measures (criterion weight=0.099)  Are recognized effective surveillance systems in place in the state OR effective prevention and control measures (vaccine, treatment – but not supportive care) available in the state OR there is a potential intervention (beyond vaccine or treatment, such as case management, vector control, infection control, etc.) available in the state for this disease in all 4 southern border states? o (3) + Surveillance AND + Prevention/control measures AND + Potential intervention o OR + Prevention/control measures AND + Potential intervention o OR + Surveillance AND + Prevention/control measures o OR + Surveillance AND + Potential intervention o (2) + Surveillance only OR + Prevention/control measures only OR + Potential intervention only o (1) No surveillance, prevention/control measures, or potential interventions 6 TX-DSHS-19-1309-A-000175 APPENDIX D: Final Results of Infectious Disease Prioritization Workshop for the US Southern Border Region Table 2. Infectious diseases considered for prioritization: Final results of prioritization and normalized weights for 20 infectious diseases. The top prioritized infectious diseases selected by the voting members are shown in bold. Rank Infectious Disease Raw Score Normalized Final Score 1 Tuberculosis 1.266686081 1 2 Vibrio infection 1.237911983 0.977283955 3 Hepatitis A 1.218692442 0.962110866 4 Dengue 1.193208165 0.941992008 5 Syphilis 1.164434067 0.919275963 6 Listeria 1.159788977 0.915608843 7 Pertussis 1.151600921 0.909144688 8 Varicella 1.151600921 0.909144688 9 Influenza 1.142046364 0.901601732 10 Rickettsioses 1.115085159 0.880316896 11 Campylobacteriosis 1.102252014 0.870185621 12 Salmonellosis (non-typhoidal) 1.102252014 0.870185621 13 STEC 1.102252014 0.870185621 14 Zika 1.090956151 0.861267971 15 Shigella 1.007741664 0.795573331 16 Hepatitis B 0.991800712 0.782988561 17 HIV infection 0.959930039 0.75782789 18 Chikungunya 0.947096894 0.747696614 19 Brucellosis 0.918322796 0.724980569 20 Chagas disease 0.707818409 0.558795443 7 TX-DSHS-19-1309-A-000176 Subject: Fw: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: 1-866-807-3352 participant 2858251 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Shuford,Jennifer (DSHS) ; Leos,Greg (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Banicki,Allison (DSHS) Optional Attendees: Garcia,Imelda M (DSHS) ; Gruber,David (DSHS) Here is the call in information for the conference call with CDC at noon central. Thanks! Linda K. Gaul, PhD, MPH State Epidemiologist 512-776-7198, office 512-247-1691, cell 512-458-7717, fax Texas Department of State Health Services 1100 W. 49th St. Austin, TX 78756 From: Thompson, Mark (CDC/DDID/NCIRD/ID) Sent: Thursday, December 27, 2018 9:35 AM To: Thompson, Mark (CDC/DDID/NCIRD/ID); Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Brammer, Lynnette (CDC/DDID/NCIRD/ID); Wentworth, David E. (CDC/DDID/NCIRD/ID); Barnes, John R. (CDC/DDID/NCIRD/ID); alexandra.peterson@azdhs.gov; Chavez, Gilbert (CDC cdph.ca.gov); Landen, Michael (CDC state.nm.us); Smelser, Chad CS (CDC state.nm.us); Rucas,Hailey (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov); McDonald, Eric (CDC sdcounty.ca.gov); Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR); Ladva, Chandresh (CDC/DDID/NCIRD/ID); Chow, Eric (CDC/DDID/NCIRD/ID); Doyle, Joshua (CDC/DDID/NCIRD/ID); Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID); Kile, James C. (CDC/DDID/NCIRD/ID); Gaul,Linda (DSHS) Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX When: Thursday, December 27, 2018 12:00 PM-1:00 PM. Where: 1-866-807-3352 participant 2858251 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 Participant Passcode: 2858251 TX-DSHS-19-1309-A-000177 Subject: Fw: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: 1-866-807-3352 participant 2858251 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Thompson, Mark (CDC/DDID/NCIRD/ID) ; Shuford,Jennifer (DSHS) ; Leos,Greg (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Banicki,Allison (DSHS) ; Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Brammer, Lynnette (CDC/DDID/NCIRD/ID) ; Wentworth, David E. (CDC/DDID/NCIRD/ID) ; Barnes, John R. (CDC/DDID/NCIRD/ID) ; alexandra.peterson@azdhs.gov ; Chavez, Gilbert (CDC cdph.ca.gov) ; Landen, Michael (CDC state.nm.us) ; Smelser, Chad CS (CDC state.nm.us) ; Komatsu, Kenneth (CDC azdhs.gov) ; Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR) ; Ladva, Chandresh (CDC/DDID/NCIRD/ID) ; Chow, Eric (CDC/DDID/NCIRD/ID) ; Doyle, Joshua (CDC/DDID/NCIRD/ID) ; Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID) ; Kile, James C. (CDC/DDID/NCIRD/ID) ; Gaul,Linda (DSHS) Optional Attendees: Garcia,Imelda M (DSHS) ; Gruber,David (DSHS) Here is the call in information for the conference call with CDC at noon central. Thanks! Linda K. Gaul, PhD, MPH State Epidemiologist 512-776-7198, office 512-247-1691, cell 512-458-7717, fax Texas Department of State Health Services 1100 W. 49th St. Austin, TX 78756 From: Thompson, Mark (CDC/DDID/NCIRD/ID) Sent: Thursday, December 27, 2018 9:35 AM To: Thompson, Mark (CDC/DDID/NCIRD/ID); Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Brammer, Lynnette (CDC/DDID/NCIRD/ID); Wentworth, David E. (CDC/DDID/NCIRD/ID); Barnes, John R. (CDC/DDID/NCIRD/ID); alexandra.peterson@azdhs.gov; Chavez, Gilbert (CDC cdph.ca.gov); Landen, Michael (CDC state.nm.us); Smelser, Chad CS (CDC state.nm.us); Rucas,Hailey (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov); McDonald, Eric (CDC sdcounty.ca.gov); Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR); Ladva, Chandresh (CDC/DDID/NCIRD/ID); Chow, Eric (CDC/DDID/NCIRD/ID); Doyle, Joshua (CDC/DDID/NCIRD/ID); Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID); Kile, James C. (CDC/DDID/NCIRD/ID); Gaul,Linda (DSHS) Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX When: Thursday, December 27, 2018 12:00 PM-1:00 PM. Where: 1-866-807-3352 participant 2858251 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? TX-DSHS-19-1309-A-000178 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 Participant Passcode: 2858251 TX-DSHS-19-1309-A-000179 Subject: Fw: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: 1-866-807-3352 participant 2858251 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Thompson, Mark (CDC/DDID/NCIRD/ID) ; Shuford,Jennifer (DSHS) ; Leos,Greg (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Aragon,Antonio (DSHS) ; Rucas,Hailey (DSHS) ; Banicki,Allison (DSHS) ; Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Brammer, Lynnette (CDC/DDID/NCIRD/ID) ; Wentworth, David E. (CDC/DDID/NCIRD/ID) ; Barnes, John R. (CDC/DDID/NCIRD/ID) ; alexandra.peterson@azdhs.gov ; Chavez, Gilbert (CDC cdph.ca.gov) ; Landen, Michael (CDC state.nm.us) ; Smelser, Chad CS (CDC state.nm.us) ; Komatsu, Kenneth (CDC azdhs.gov) ; Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR) ; Ladva, Chandresh (CDC/DDID/NCIRD/ID) ; Chow, Eric (CDC/DDID/NCIRD/ID) ; Doyle, Joshua (CDC/DDID/NCIRD/ID) ; Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID) ; Kile, James C. (CDC/DDID/NCIRD/ID) ; Gaul,Linda (DSHS) Optional Attendees: Garcia,Imelda M (DSHS) ; Gruber,David (DSHS) Here is the call in information for the conference call with CDC at noon central. Thanks! Linda K. Gaul, PhD, MPH State Epidemiologist 512-776-7198, office 512-247-1691, cell 512-458-7717, fax Texas Department of State Health Services 1100 W. 49th St. Austin, TX 78756 From: Thompson, Mark (CDC/DDID/NCIRD/ID) Sent: Thursday, December 27, 2018 9:35 AM To: Thompson, Mark (CDC/DDID/NCIRD/ID); Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Brammer, Lynnette (CDC/DDID/NCIRD/ID); Wentworth, David E. (CDC/DDID/NCIRD/ID); Barnes, John R. (CDC/DDID/NCIRD/ID); alexandra.peterson@azdhs.gov; Chavez, Gilbert (CDC cdph.ca.gov); Landen, Michael (CDC state.nm.us); Smelser, Chad CS (CDC state.nm.us); Rucas,Hailey (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov); McDonald, Eric (CDC sdcounty.ca.gov); Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR); Ladva, Chandresh (CDC/DDID/NCIRD/ID); Chow, Eric (CDC/DDID/NCIRD/ID); Doyle, Joshua (CDC/DDID/NCIRD/ID); Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID); Kile, James C. (CDC/DDID/NCIRD/ID); Gaul,Linda (DSHS) Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX When: Thursday, December 27, 2018 12:00 PM-1:00 PM. Where: 1-866-807-3352 participant 2858251 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? TX-DSHS-19-1309-A-000180 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 Participant Passcode: 2858251 TX-DSHS-19-1309-A-000181 Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: new number 866 811 0826 code 151367 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Thompson, Mark (CDC/DDID/NCIRD/ID) ; Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Brammer, Lynnette (CDC/DDID/NCIRD/ID) ; Wentworth, David E. (CDC/DDID/NCIRD/ID) ; Barnes, John R. (CDC/DDID/NCIRD/ID) ; alexandra.peterson@azdhs.gov ; Chavez, Gilbert (CDC cdph.ca.gov) ; Landen, Michael (CDC state.nm.us) ; Smelser, Chad CS (CDC state.nm.us) ; Rucas,Hailey (DSHS) ; Komatsu, Kenneth (CDC azdhs.gov) ; Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR) ; Ladva, Chandresh (CDC/DDID/NCIRD/ID) ; Chow, Eric (CDC/DDID/NCIRD/ID) ; Doyle, Joshua (CDC/DDID/NCIRD/ID) ; Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID) ; Kile, James C. (CDC/DDID/NCIRD/ID) ; Gaul,Linda (DSHS) ; Messonnier, Nancy (CDC/DDID/NCIRD/OD) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Optional Attendees: Aragon,Antonio (DSHS) ; Bresee, Joseph (CDC/DDID/NCIRD/ID) ; Gruber,David (DSHS) ; Djuric, Maria ; Kubin,Grace (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Banicki,Allison (DSHS) ; Harriman, Kathleen@CDPH ; Fernandez, April@CDPH ; Hughes, Michelle (CDC/DDID/NCIRD/ID) WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: 1. Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? 2. Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? TX-DSHS-19-1309-A-000182 Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: new number 866 811 0826 code 151367 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Thompson, Mark (CDC/DDID/NCIRD/ID) ; Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Brammer, Lynnette (CDC/DDID/NCIRD/ID) ; Wentworth, David E. (CDC/DDID/NCIRD/ID) ; Barnes, John R. (CDC/DDID/NCIRD/ID) ; alexandra.peterson@azdhs.gov ; Chavez, Gilbert (CDC cdph.ca.gov) ; Landen, Michael (CDC state.nm.us) ; Smelser, Chad CS (CDC state.nm.us) ; Rucas,Hailey (DSHS) ; Komatsu, Kenneth (CDC azdhs.gov) ; Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR) ; Ladva, Chandresh (CDC/DDID/NCIRD/ID) ; Chow, Eric (CDC/DDID/NCIRD/ID) ; Doyle, Joshua (CDC/DDID/NCIRD/ID) ; Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID) ; Kile, James C. (CDC/DDID/NCIRD/ID) ; Gaul,Linda (DSHS) ; Messonnier, Nancy (CDC/DDID/NCIRD/OD) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Optional Attendees: Aragon,Antonio (DSHS) ; Bresee, Joseph (CDC/DDID/NCIRD/ID) ; Gruber,David (DSHS) ; Djuric, Maria ; Kubin,Grace (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Banicki,Allison (DSHS) ; Harriman, Kathleen@CDPH ; Fernandez, April@CDPH ; Hughes, Michelle (CDC/DDID/NCIRD/ID) WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: 1. Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? 2. Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? TX-DSHS-19-1309-A-000183 Subject: FW: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: 1-866-807-3352 participant 2858251 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Kubin,Grace (DSHS) Grace here is the call information for 12 noon. -----Original Appointment----From: Thompson, Mark (CDC/DDID/NCIRD/ID) [mailto:isq8@cdc.gov] Sent: Thursday, December 27, 2018 9:42 AM To: Thompson, Mark (CDC/DDID/NCIRD/ID); Shuford,Jennifer (DSHS); Leos,Greg (DSHS); Tupy,Shawn (DSHS); Gamez,Monica (DSHS); Aragon,Antonio (DSHS); Rucas,Hailey (DSHS); Banicki,Allison (DSHS); Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Brammer, Lynnette (CDC/DDID/NCIRD/ID); Wentworth, David E. (CDC/DDID/NCIRD/ID); Barnes, John R. (CDC/DDID/NCIRD/ID); alexandra.peterson@azdhs.gov; Chavez, Gilbert (CDC cdph.ca.gov); Landen, Michael (CDC state.nm.us); Smelser, Chad CS (CDC state.nm.us); Komatsu, Kenneth (CDC azdhs.gov); Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov); McDonald, Eric (CDC sdcounty.ca.gov); Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR); Ladva, Chandresh (CDC/DDID/NCIRD/ID); Chow, Eric (CDC/DDID/NCIRD/ID); Doyle, Joshua (CDC/DDID/NCIRD/ID); Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID); Kile, James C. (CDC/DDID/NCIRD/ID); Gaul,Linda (DSHS) Cc: Garcia,Imelda M (DSHS); Gruber,David (DSHS) Subject: Fw: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX When: Thursday, December 27, 2018 1:00 PM-2:00 PM (UTC-05:00) Eastern Time (US & Canada). Where: 1-866-807-3352 participant 2858251 Here is the call in information for the conference call with CDC at noon central. Thanks! Linda K. Gaul, PhD, MPH State Epidemiologist 512-776-7198, office 512-247-1691, cell 512-458-7717, fax Texas Department of State Health Services 1100 W. 49th St. Austin, TX 78756 From: Thompson, Mark (CDC/DDID/NCIRD/ID) Sent: Thursday, December 27, 2018 9:35 AM To: Thompson, Mark (CDC/DDID/NCIRD/ID); Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Brammer, Lynnette (CDC/DDID/NCIRD/ID); Wentworth, David E. (CDC/DDID/NCIRD/ID); Barnes, John R. (CDC/DDID/NCIRD/ID); alexandra.peterson@azdhs.gov; Chavez, Gilbert (CDC cdph.ca.gov); Landen, Michael (CDC state.nm.us); Smelser, Chad CS (CDC state.nm.us); Rucas,Hailey (DSHS); Komatsu, Kenneth (CDC azdhs.gov); Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov); McDonald, Eric (CDC sdcounty.ca.gov); Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR); Ladva, Chandresh (CDC/DDID/NCIRD/ID); Chow, Eric (CDC/DDID/NCIRD/ID); Doyle, Joshua (CDC/DDID/NCIRD/ID); Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID); Kile, James C. (CDC/DDID/NCIRD/ID); Gaul,Linda (DSHS) Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX When: Thursday, December 27, 2018 12:00 PM-1:00 PM. Where: 1-866-807-3352 participant 2858251 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? TX-DSHS-19-1309-A-000184 c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 Participant Passcode: 2858251 TX-DSHS-19-1309-A-000185 Subject: Flu Surveillance along US-Mexico border in CA, AZ, NM, and TX Location: new number 866 811 0826 code 151367 Start: Thursday, December 27, 2018 1:00 PM EST End: Thursday, December 27, 2018 2:00 PM EST Show Time As: Tentative Recurrence: None Meeting Status: Not yet responded Organizer: Thompson, Mark (CDC/DDID/NCIRD/ID) Required Attendees: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Brammer, Lynnette (CDC/DDID/NCIRD/ID) ; Wentworth, David E. (CDC/DDID/NCIRD/ID) ; Barnes, John R. (CDC/DDID/NCIRD/ID) ; alexandra.peterson@azdhs.gov ; Chavez, Gilbert (CDC cdph.ca.gov) ; Landen, Michael (CDC state.nm.us) ; Smelser, Chad CS (CDC state.nm.us) ; Rucas,Hailey (DSHS) ; Komatsu, Kenneth (CDC azdhs.gov) ; Murray, Erin@cdph.ca.gov (CDC cdph.ca.gov) ; McDonald, Eric (CDC sdcounty.ca.gov) ; Dueger, Erica (CDC/DDID/NCIRD/ID) (CTR) ; Ladva, Chandresh (CDC/DDID/NCIRD/ID) ; Chow, Eric (CDC/DDID/NCIRD/ID) ; Doyle, Joshua (CDC/DDID/NCIRD/ID) ; Iuliano, A. Danielle CDC/OID/NCIRD (CDC/DDID/NCIRD/ID) ; Kile, James C. (CDC/DDID/NCIRD/ID) ; Gaul,Linda (DSHS) ; Messonnier, Nancy (CDC/DDID/NCIRD/OD) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Optional Attendees: Gaul,Linda (DSHS) ; Aragon,Antonio (DSHS) ; Bresee, Joseph (CDC/DDID/NCIRD/ID) ; Gruber,David (DSHS) ; Djuric, Maria ; Kubin,Grace (DSHS) ; Tupy,Shawn (DSHS) ; Gamez,Monica (DSHS) ; Banicki,Allison (DSHS) ; Harriman, Kathleen@CDPH ; Fernandez, April@CDPH ; Hughes, Michelle (CDC/DDID/NCIRD/ID) WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. See topics and call-in information below. State Epi leads should feel free to forward to others on your local team. Topics: 1. Influenza Surveillance a. Is there additional surveillance we should be doing to better characterize the increase in respiratory diseases at healthcare facilities along the border and among migrants? b. Should we increase submission of specimens for sequencing and full characterization? c. How best to work with DHS on respiratory disease monitoring in facilities under their jurisdiction? 2. Vaccination and Prevention a. Are current vaccination efforts sufficient for addressing the growing potential for overcrowded migrant holding facilities with increasing durations of stay? b. Is vaccine available to State and County Departments of Health to meet current need? c. Is there additional guidance that should be developed regarding vaccination or antiviral prophylaxis/treatment of migrants being held in facilities? TX-DSHS-19-1309-A-000186 From: Electronic Data Exchange (CDC) Sent: Wednesday, January 02, 2019 12:55 PM EST To: Electronic Data Exchange (CDC) CC: Hoover, Michele (CDC/DDPHSS/CSELS/DHIS) ; Hall, Christopher (Jason) (CDC/DDID/NCEZID/DPEI) Subject: CDC Announces New Message Mapping Guide for Foodborne and Diarrheal Diseases HL7 Case Notifications WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. CDC Announces New Message Mapping Guide for Foodborne and Diarrheal Diseases HL7 Case Notifications The CDC National Notifiable Diseases Surveillance System (NNDSS), in collaboration with the CDC National Center for Emerging and Zoonotic Infectious Diseases, is pleased to announce that a finalized HL7 message mapping guide (MMG) is now available for foodborne and diarrheal diseases (FDD). Public health jurisdictions can prepare to send their FDD diseases notifications by using this MMG, which is posted on the NNDSS HL7 Case Notification Resource Center at https://wwwn.cdc.gov/nndss/case-notification/message-mapping-guides.html. CDC developed this MMG to support public health’s response needs as part of the NNDSS Modernization Initiative (NMI). The NMI Technical Assistance and Onboarding teams are ready to assist jurisdictions in implementing the new messages and in obtaining approval to begin transmitting them. Please contact edx@cdc.gov to request technical assistance or to begin the onboarding process. About NNDSS To protect Americans from serious disease, NNDSS helps public health monitor, control, and prevent about 120 diseases. These diseases are important to monitor nationwide and include infectious diseases such as Zika, foodborne outbreaks such as E. coli, and noninfectious conditions such as lead poisoning. About 3,000 public health jurisdictions gather and use data on these diseases to protect their local communities. Through NNDSS, CDC receives and uses these data to keep people healthy and defend America from health threats. About the NNDSS Modernization Initiative NNDSS relies on the monitoring and disease control activities performed by local and state public health jurisdictions across the country. The NNDSS Modernization Initiative is making it faster and easier for public health jurisdictions to send data to CDC, and CDC is improving how we deliver these data to our disease programs. As part of the NMI effort and through collaboration and commitment from subject matter experts across multiple CDC national centers and involvement of jurisdiction partners and other key stakeholders, CDC is developing and adopting newgeneration MMGs for HL7 case notifications. With these guides, CDC will migrate from legacy messaging structures to the widely adopted HL7 standards that provide content standardization and interoperable message exchange structures. In addition to providing core data elements and data exchange formats, these new MMGs will satisfy CDC program requests for disease-specific variables for notifiable conditions. For more information about NMI, please access the NMI website athttp://www.cdc.gov/nmi/index.html. Social Media Text: TWITTER Public Health Agencies: NNDSS announces the availability of a new #HL7 message mapping guide for sending your foodborne and diarrheal diseases case notifications to CDC. Learn more: https://go.usa.gov/xnsRm LINKEDIN Public Health Agencies: NNDSS announces the availability of a new HL7 message mapping guide (MMG) for sending your foodborne and diarrheal diseases (FDD) case notifications to CDC. CDC developed this MMG to support public health’s response needs as part of the NNDSS Modernization Initiative. Learn more: https://go.usa.gov/xnsRm TX-DSHS-19-1309-A-000187 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Wednesday, January 02, 2019 1:06 PM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: 2019 ELC Annual Meeting Announcement WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings. If you have not done so already, we wanted to remind you to place your lunch orders for the upcoming 2019 ELC Annual Meeting. Food service is provided by Jerry's Famous Catering so place your order by going here: https://ordernow.menudrive.com/jerrysfamouscatering A discounted, flat rate has been arranged to cover daily meals, snacks, and beverage services for the ELC Annual Meeting guests. The flat rate (i.e., $20/day) includes: 1. Morning break service (coffee/tea and a snack) which is only available through the caterer. 2. Lunch 3. Afternoon break service (beverage and snack) which is only available through the caterer. If you do not wish to have onsite coffee/tea in the mornings and afternoons, other lunch options do exist across the street from the CDC at Emory Point. For scheduling purposes, please keep in mind that each leaving and re-entrance to the CDC campus will require passing through CDC Security. Please Note: All orders need to be placed before the Tuesday, March 19, 2019, cut-off date. Sincerely, The ELC Team TX-DSHS-19-1309-A-000188 From: Chavez, Gil@CDPH Sent: Friday, January 04, 2019 1:04 PM EST To: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Komatsu, Kenneth (CDC azdhs.gov) ; alexandra.peterson@azdhs.gov ; Landen, Michael (CDC state.nm.us) ; McDonald, Eric (San Diego County) ; Gaul,Linda (DSHS) ; Gamez,Monica (DSHS) ; Thompson, Mark (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Koppaka, Ram (CDC/DDID/NCIRD/ISD) ; Wharton, Melinda (CDC/DDID/NCIRD/ISD) ; Fernandez, April@CDPH ; Harriman, Kathleen@CDPH ; Siegel, Jane@CDPH ; Hull, Torane (CDC/DDID/NCIRD/ISD) ; Hull, Torane (CDC dhhs.nh.gov) ; Rogers, Denise (CDC/DDID/NCIRD/ISD) ; Murray, Erin@CDPH ; Gaul,Linda (DSHS) ; Katz, Jackie M. (CDC/DDID/NCIRD/ID) Subject: RE: Flu Surveillance and Prevention along US-Mexico border in CA, AZ, NM, and TX WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Capacity exceeded on the line again so can’t get in. Gil F. Chavez, MD, MPH State Epidemiologist Deputy Director for Infectious Diseases California Department of Public Health (916) 440-7434 -----Original Appointment----From: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) Sent: Thursday, January 03, 2019 6:15 AM To: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Chavez, Gil@CDPH; Komatsu, Kenneth (CDC azdhs.gov); alexandra.peterson@azdhs.gov; Landen, Michael (CDC state.nm.us); McDonald, Eric (San Diego County); Gaul, Linda (CDC dshs.state.tx.us); Gamez,Monica (DSHS; Thompson, Mark (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Koppaka, Ram (CDC/DDID/NCIRD/ISD); Wharton, Melinda (CDC/DDID/NCIRD/ISD); Fernandez, April@CDPH; Harriman, Kathleen@CDPH; Siegel, Jane@CDPH; Hull, Torane (CDC/DDID/NCIRD/ISD); Hull, Torane (CDC dhhs.nh.gov); Rogers, Denise (CDC/DDID/NCIRD/ISD); Murray, Erin@CDPH; Gaul,Linda (DSHS; Katz, Jackie M. (CDC/DDID/NCIRD/ID) Subject: Flu Surveillance and Prevention along US-Mexico border in CA, AZ, NM, and TX When: Friday, January 04, 2019 1:00 PM-2:00 PM (UTC-05:00) Eastern Time (US & Canada). Where: 1-866-807-3352 X2858251# All: We have reserved this time as a follow-up to prior discussions. We will give updates of where CDC is with the current investigations and provide an update on initial recommendation development. You can forward to needed other participants within your organization, but please add judiciously. 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 # Participant Passcode: 2858251 # Thanks Dan Daniel B. Jernigan, MD MPH Captain, USPHS Director, Influenza Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Rd NE, Atlanta, GA 30329 Phone 404-639-2621, Cell 404-375-7508 djernigan@cdc.gov, www.cdc.gov/flu TX-DSHS-19-1309-A-000189 From: Harriman, Kathleen@CDPH Sent: Friday, January 04, 2019 1:06 PM EST To: Chavez, Gil@CDPH ; Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) ; Komatsu, Kenneth (CDC azdhs.gov) ; alexandra.peterson@azdhs.gov ; Landen, Michael (CDC state.nm.us) ; McDonald, Eric (San Diego County) ; Gaul,Linda (DSHS) ; Gamez,Monica (DSHS) ; Thompson, Mark (CDC/DDID/NCIRD/ID) ; Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID) ; Koppaka, Ram (CDC/DDID/NCIRD/ISD) ; Wharton, Melinda (CDC/DDID/NCIRD/ISD) ; Fernandez, April@CDPH ; Siegel, Jane@CDPH ; Hull, Torane (CDC/DDID/NCIRD/ISD) ; Hull, Torane (CDC dhhs.nh.gov) ; Rogers, Denise (CDC/DDID/NCIRD/ISD) ; Murray, Erin@CDPH ; Gaul,Linda (DSHS) ; Katz, Jackie M. (CDC/DDID/NCIRD/ID) Subject: Re: Flu Surveillance and Prevention along US-Mexico border in CA, AZ, NM, and TX WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Call 866-811-0826 151367 From: Chavez, Gil@CDPH Sent: Friday, January 4, 2019 10:05 AM To: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Komatsu, Kenneth (CDC azdhs.gov); alexandra.peterson@azdhs.gov; Landen, Michael (CDC state.nm.us); McDonald, Eric (San Diego County); Gaul, Linda (CDC dshs.state.tx.us); Gamez,Monica (DSHS; Thompson, Mark (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Koppaka, Ram (CDC/DDID/NCIRD/ISD); Wharton, Melinda (CDC/DDID/NCIRD/ISD); Fernandez, April@CDPH; Harriman, Kathleen@CDPH; Siegel, Jane@CDPH; Hull, Torane (CDC/DDID/NCIRD/ISD); Hull, Torane (CDC dhhs.nh.gov); Rogers, Denise (CDC/DDID/NCIRD/ISD); Murray, Erin@CDPH; Gaul,Linda (DSHS; Katz, Jackie M. (CDC/DDID/NCIRD/ID) Subject: RE: Flu Surveillance and Prevention along US-Mexico border in CA, AZ, NM, and TX Capacity exceeded on the line again so can’t get in. Gil F. Chavez, MD, MPH State Epidemiologist Deputy Director for Infectious Diseases California Department of Public Health (916) 440-7434 -----Original Appointment----From: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) Sent: Thursday, January 03, 2019 6:15 AM To: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID); Chavez, Gil@CDPH; Komatsu, Kenneth (CDC azdhs.gov); alexandra.peterson@azdhs.gov; Landen, Michael (CDC state.nm.us); McDonald, Eric (San Diego County); Gaul, Linda (CDC dshs.state.tx.us); Gamez,Monica (DSHS; Thompson, Mark (CDC/DDID/NCIRD/ID); Grohskopf, Lisa A. (CDC/DDID/NCIRD/ID); Koppaka, Ram (CDC/DDID/NCIRD/ISD); Wharton, Melinda (CDC/DDID/NCIRD/ISD); Fernandez, April@CDPH; Harriman, Kathleen@CDPH; Siegel, Jane@CDPH; Hull, Torane (CDC/DDID/NCIRD/ISD); Hull, Torane (CDC dhhs.nh.gov); Rogers, Denise (CDC/DDID/NCIRD/ISD); Murray, Erin@CDPH; Gaul,Linda (DSHS; Katz, Jackie M. (CDC/DDID/NCIRD/ID) Subject: Flu Surveillance and Prevention along US-Mexico border in CA, AZ, NM, and TX When: Friday, January 04, 2019 1:00 PM-2:00 PM (UTC-05:00) Eastern Time (US & Canada). Where: 1-866-807-3352 X2858251# All: We have reserved this time as a follow-up to prior discussions. We will give updates of where CDC is with the current investigations and provide an update on initial recommendation development. You can forward to needed other participants within your organization, but please add judiciously. 1-210-515-6875 1-866-807-3352 Leader Passcode: 3416989 # Participant Passcode: 2858251 # Thanks Dan Daniel B. Jernigan, MD MPH Captain, USPHS Director, Influenza Division National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Rd NE, Atlanta, GA 30329 TX-DSHS-19-1309-A-000190 Phone 404-639-2621, Cell 404-375-7508 djernigan@cdc.gov, www.cdc.gov/flu TX-DSHS-19-1309-A-000191 From: Aldridge,Tiffany (DSHS) Sent: Tuesday, January 08, 2019 1:30 PM EST To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,Imelda M (DSHS) Subject: RE: Question RE: 2019 ELC Annual Meeting registration ( Thank You! Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Tuesday, January 8, 2019 12:26 PM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: Question RE: 2019 ELC Annual Meeting registration ( Yes please. I’ll let Jason know. From: Aldridge,Tiffany (DSHS) Sent: Tuesday, January 8, 2019 1:23 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Garcia,Imelda M (DSHS) Subject: RE: Question RE: 2019 ELC Annual Meeting registration ( Hi De’Lisa, As City of Brownsville employees, they should not be registered to attend. Would you like for us to reach out to them or will CDC reach out to them to let them know they are not eligible? Happy New Year! Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Tuesday, January 8, 2019 12:12 PM To: Aldridge,Tiffany (DSHS) ; Garcia,Imelda M (DSHS) Subject: FW: Question RE: 2019 ELC Annual Meeting registration ( WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Do you know these individuals that registered for the grantee meeting? From: Snow, Jason N. (CDC/DDID/NCEZID/DPEI) Sent: Tuesday, January 8, 2019 1:02 PM To: henry.presas@cob.us; fbarnes@cob.us Cc: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: Question RE: 2019 ELC Annual Meeting registration ( Good afternoon. TX-DSHS-19-1309-A-000192 In reviewing the current registrations for the upcoming 2019 ELC Annual Meeting, the names (listed below) were flagged because of the ‘company’ is listed as being ‘City of Brownsville’ which is not one of our usual ELC partners. 1. 2. Henry Presas = Public Health Consultant - Emerging Threats Fredrick Barnes = Pest Control Officer While both the Houston Health Department and also the Texas Department of State Health Services are Recipients of ELC Cooperative Agreement funding, no other jurisdiction in Texas receives ELC funding. Additionally, as the new (i.e. 2019) ELC Notice Of Funding Opportunity (NOFO) will have eligibility requirements of being one of the current ELC Recipients, only the Houston Health Department and the Texas Department of State Health Services would be able to submit eligible applications to meet needs in Texas. The 2019 ELC Annual Meeting, like meetings from prior years, is intended to provide technical assistance to ELC Recipients. I bring this to your attention so as not to waste your time and/or your city’s resources to attend a meeting that might be of little interest or use to you professionally. I hope you have a great rest of the day today. ______________________________________ Jason N. Snow, Ph.D. Health Scientist Scientific & Program Services Branch (SPSB) Division of Preparedness and Emerging Infections (DPEI) National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention (CDC) 1600 Clifton, Building 24, Room 11111.2 Mailstop H24-11 Atlanta, GA 30329 Email: JNSnow@cdc.gov Office: 404-639-4577 Mobile: 404-307-3294 ELC web page: www.cdc.gov/ELC NOTE: I telework on Wednesdays & Fridays and can be reached by mobile or email. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000193 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, January 24, 2019 2:33 PM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Annual Meeting Announcement WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, The Centers for Disease Control and Prevention’s (CDC) Division of Preparedness and Emerging Infections (DPEI) is hosting the 2019 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Annual Meeting, which will take place April 2-4, 2019. The meeting will be held in the Global Communications Center at CDC’s Roybal Campus in Atlanta, GA. Participants will include state, local, and territorial leaders in epidemiology, laboratory, and health information systems, as well as infection control professionals and national partners. By now you should have received registration information via emails from the ELC mailbox and Eventbrite. Registration is free but necessary in order to attend; therefore, it is strongly recommended that you register. If plans change, you can always cancel your registration at a later time. Please note: Registration closes on Wednesday, March 6, 2019, and no late registrations will be accepted due to CDC Security policies. We wanted to let you know that you can now find the draft agenda for the 3-day meeting posted to the 2019 ELC Annual Meeting Website. Consistent with previous communications, we ask that each ELC-funded jurisdiction limit the number of attendees to no more than five (5) attendees, including a representative who is responsible for the fiscal management of the ELC Cooperative Agreement in the jurisdiction. Therefore, please coordinate with your ELC Principal Investigator (PI) to determine the optimal representation at the meeting. If you have any additional questions regarding the 2019 ELC Annual Meeting, please contact the ELC at elc@cdc.gov. Thank You, The ELC Team TX-DSHS-19-1309-A-000194 From: Elson, Diana Sent: Thursday, January 31, 2019 6:17 PM EST To: Prot,Emilie (DSHS) CC: Coffey, Qiana L ; Larson, Jesse M ; Bogle, Shawna G ; Haug, Jeff E Subject: RE: Varicella Guidelines Attachment(s): "Public Health Actions for Mgmt of Varicella and Herpes Zoster.pdf" Hi Dr. Prot, Please do not share the draft guidance with facilities until it is approved. I attached the current, approved version that can be shared just as a reference (not as official policy for facilities without IHSC staffing). MMR vaccine: we can request MMR from our Chief Pharmacist to send an express bulk order to the facility. He will need a list of all ICE detainees to whom it will be administered with A#s. MMR supplied by IHSC may only be used for ICE detainees. The facilities should make the request through the assigned IHSC Field Medical Coordinator who will route it to the IHSC Chief Pharmacist. I have copied them on this response. El Valle Detention Facility – I believe must adhere with 2011 ICE Performance Based Detention Standards, which are available here: https://www.ice.gov/doclib/detention-standards/2011/4-3.pdf; pharmaceutical management is covered on pages 265-266. https://www.ice.gov/detention-standards/2011 El Valle is operated by the county, so local regulations also apply. I believe the facility must cover the costs of shipping the specimens to the state lab. They paid per detainee per day to care for them, and that expense should fall under care. Rio Grande Detention Center is operated by Geo, which is a private, for profit detention management corporation. They can afford to ship the specimen; shipping and courier costs cannot be included in our medical claims process. If there is a problem with that, please contact the Geo Chief Medical Officer: John E. Christakis, M.D. Chief Medical Officer, Health Services The GEO Group, Inc. ® One Park Place, Suite 700, 621 NW 53rd Street Boca Raton, Florida 33487 Tel: 561 999 8128 Mobile: 561 617 0074 Thank you for everything! Diana Diana Elson, DrPH, MA, CAPT USPHS Chief, Public Health, Safety, and Preparedness (PHSP) Unit DHS/ICE/ERO/ICE Health Service Corps Office: 202-732-3467 Cell: 202-210-6804 Fax: 866-573-8531 Email: Diana.Elson@ice.dhs.gov In office: Mon, Wed Telework: Tue, Thu, Fri From: Prot,Emilie (DSHS) Sent: Thursday, January 31, 2019 5:19 PM To: Elson, Diana Subject: RE: Varicella Guidelines Thank you Dr. Elson. The facilities like to have guidance from both state/local and ICE. They want to make sure they are respecting guidance from ICE and bureau of prisons for inspections. I have a couple more questions. East Hidalgo wanted to order MMR stock for detainees and they were told it would take too long to receive the vaccine. Is this something you can help with? We will be going through our channels to help out with 50 doses of MMR. Also El Valle’s fridge failed and 39 doses we deemed no good by the manufacturer. Are there any requirements by ICE for generators/automatic temperature keeping/alarm systems in order to minimize loss of medications that require to be kept at cold temperatures? Another facility’s Warden, Rio Grande Facility does not want to pay for FedEx of a sample to be tested. Who incurs the cost? TX-DSHS-19-1309-A-000195 Thank you very much for your help and collaboration. -EYP EMILIE PROT, DO, MPH REGIONAL MEDICAL DIRECTOR, REGION 11 Department of State Health Services 601 W. Sesame Dr. Harlingen, Texas 78550 Office: 956-421-5504 Cell: 956-792-0844 Email: emilie.prot@dshs.texas.gov TEXAS HealthandHuman Services I HealthServices iFe .xasDepartment o(State CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code § 81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. From: Elson, Diana [mailto:Diana.Elson@ice.dhs.gov] Sent: Thursday, January 31, 2019 1:08 PM To: Prot,Emilie (DSHS) Subject: RE: Varicella Guidelines WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Dr. Prot, ICE Health Service Corps (IHSC) does have a detailed guidance on management of varicella. Officially, IHSC guidance is written for the 23 facilities where we directly operate the medical clinics (including the Port Isabel Detention Center in Region 11). Ideally, each facility or employer should have their own operational policies. We will share ours with facilities for which we are not the medical authority if they request, but we don’t have the authority to oversee other entities’ operations. We always recommend that facilities seek guidance from their local or state health departments The IHSC policy was recently revised and is going through the review process, but I attached a draft of the new version. We added the following based on the attached seroprevalence study that we conducted to inform this policy. · For purposes of recommending cohorting with restricted movement, health care staff may consider a detainee’s self-report during the individual health assessment of having a positive history of varicella as a predictive indicator of presumptive immunity if the detainee is healthy, not immunocompromised, does not have HIV, and is not pregnant. History of varicella self-reported during the individual health assessment should be documented in the detainee’s medical record. A detainee self-report of unknown history or of no history of varicella is not similarly predictive of positive or negative presumptive immunity. Diana Elson, DrPH, MA, CAPT USPHS Chief, Public Health, Safety, and Preparedness (PHSP) Unit DHS/ICE/ERO/ICE Health Service Corps Office: 202-732-3467 Cell: 202-210-6804 Fax: 866-573-8531 Email: Diana.Elson@ice.dhs.gov In office: Mon, Wed Telework: Tue, Thu, Fri From: Prot,Emilie (DSHS) Sent: Wednesday, January 30, 2019 3:39 PM To: Elson, Diana Subject: Varicella Guidelines Good afternoon Dr. Elson, I was trying to find your guidelines or summary sheet (like the one for mumps) on varicella. I could not locate anything on the ICE website and thought I would reach out. I had a question regarding IgG testing and wanted to know if it was on the ICE guidelines. I want to align our recommendations and make sure we have several option for diagnosis in case the stage of the lesions are not favorable for a sample for PCR. TX-DSHS-19-1309-A-000196 Would you please let me know if you have any specific guidelines for your facilities? Thank you, -EYP EMILIE PROT, DO, MPH REGIONAL MEDICAL DIRECTOR, REGION 11 Department of State Health Services 601 W. Sesame Dr. Harlingen, Texas 78550 Office: 956-421-5504 Cell: 956-792-0844 Email: emilie.prot@dshs.texas.gov TEXAS HealthandHuman Senr1ces 1Fe .xasDepartmentofState Heal'th Servim CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code § 81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000197 U.S. Immigration and Customs Enforcement ICE Health Services Corps (IHSC) Enforcement and Removal Operations U.S. Immigration and Customs Enforcement Public Health Actions for the Management of Varicella and Herpes Zoster in IHSC-Staffed Medical Clinics Approved by: Stewart D. Smith, DHSc Title: ERO – IHSC Acting AD Effective Date: 24 Mar 2016 TX-DSHS-19-1309-A-000198 Table of Contents I. Overview .............................................................................................................. - 5 A. Purpose .......................................................................................................... - 5 B. Responsibilities .............................................................................................. - 5 C. About Varicella ............................................................................................... - 6 D. About Herpes Zoster ...................................................................................... - 8 E. Acronyms ....................................................................................................... - 9 F. Definitions with Expanded Information ........................................................... - 9 - II. Clinical Management .......................................................................................... - 12 - III. Herpes Zoster Infection Prevention and Control ................................................. - 14 IV. Varicella Infection Prevention and Control.......................................................... - 14 A. Family Residential Centers .......................................................................... - 14 B. Adult Detention Facilities .............................................................................. - 16 V. Contact Investigations ........................................................................................ - 23 A. Purpose ........................................................................................................ - 23 B. Initiating Contact Investigations.................................................................... - 23 C. Education ..................................................................................................... - 23 D. Collaborations .............................................................................................. - 24 E. Surveillance.................................................................................................. - 24 VI. Varicella Outbreak Investigation ......................................................................... - 24 A. Steps for management of varicella outbreaks .............................................. - 24 VII. Employee Health Considerations ....................................................................... - 27 VIII. Program Monitoring ............................................................................................ - 27 IX. Training and Education ....................................................................................... - 27 - Page - 2 - of 28 TX-DSHS-19-1309-A-000199 A. Health Staff .................................................................................................. - 27 B. Detainees ..................................................................................................... - 27 X. Privacy and Recordkeeping ................................................................................ - 27 XI. References and Resources ................................................................................ - 27 - Page - 3 - of 28 TX-DSHS-19-1309-A-000200 Foreword This Public Health Actions for the Management of Varicella and Herpes Zoster in IHSCStaffed Medical Clinics Guide supplements the following IHSC Directive: • # 05-06 (ERO # 11781.1), Infectious Disease Public Health Actions This Guide explains concepts, assigns responsibilities and details procedures for the management and control of varicella and herpes zoster. The intended audience is IHSC-staffed facilities supporting health care operations in ICE-owned or contracted detention facilities. Page - 4 - of 28 TX-DSHS-19-1309-A-000201 I. Overview A. Purpose This guide assists health staff to implement public health actions for the management of varicella and herpes zoster. This guide provides health staff with the procedures and resources to implement infection prevention and control measures related to varicella and herpes zoster. B. Responsibilities Health Services Administrator • Oversee and implement infection prevention and control activities. • Oversee contact and outbreak investigations. • Ensure reporting of detainees/residents with varicella to the health department in accordance with local and state laws. • Ensures health staff receive orientation and annual training. Medical Providers • Oversee the clinical management of detainees/residents diagnosed with varicella or herpes zoster. • Report detainees/residents with varicella to the health department in or reports case to Safety, Infection Prevention and Control Coordinator for reporting case to health department can occur in accordance with local and state laws. Health Staff • Implement infection prevention and control measures to stop or limit the spread of varicella and herpes zoster. • Adhere with national guidelines, regulations, and standards. Safety, Infection Prevention and Control Coordinator • Assist the Health Services Administrator (HSA) to implement infection prevention and control activities. • Report detainees/residents with cases of varicella to the health department in accordance with local and state. Page - 5 - of 28 TX-DSHS-19-1309-A-000202 • Assist the HSA to conduct contact and outbreak investigations. Public Health Safety and Preparedness Unit • Provide technical guidance to IHSC staff on varicella and herpes zoster infection prevention and control activities. • Review and update this guide and the Directive 05-06 Infectious Disease Public Health Actions. • Conduct periodic monitoring. • Conduct surveillance for detainees/residents with varicella and herpes zoster diagnosed in IHSC- staffed medical clinics. IHSC Infectious Disease Consultant • Provide technical guidance related to clinical management and public health actions for the management of varicella and herpes zoster at the request of the medical provider or headquarters staff. C. About Varicella Varicella (chickenpox) is the disease that results from primary infection with the varicella zoster virus (VZV). It is a highly contagious disease that causes a blister-like rash with itching, tiredness, and fever. Varicella most commonly causes an illness that lasts about 5–10 days. Transmission Varicella is transmitted from person to person by direct contact with persons with either varicella or herpes zoster (shingles) or by airborne spread (from respiratory secretions or aerosolized vesicular fluid from skin lesions). Exposure occurs through close contact with an infectious person, such as close indoor contact (e.g., in the same room) or faceto-face contact. Experts differ in their opinion about the duration of contact needed to contract varicella; some suggest five minutes and others up to one hour, but all experts agree that significant exposure does not include transitory contact. Incubation Period The incubation period for varicella is 10-21 days. Page - 6 - of 28 TX-DSHS-19-1309-A-000203 Infectious Period Persons with varicella are considered infectious from one to two days before the rash appears and until all lesions are crusted over (on average, this occurs four to seven days after rash onset). Persons with underlying immunocompromising medical conditions (e.g., cancer, HIV/AIDS) are especially likely to have more severe disease and the crusting of lesions may take longer; thus, they may shed the virus from skin lesions for a prolonged period. Signs and Symptoms Varicella presents as a classic rash which is initially itchy, fluid-filled blisters that eventually form scabs. The rash may first show up on the face, chest, and back then spread to the rest of the body, usually sparing the palms and soles. It usually takes about one week for all of the blisters to become scabs. Other typical symptoms that may begin to appear 1-2 days before the rash include: • High fever • Fatigue • Loss of appetite • Headache The most common complication (although still unusual) is bacterial superinfection with common skin flora such as Staphylococcus aureus and Group A streptococcus. The following individuals are at increased risk of having more severe symptoms and complications (hereafter referred to as “high risk”): • Infants • Pregnant women • Persons with health problems or treatment regimens that affect the immune system (e.g., HIV, cancer, transplant patients) Prevention The best way to prevent becoming infected with varicella is to receive the vaccine. The vaccine is safe and effective at preventing the disease. Most people who get the vaccine will not get varicella. Varicella vaccination is included in routine immunization schedules in the United States. However, most developing countries do not include varicella vaccination in national vaccine preventable disease programs. Page - 7 - of 28 TX-DSHS-19-1309-A-000204 Most detainees and residents will not have been previously vaccinated; therefore, the risk of exposure and susceptibility to VZV is greater. D. About Herpes Zoster Herpes zoster (also known as shingles) is caused by the reactivation of VZV in the body, the same virus that causes varicella. VZV chronically infects humans and will live dormant for the remainder of the infected person’s life; as people age and/or develop a weakend immune system (which can be due to temporary stressors), they may experience an episode of shingles. Shingles can occur more than once in a person’s life time. Anyone who has had varicella can develop shingles. However, it more commonly affects the following groups: • Elderly o The older the individual, the more likely they are to develop post-herpetic neuralgia, a potentially lifelong and debilitating “phantom” nerve pain. • Persons with health problems or treatment regimens that affect the immune system (e.g., HIV, cancer, transplant patients). Transmission A person with shingles can spread the virus when the rash is in the blister phase. A person who is exposed to a shingles rash and who has never been infected with VZV before will develop varicella, not shingles. The virus is spread through direct contact with fluid from the rash blister (all shingles patients) or airborne exposure (only among people that are severely immunocompromised, such as people with AIDS or organ transplant recipients). Herpes zoster is less contagious than varicella and the risk of a person with herpes zoster spreading the virus is low if the lesions are covered. Infectious period The infectious period for herpes zoster begins at onset of rash and ends after all of the lesions are crusted over to form scabs. Symptoms Shingles commonly presents as an itchy, sometimes painful, unilateral dermatomal rash. Malaise, headache, and severe neuropathic type pain may precede the rash. Other typical symptoms that may begin to appear 1-2 days before the rash include: Page - 8 - of 28 TX-DSHS-19-1309-A-000205 • High fever • Fatigue • Loss of appetite • Headache E. Acronyms AII – Airborne Infection Isolation CDC – U.S. Centers for Disease Control and Prevention DFA – Direct Fluorescent Antibody HICPAC – Healthcare Infection Control Practices Advisory Committee HIV – Human Immunodeficiency Virus IgG – Immunoglobulin G PCR – Polymerase Chain Reaction PPE – Personal Protective Equipment VIS – Vaccine Information Statement VZV – Varicella Zoster Virus VariZIG – Varicella zoster immune globulin F. Definitions with Expanded Information Airborne Infection Isolation (AII) Precautions – Isolation of patients infected with infectious organisms spread through the air to minimize person to person transmission. Airborne Infection Isolation (AII) Room – A single-occupancy patient-care room, formerly called a negative pressure isolation room; environmental factors are controlled so the isolation room receives substantial air changes per hour (ACH) (≥12 ACH for new construction since 2001 and ≥6 ACH for construction before 2001) and is under negative pressure (the direction of air flow is from the outside adjacent space [the corridor] into the room). AII room air is preferably exhausted to the outside, or recirculated if the return air is filtered through a high efficiency particulate air (HEPA) filter. Page - 9 - of 28 TX-DSHS-19-1309-A-000206 Airborne Transmission – Dissemination of airborne particles that can infect people over time and distance (droplet nuclei 1 to 5 μm in diameter associated with coughing or aerosolization of contaminated fluids). Cohorting – Cohorting is a public health strategy used to house individuals separately as a group based on their infectious or exposure status. Contact Investigation – The process of identifying, evaluating, and treating all persons (contacts) who have sustained a significant exposure to a person with suspected or confirmed infection. Contagious – When a disease can be transmitted from one living being to another through direct or indirect contact; communicable; infectious; usually microorganisms. Direct Contact Transmission – Direct transfer of a microorganism from an infected person to another person. Disseminated Herpes Zoster – Appearance of lesions outside the primary or adjacent dermatomes. Exposure – The condition of being subjected to something in the working environment (noise, dust, chemicals, radiation, infectious agents) that could have an adverse health effect. Herpes Zoster (Shingles) – Primarily dermatologic disease caused by the reactivation of latent varicella zoster virus High Efficiency Particulate Air (HEPA) Filter – A filter that is certified to remove ≥99.97% of particles 0.3 μm in size, including M. tuberculosis–containing droplet nuclei; either portable or stationary; required for AII room exhaust ventilation; requires expertise in installation and maintenance. Incubation Period – The interval between exposure to a communicable microorganism and onset of symptoms. Infection Control – Institutional procedures and policies for monitoring and attempting to control the transmission of communicable diseases. Infectious Period – The period during which a person might have transmitted a communicable microorganism to others. N95 Disposable Respirator – An air-purifying, filtering-facepiece respirator that is ≥95% efficient at removing 0.3 μm particles and is not resistant to oil; education and fit Page - 10 - of 28 TX-DSHS-19-1309-A-000207 testing is required before wearing a respirator; used to protect the wearer from exposures in the air; not worn by a patient. Outbreak – The occurrence of more people with a disease, injury, or other health condition than expected in a given area or among a specific group of persons during a specific period. Personal Protective Equipment (PPE) – Equipment that protects a person from hazardous exposures such as chemicals, dust, noise, radiation, infectious diseases and includes respirators, gloves, mask, goggles, gowns, face shields, ear plugs, hard hats, and steel toe boots. Respirator – A form of PPE with filtering capability that fits snug on the face over the nose and mouth to prevent the wearer from inhaling hazardous airborne particles. Shingles – The colloquial name of the dermatomal rash caused by reactivation of varicella zoster virus. Significant Exposure – Exposure under conditions more likely to result in transmission of infection. Surgical mask – A protective device that covers the patient’s nose and mouth to protect health care workers from exposures to wearer-generated microorganisms. Symptomatic – A term applied to a patient with health-related complaints (symptoms) that might indicate the presence of disease. Symptom Screen – A procedure used during a clinical evaluation in which a person is asked if they have experienced any departure from normal in function, appearance, or sensation related to the health condition of interest. Transmission-Based Precautions – Precautions that provide additional protections beyond Standard Precautions to interrupt the transmission of pathogens. Vaccine – A suspension containing antigenic molecules derived from a microorganism, given to stimulate an immune response to an infectious disease. Varicella (Chickenpox) – An acute infectious disease, usually seen in children aged less than 15 years, caused by the varicella-zoster virus. Varicella Zoster Virus (VZV) – The virus that causes varicella and shingles. Page - 11 - of 28 TX-DSHS-19-1309-A-000208 II. Clinical Management A medical provider is responsible for the clinical management of detainees/residents diagnosed with or suspected of having varicella or herpes zoster. HIV testing is recommended for detainees with herpes zoster or a history of herpes zoster. The diagnosis of VZV infection can be made or supported by one or more of the following: • Physical examination to identify the symptoms typical of VZV rash (see Figures 1 and 2), including assessment of the following: • Varicella: Lesions that are simultaneously in all stages of development— from vesicles on a red base, to umbilicated pustules, to crusted lesions. • Herpes zoster: Unilateral, dermatomal distribution of a painful vesicular rash. Page - 12 - of 28 TX-DSHS-19-1309-A-000209 Figure 1. Varicella rash in a person with a light complexion H a r d c ru s t B l i s te r -- ------'; - -- ---------1,---,--~ \ ___. R e d s po t -- - (_ ~ . ~ Chickenpox (Varicella) ; . ~\ © Madroine N~. lno. Figure 2. Common presentation of herpes zoster J Most commonly, the rash occurs in a single stripe around either the left or right side of the body. In other occurrences, the rash occurs on one side of the face. In rare occurrences, the rash may be more widespread and look similar to a varicella rash. • History of exposure to varicella or herpes zoster in the past three weeks, in a susceptible contact. • Laboratory tests are not routinely required, but can be useful for confirmation of the diagnosis, particularly if the presentation is atypical. VZV testing includes the following methods: • • Rapid VZV identification. Polymerase chain reaction (PCR) or direct fluorescent antibody (DFA) testing is widely available from commercial labs, with results available in several hours • Viral culture (rarely necessary, less sensitive than rapid tests above) Health staff should document varicella or herpes zoster diagnoses in the health record using appropriate ICD coding. Page - 13 - of 28 TX-DSHS-19-1309-A-000210 For general information about surveillance and reporting please reference the Infectious Disease Surveillance and Reporting for IHSC-Staffed Medical Clinics Guide. III. Herpes Zoster Infection Prevention and Control Infection control measures for herpes zoster are summazired in Table 1. Table 1. Transmission-Based Precautions for Herpes Zoster Localizeda Immunocompetent Immunocompromised Disseminatedb • Standard precautions* • Cover lesions* See immunocompromsed * until lesions are crusted over to form scabs; if lesions cannot be effectively covered, follow contact and airborne precautions • Standard precautions* • Contact precautions* • Airborne precautions* • Standard precautions* • Contact precautions* • Airborne precautions* *until disseminated shingles is ruled out, then standard precautions until lesions are crusted over to form scabs * until lesions are crusted over to form scabs a Localized herpes zoster has the appearance of lesions in primary or adjacent dermatomes b Disseminated herpes zoster has the appearance of lesions outside the primary or adjacent dermatomes IV. Varicella Infection Prevention and Control A. Family Residential Centers Immunization Herd immunity to varicella in the Family Residential Center (FRC) population is expected to be lower than in congregate settings in the United States (e.g., schools and Page - 14 - of 28 TX-DSHS-19-1309-A-000211 child care) due to a larger proportion of previously unvaccinated residents. Fifteen to 20% of children vaccinated with one dose of varicella vaccine remain at risk for varicella if exposed due to the lack of immune response or partial protection. Residents arriving at FRCs with active varicella (including residents who are pre-symptomatic) will continually introduce varicella into the FRC population, presenting a risk of transmission. Pre- and post-exposure vaccination with education and consent should be the primary strategies for controlling transmission and managing varicella outbreaks. • Vaccination is the primary strategy for mitigating varicella transmission in FRCs. Refer to OM 15-013 IHSC Immunization Protocol for ICE Family Residential Centers and OM 15-007 National Juvenile Immunization Policy for guidance on pediatric and adult immunization schedules. Transmission-Based Precautions • When active varicella is suspected or confirmed, health care personnel must institute airborne (if available) and contact precautions following the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. • Health staff should don appropriate personal protective equipment for contact with a resident with active varicella or exposed contacts without immunity still within the incubation period; see also the IHSC Personal Protective Equipment Program Guide and the IHSC Bloodborne Pathogens and Other Potentially Infectious Materials Guide. • The HSA or designee must adjust work schedules and assignments for susceptible or vulnerable staff members that would be at high risk for complications if exposed to and infected with varicella, including pregnant women and individuals with a weakened immune system due to health conditions or therapies. • Health care personnel must place a surgical mask on the ill resident when in close proximity to others. • Health care personnel must move the ill residents to a room or area that minimizes contact with other residents, especially non-family members that may not have had previous exposure. This may be an airborne infection isolation (AII) room, if available, or another room with restricted contact to other residents. Transfer to a community hospital may be considered if medically necessary. Page - 15 - of 28 TX-DSHS-19-1309-A-000212 • Parents may be placed in a room with an ill child, and children may be placed in a room with an ill parent if the room can accommodate co-habitation and the nonill family member is not at high risk for complications. • Health staff must implement standard cleaning and disinfection guidelines. See the Healthcare Infection Control Practices Advisory Committee (HICPAC) Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. • It is recommended that residents with varicella not be housed with any immunocompromised persons. Management of Exposed Contacts • With open movement in FRCs, residents exposed to varicella, but who are not ill, should not be housed separately. • IHSC staff should seek consultation by the Regional Clinical Director and/or IHSC Infectious Disease Consultant for post-exposure management of identified residents at high risk for complications (i.e., pregnant females, infants, and immunocompromised residents). • Health staff must remain vigilant for additional residents potentially developing varicella following possible exposures or among recently arrived residents. • If exposed, non-immune residents must be released or removed, health staff should implement the following prior to release or removal: • Educate the resident on their exposure and instruct him or her to seek medical attention if her or she develops symptoms. • Give the documentation of relevant medical information, including test results for VZV immunity and documentation of vaccination, if administered. B. Adult Detention Facilities Transmission-Based Precautions • When active varicella is suspected or confirmed, health care personnel must institute airborne (if available) and contact precautions following the 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Page - 16 - of 28 TX-DSHS-19-1309-A-000213 • Health staff should don appropriate personal protective equipment for contact with a detainee with active varicella or exposed contacts without immunity still within the incubation period; see also the IHSC Personal Protective Equipment Program Guide and the IHSC Bloodborne Pathogens and Other Potentially Infectious Materials Guide. • The HSA or designee must adjust work schedules and assignments for susceptible or vulnerable staff members that would be at high risk for complications if exposed to and infected with varicella, including pregnant women and individuals with a weakened immune system due to health conditions or therapies. • Health care personnel must place a surgical mask on the ill detainee when in close proximity to others. • Health care personnel must move the ill detainees to a room or area that minimizes contact with other detainees. This may be an AII room, if available, or another room with restricted contact to other detainees. Transfer to a community hospital may be considered if medically necessary. • Health staff must implement standard cleaning and disinfection guidelines (See the HICPAC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008). • It is recommended that detainees with varicella not be housed with any immunocompromised persons. Page - 17 - of 28 TX-DSHS-19-1309-A-000214 Figure 3. Varicella and Herpes Zoster Infection Control Measures Varicella or Herpes Zoster Diagnosis I I t Institute appropriate contact and/or airborne precautions Monitor detainee daily Adjust work schedules for vulnerable or susceptible staff t t Discontinue isolation, contact/airborne precautions, and special work assignments when all of the detainee’s lesions are dry and crusted over I I Management of Exposed Contacts A medical provider is responsible for the overall management of susceptible contacts. Health staff should identify detainees that may have had a significant exposure to a detainee with varicella or herpes zoster. Table 2 provides guidance on establishing significant exposures. Page - 18 - of 28 TX-DSHS-19-1309-A-000215 Table 2. Establishing Significant Exposure During the Infectious Period Disease Exposure Significant Exposure Varicella At least one hour exposure, including any of the following: • Contact with nasopharyngeal secretion or lesions, or • Face-to-face interaction, or • Sharing indoor airspace* during the infectious period Uncomplicated herpes zoster Direct contact with lesions or secretions Disseminated herpes zoster At least one of the following: • Contact with lesions or secretions, or • Sharing indoor airspace* Disseminated or localized herpes zoster in an immunocompromised person At least one of the following: • Contact with lesions or secretions, or • Sharing indoor airspace* *Sharing indoor airspace refers to being within three feet, such as in the same 2-4 bed ward, or in an adjacent bed in a large ward • Health care personnel determine immune status of contacts among detainees with a significant exposure. Evidence suggestive of immunity to VZV includes the following: o Documentation of varicella or herpes zoster vaccination  Documentation of varicella vaccination includes 2 doses of vaccine  Documentation of herpes zoster vaccination includes 1 dose at age 60 or older o Laboratory evidence suggestive of immunity (VZV IgG positive) o Diagnosis or documented history of varicella disease by a healthcare provider (note: rarely a person can get varicella disease more than once). Page - 19 - of 28 TX-DSHS-19-1309-A-000216 o Diagnosis or documented history of herpes zoster by a healthcare provider (note: rarely a person can have a second or a third episode of herpes zoster). • If documentation of immunity is not available, a medical provider should order serologic titers (Varicella IgG) within 48 hours of exposure for exposed contacts without documented immunity to varicella. o Contacts with a positive titer (Varicella IgG) suggestive of immunity can be released from cohorting with restricted movement. o It is not recommended to perform serologic titers (Varicella IgG) after vaccination, even if secondary exposures occur. • A medical provider should evaluate exposed, immune compromised detainees with or without a history of varicella or herpes zoster within 72 hours of identification. • A medical provider should order isolation of detainees with clinical signs or symptoms. • All health assessments and laboratory testing results for exposed detainees must be documented in the health record. Observation • Health care personnel must perform daily visual inspections on all exposed detainees to identify signs or symptoms of active varicella for 21 days from the time of latest exposure. • Health care personnel must isolate detainees with clinical signs or symptoms of active varicella. Cohorting with Restricted Movement For exposed detainees without reliable documentation suggesting immunity, the HSA or designee should recommend the following to law enforcement and custody staff: Page - 20 - of 28 TX-DSHS-19-1309-A-000217 • Maintain social distancing to the extent possible to control the spread of infectious diseases of public health significance. • Implement cohorting (housing together as a group) with restricted movement for 21 days from the latest exposure to varicella, unless release or removal is unavoidable (see Isolation and Management of Detainees Exposed to Infectious Organisms in IHSC-Staffed Medical Clinics). o If an additional person(s) with varicella disease is identified in the cohorted group, the 21 day period of restricted movement begins again, with the date of latest exposure being day zero and continues until there is a full incubation period without any new disease. Documentation upon release or removal If exposed, non-immune detainees must be released or removed, health staff should implement the following prior to release or removal: • Educate the detainee on their exposure and instruct him or her to seek medical attention if her or she develops symptoms. • Give the detainee written instructions regarding their exposure and recommended follow up. • Give the documentation of relevant medical information, including test results for VZV immunity and documentation of vaccination, if administered. Page - 21 - of 28 TX-DSHS-19-1309-A-000218 Figure 3. Varicella Exposure Management in Adult Detention Facilities Assess those potentially exposed to a person with active varicella i Significant exposure 7~ T Yes No .---------,I 1 .- > Provide detainee education on awareness of signs and symptoms of varicella and the importance of seeking medical attention if symptoms persist Immune compromised Refer to a medical provider for evaluation No Yes Evidence of immunity • • Cohort with restricted movement for 21 days and monitor daily to identify detainees with new onset of symptoms If detainees with new onset of varicella are identified, the incubation period restarts and detainee(s) with active varicella is isolated until no longer contagious Consider drawing varicella titers Consider administering first dose of varicella vaccine to prevent or control outbreaks ....._____,.... ~I ) Yes No • • No cohort Titer Result (IgG) (if applicable) May release from cohort and does not need second dose of vaccine Positive • • Negative Cohort during restricted movement period until no additional detainee(s) with active varicella is identified Consider administering a second dose of vaccine 4-8 weeks after initial dose to prevent or control outbreaks Page - 22 - of 28 TX-DSHS-19-1309-A-000219 V. Contact Investigations A varicella contact investigation involves identifying, evaluating, and managing all persons (contacts) who have sustained a significant exposure to a person with varicella. A contact investigation may be required to help control transmission of varicella within the facility and between facilities. Contact investigations are not usually required for exposures to uncomplicated, localized herpes zoster; contact investigations may be recommended for exposures to disseminated herpes zoster or exposres to localized herpes zoster among immunocompromised detainees. Health staff should report contact investigations to the Public Health, Safety, and Preparedness (PHSP) Unit staff. For more information refer to the IHSC Contact and Outbreak Investigation Guide and CDC’s Strategies for the Control and Investigation of Varicella Outbreaks Manual, 2008. A. Purpose Contact investigations are performed to: • Halt transmission • Identify additional people with varicella disease • Initiate appropriate medical intervention • Prevent the development of varicella disease among recently infected contacts B. Initiating Contact Investigations Health staff should initiate a contact investigation as soon as a detainee is diagnosed with varicella. This allows for prompt identification of significant close contacts to prevent transmission. Health staff should document relevant laboratory, treatment, and risk factor information for exposed detainees using a contact investigation tracking tool and as appropriate, in the health record. C. Education Health care personnel should educate exposed contacts about varicella and herpes zoster, and inform them of the voluntary and confidential nature of a contact investigation. Health care personnel educate staff about the potential for an outbreak or the current outbreak and encourage everyone to maintain a high index of suspicion for varicella when providing medical care and evaluation. Page - 23 - of 28 TX-DSHS-19-1309-A-000220 D. Collaborations Health staff should collaborate with local or state health departments to conduct contact investigations, if needed. Health departments have expertise in conducting contact investigations and may be used as a resource for determining the scope of the contact investigation and management of exposed contacts. Obtain information from the ill detainee(s) regarding places where they stayed during the infectious period prior to arrival at the facility so that the health department or other entities can investigate those potential exposures. E. Surveillance Health staff should maintain a high index of suspicion for varicella in the facility to identify additional people with varicella, detect an outbreak, and implement control measures in a timely manner. Health staff must notify the PHSP Unit of known or suspected transmission within the facility. Health staff must also notify the health department in accordance with local and state regulations. VI. Varicella Outbreak Investigation Prompt identification, investigation, and control of varicella outbreaks is important. See the the IHSC Contact and Outbreak Investigation Guide and Strategies for the Control and Investigation of Varicella Outbreaks 2008 for additional guidance. A. Steps for management of varicella outbreaks Steps for managing possible varicella outbreaks might occur simultaneously or in a different order than listed below. 1. Confirm the occurrence of an outbreak • The occurrence of ≥5 people with varicella with an epidemiologic link defines an outbreak. The following guidance is used to establish epidemiologic links: o A known epidemiologic link is established as follows: − One of the ill detainees named the other as a contact during one of the ill detainee’s infectious period, or − The two detainees were at the same place at the same time during one of the ill detainee’s infectious periods. Page - 24 - of 28 TX-DSHS-19-1309-A-000221 o A possible epidemiologic link is established as follows: − The two ill detainees spent time at the same place around the same time, but the timing was not definite enough to meet the criteria for a known epidemiologic link, or − The two ill detainees were in the same geographic area around the same time and shared social or behavioral traits that increased the chances of transmission. • Health staff must notify the PHSP Unit staff. • Health staff must report to health departments in accordance with local, state, and federal laws. 2. Identify people with varicella • Laboratory confirmation is recommended for at least three people with varicella disease to confirm an outbreak. 3. Enhance control measures • Health staff must implement control measures for case management, exposure management, and contact investigations. • Health staff should consider enhancing control measures if there is an increase in the number of detainees with varicella in the facility in the absence of an epidemiologic link. • Health staff might consider enhanced screening for varicella at intake. • A medical provider might consider vaccination to prevent or control outbreaks. o A medical provider considers vaccinating persons without evidence of immunity to varicella if they do not have a contraindication to vaccination, if vaccine is available, and in consultation with the Deputy Assistant Director, Clinical Services, Associate Medical Director, or Regional Medical Director. o Medical providers refer to CDC guidelines regarding the safe administration of the vaccine, Varicella Vaccination: Information for Health Care Providers. o Medical providers must be familiar with potential side effects and adverse reactions associated with the varicella vaccine. Page - 25 - of 28 TX-DSHS-19-1309-A-000222 o Health care personnel must provide the Vaccine Information Statement (VIS) and appropriate detainee education regarding the vaccine schedule and the vaccine’s associated benefits and risks. − VISs in multiple languages are available at Vaccine Information Statements - VISs - CDC information sheets for patients o For more information on varicella vaccination and recommendations for use, health care personnel should refer to the Prevention of Varicella: Recommendations of the Advisory Committee on Immunization Practices o The CDC recommends VariZIG for high risk, susceptible contacts within 96 hours of exposure. When VariZIG is administered, the incubation period extends to 28 days. Facilities may procure VariZIG directly from the manufacturer: http://www.varizig.com/ordering_info.html o Health care personnel administer a first dose of varicella vaccine to eligible, non high risk, susceptible contacts within five days of exposure if available or as recommended by the health department. For adult detainees, health care personnel administer second dose of vaccine 4 weeks after the first dose. 4. Enhance surveillance • Health staff implement surveillance for two incubation periods (42 days) after rash onset of the last identified person with varicella. 5. Documentation and reporting • Health staff use a tracking tool to document detainees identified with varicella associated with an outbreak. • Health staff must notify the PHSP Unit of known or suspected transmission within the facility. • Health staff must also notify the health department in accordance with local and state regulations. • Health staff document and summarize outbreak findings to inform efforts to prevent and control future outbreaks. • The HSA or designee evaluates the outbreak management process and develop plan to prevent future outbreaks. Page - 26 - of 28 TX-DSHS-19-1309-A-000223 VII. Employee Health Considerations Health staff without verified immunity that have had significant, unprotected exposure are recommended to see their personal healthcare provider for evaluation and management; see also IHSC Directive 05-02, Occupational Health, and the IHSC Employee Health Program Guide. VIII. Program Monitoring PHSP Unit staff monitor diagnoses of varicella and herpes zoster using the electronic health record reporting tools. PHSP Unit staff will periodically request information from health staff at IHSC-staffed medical clinics for program monitoring. IX. Training and Education A. Health Staff The Health Services Administrator (HSA) or designee must ensure that orientation and annual training includes public health actions for the management of varicella and herpes zoster. Training records must include the date of the session, a content summary, name of the instructor, and names and job titles or all persons attending the session. Health staff must sign training logs to verify receipt of training. B. Detainees Health care personnel must educate detainees diagnosed with varicella or herpes zoster about transmission, risk factors, infection prevention and control, and continuity of care. X. Privacy and Recordkeeping Health staff refer to IHSC Directive 05-06, Infectious Disease Public Health Actions for guidance on complying with privacy and recordkeeping procedures. XI. References and Resources 1. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases. Lopez AS, Marin M. Strategies for the Control and Investigation of Varicella Outbreaks, 2008. 2. Centers for Disease Control and Prevention. The Pink Book: Course Textbook – 13th Edition, Chapter 21 (Varicella). Atkinson W, Wolfe S, Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases: Varicella. 2015. Page - 27 - of 28 TX-DSHS-19-1309-A-000224 3. Centers for Disease Control and Prevention. Preventing Varicella-Zoster Virus (VZV) Transmission from Zoster in Healthcare Settings. 4. Federal BOP Clinical Practice Guideline: Management of Varicella Zoster Virus (VZV) Infections. 5. Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. 6. Healthcare Infection Control Practices Advisory Committee. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008. 7. Review of the Use of Segregation for ICE Detainees, Policy No. 11065.1, September 4, 2013. Page - 28 - of 28 TX-DSHS-19-1309-A-000225 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, February 01, 2019 11:28 AM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Post-Award Actions Webinar Resources Attachment(s): "REDCap ELC Post Award Request Recipient User Guide - Jan 2019.pdf","2019 ELC Post Award Actions Webinar_1_21_19.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, Thank you for attending the Post-Award Actions Webinar yesterday. As a follow-up to the webinar we are providing a copy of yesterday’s presentation and user guide. The same resources will be added to the File Repository within the Post-Award Project in REDCap. In addition to these resources, everyone on the governance team that has a REDCap account has been added to the project. If there is someone in your jurisdiction that needs access, please contact Char Njoroge (wkv2@cdc.gov) and Megan Light (wpa8@cdc.gov). Please let us know if you have any questions regarding these resources or the Post-Award Actions Portal. Thank You, ELC Team TX-DSHS-19-1309-A-000226 2019ELCPostAwardActions Webinar January2019 ELG NATIONAL FUNDING STRATEGY ,i. ~sitW t:.;t, PREVENTING (JJJJP TX-DSHS-19-1309-A-000227 Agenda • Overview • PostAwardRequestToolDemo • NextSteps • QuestionsandAnswers PREVENTING TX-DSHS-19-1309-A-000228 ELCandREDCap • Epidemiology andLaboratory Capacityfor Infectious DiseasesCooperative Agreement (ELC) o ZikaandBiosafety Performance Measures o ProjectMonitoring (Epi/LabCross-Cutting, HIS,Vectorborne,etc.) o ELCApplication andMonitoring Portal PREVENTING TX-DSHS-19-1309-A-000229 REDCap forPostAward Actions • Toolto facilitateandtrackthesubmission processandhelpELC Recipients draftBudgetExtensions, Carryovers, andRedirection requestsfor submission to GrantSolutions • Increased transparency for ELCProjectOfficers,ELCRecipients, andCDCPartnerPrograms • Consistent formattingfor requiredtemplatesfor GrantSolutions • Historicalarchiveandtrackingof all postawardactions • ELCandOGSpost-award resourcesavailable PREVENTING TX-DSHS-19-1309-A-000230 PostAwardRequest Checklist DOGStemplatetext □ Request summary table □ Individual projecttables □ Justification for eachproposed carryover/redirection/unobligated amount □ New contractelements, if applicable □ Official agencyletterhead □ Two Signatures □ FederalFinancial Report(FFR)SF425 □ Current IndirectCostRateAgreement if requesting changesto indirectcosts NotBS: PBrthBTBrms6 Conditions ofthBNoticBOfAward,all post-award actionsmustbBsubmittBd nolatBrthan120 daysbBforB thBBndof thBbudgB pBriod. ThBREDCap portalis dBvBlopBd to hBlpBXpBditB prBparation 6 procBssing; howBvBr, thBofficialsubmission muststill bBthroughGrantSolution . PREVENTING TX-DSHS-19-1309-A-000231 Epi?demi?ologyand laboratory Capacity far Infectious Diseases (ELC) Cooperative Agreement Post Award Action Demo PREVENTING Drafting a NewPostAwardRequest • Tostartdrafting a newpostawardrequest, youwillneedtoadda new record. • Eachpostawardrequest isitsownindividual record. lliE] ~ I ,,,__..,. ___--"---·-----..... ~ _..~ ..---~... - I Record StatLis Dasl1board bl Add/ Edit Records N EW Post Aw ard Request 1 Cllhioose a1rn,ex1 i st i1r1g1 r Post Awa.rd Req1uest I--se led record -- - Create new record s;or edit/v iew e),(iscing on es: Hide daca collea ion inst, umems ... 11 Post Awa rd Requ est Post Awa rd Request Page 2 Proj ect Tab les I Add new record I Il Da1ta Collect ion Instrument Post Award Requ est Post Aw ard Requ est Page 2 Proj ect Tables / g Prog ram Supp ort Program Support Prog ram Supp ort Page 2. Progr am Su ppo rt Page .2 Redirection/ Canyove r Action sum ma ry Budg et Ext en sion Acti on sum mary __J Red irect ion/ Car ryover Act ion Summary Budget Extensio n Act ion Summ ary PREVENTING Status 0 0 0 0 TX-DSHS-19-1309-A-000233 PostAwardRequest (Page1 and2) • GeneralRequestInformation • Page1: Requestinformation on upto 5 projectsinvolvedin the request • Page2: Requestinformation on project5-15(if >5 projectsare involved) • Revisedtotalsbasedon the post-award actionrequest PREVENTING TX-DSHS-19-1309-A-000234 1. Project Table: A: Cross Cutting Epidemiology PostAwardRequest ELC Projec t (e.g. A, B , 14, etc.) - ELC_Project Name(e.g. Cross-Cutting Epidemio logy ,ca.pacity, Crosscutting l aborat,ory C3pacity, PulseNetUSA) • Foreachproject,youwillfill out: ■ ■ ■ Project name Original amounts foreachcost category Proposed/unobligated amounts for eachcostcategory A Cross Cutting Epidemiolog,y Personnel Note,'. Values. should.I.reenteredas wholenumbers,only,.wilt1outany,dollarsigns($)or,commas(e.g. $100,000= 100000) Or ig inal Award (Budg:et Period 5 (B./1/H - 7f31f19H Pro pose d carryover (Budget Periodl 4 (8/1f17 - 7131118)) 200000 - 30000 I Reviisedl Award ,(Budget Perio d 5 (8/1f18 - 71311 19)) {Calcu lated fro llill Orig inal!Awa 1rd andl IProip,osed carryove r) _ 230000 J View equatio n I Reason f unds remain avaiilabfe: • "Reason fundsremainavailable" and"Justification of howfunds wouldbe usedin currentbudget period" Expand Ju st ifticaition of how funds would be us&d in current bud get period: Expand ---------------------------- PREVENTING TX-DSHS-19-1309-A-000235 PostAwardRequest • Foreachproject,a projecttablewill begeneratedin REDCapbasedon theinformation entered. • Afterall requestdetailshavebeen entered, markthe PostAward Requestpagesas "Complete" to movethe processto the ELC ProjectOfficersandCDCPartner Programs. PREVENTING 1. Project Table:A: Cros,s Cutting Ep,idemiolog1y CATE,G0RY 1 OriginalAward Proposed Carryo,v,er Budg·et Period5 (:8111 1:871'31/1 19) BudgetPeriod4 (8J1117- 200000 Frin,ge Be-nems 100000 T1rav,eE 20000 Equipment 20000 Siupp ti es 10000 co,ntr:actual 100000 Other 50000 Perso1n1nel Total Direct c o,sts Indirect cost:s Total 713-1 /18) Revised! Award 30000 0 5000 100000 0 200000 100000 23000D 1000001 25000 1200001 10000 3000001 15000D 1500000 435·000 9350001 1600 00 560000 0 60000 99500D 435000 TX-DSHS-19-1309-A-000236 ProjectTables • Onceyouhaveenteredthe requeston the"PostAwardRequest"pageandthe"Post AwardRequestPage2" (if necessary), markbothpagesas "Complete." Form1.Status Co:mplete?' • Youcanreviewthesummarytableandindividualprojecttableson the"Project Tables"page. • At thispoint,youshouldemailyourELCProjectOfficerto indicateyourdraftin REDCapis doneandis readyfor ELCProjectOfficerandCDCPartnerProgram review. I PREVENTING TX-DSHS-19-1309-A-000237 Program Support (Page1 and2) • ELCProjectOfficerswillworkwithyouandthe relevantCDCPartner Programsto reviewyourpost-award action. • Youwill haveread-onlyaccessto thesepages,andwill be ableto see the requestsyousubmittedandwheretheyarein the reviewprocess. • Duringthistime,youmaybe askedfor additionaldocumentation from yourELCProjectOfficers. PREVENTING TX-DSHS-19-1309-A-000238 Program Support ■ Yes IPers0n11el- iC,DC Program suipports request - @ Yes O No 0 Partiall reset 0 Yes O No ® Partial! Travel _, CDC P1rogram s,upports 1req u:est ■ No How muc,h does the coc Program siuppol1? - reset 2500 Fll ndls, can b e used ! for ICE ID not for CSTE. ■ Partial Rationale Expand PREVENTING TX-DSHS-19-1309-A-000239 ActionSummary • Textgeneratedfor the letterto submitto GrantSolutions, if necessary • Separatepagesdepending on actiontype(Redirection, Carryover, BudgetExtension) • CopyandPastetheActionSummaryintoa worddocument. This includes: ■ ■ ■ TheOGStemplatetext Summary table EachProjecttable PREVENTING ■ ■ Justifications Newcontractelements,if applicable TX-DSHS-19-1309-A-000240 ActionSummary • Oncethe letterhasbeengenerated, thefollowingrequirements still need to be completed: ■ ■ ■ ■ Officialagency(healthdepartment) letterhead TwoSignatures -AuthorizedBusinessOfficialandProjectDirector(i.e.,ELC PrincipleInvestigator) FederalFinancialReport(FFR)SF425 CurrentIndirectCostRateAgreementif requesting changesto indirectcosts Afterall requirements areincluded,the lettermustbe submittedthrough GrantSolutions to be considered an officialrequestandto startOGS processing. I PREVENTING TX-DSHS-19-1309-A-000241 PostAwardRequest Checklist DOGStemplatetext □ Request summary table □ Individual projecttables □ Justification for eachproposed carryover/redirection/unobligated amount □ New contractelements, if applicable □ Official agencyletterhead □ Two Signatures □ FederalFinancial Report(FFR)SF425 □ Current IndirectCostRateAgreement if requesting changesto indirectcosts NotBS: PBrthBTBrms6 Conditions ofthBNoticBOfAward,all post-award actionsmustbBsubmittBd nolatBrthan120 daysbBforB thBBndof thBbudgB pBriod. ThBREDCap portalis dBvBlopBd to hBlpBXpBditB prBparation 6 procBssing; howBvBr, thBofficialsubmission muststill bBthroughGrantSolution . PREVENTING TX-DSHS-19-1309-A-000242 NextSteps • Accessto PostAwardActionproject • StartingFebruary4, 2019,the initiationof all post-award actionsare stronglyencouraged to occurin the REDCapportalto helpthe ELC ensuretimelyprocessing. • ForhelpwithSAMS/REDCap, pleasecontactCharNjoroge (wkv2@cdc.gov ) or MeganLight(wpa8@cdc.gov ). • Referto PostAwardActionUserGuideto navigatethroughthe project. PREVENTING TX-DSHS-19-1309-A-000243 Questions? ELG NATIONAL FUNDING STRATEGY ,i. ~sitW t:.;t, PREVENTING (JJJJP TX-DSHS-19-1309-A-000244 REDCap User Guide ELC Post Award Actions Recipient User’s Guide—2019 This user guide provides step-by-step instructions for ELC Recipients to submit post award actions through the REDCap project called “ELC Post Award Actions.” If you cannot access SAMS or REDCap, contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). 1 Drafting a New Post Award Request To start drafting a new post award request, you will need to add a new record. Each post award request is its own individual record. 1. To add a new record, first click on the “Add / Edit Records” link in the NEW Post Award Requ est 9 left hand navigation menu. Data Colle ction Instrument Status 2. On the Add / Edit Records page, click “Add new record.” REDCap will Post Aw ard Requ est 0 generate a new record for you with a unique numeric Request Number. Post Aw ard Request Page 2 0 ProjectTables 0 3. This will bring you to the Record Home Page. From here, click into the ELC Project Officer 0 gray status bubble next to the “Post Award Request” page to begin Program Support 0 working on your request. Program Support Page 2 0 Redirection / Carryover Act ion Summa ry NOTE: If a request needs to be deleted, the record can be deleted on the record home page under the “Choose action for record” dropdown. 2 BudgetExtensionActionSummary 0 0 Post Award Request & Post Award Request Page 2 “Post Award Request” includes general information about the request, and information on up to 5 projects involved in the request. If the request involves more than 5 projects, the remaining projects (up to 15 projects) will be detailed on “Post Award Request Page 2.” If the request involves 5 projects or less, “Post Award Request Page 2” will be blank. The first section on the Post Award Request page requires basic information: Recipient name, Date, Request Type [Redirection, Carryover (Non-PPHF), Budget Extension (PPHF and other special/supplemental funding)], number of ELC projects involved, budget period(s) involved, Grants Management Officer, NOA number, general description, and ELC Principle Investigator and contact information. Information in this section will dictate questions, options, and calculations throughout the rest of the data entry screens and into the OGS template. Next, you are asked to enter the NOA Totals. These totals are used later for the summary table. (1) Budget Extension – Totals on the NOA for the Budget Period in which the funds were originally awarded (i.e., will not be the current Budget Period but a prior one) (2) Carryover – Totals on the NOA for the current/active Budget Period into which the prior budget period funds will be added to comprise revised amounts for the current Budget Period 12/3/2018 Page 1 of 4 TX-DSHS-19-1309-A-000245 REDCap User Guide (3) Redirection – Totals on the NOA for the current/active Budget Period in which the funds reside that require redirecting. You will then be directed through a section for each project involved in the request (shown below). For each project, you will fill out the project name, and original and proposed/unobligated amounts for each cost category. The example shown throughout this guide is a Carryover from BP4 (8/1/17 – 7/31/18) to BP5 (8/1/18 – 7/31/19). 1. Project Table: A: Cross Cutting Epidemiology ELC Project (e.g. A , B, 14, etc .) A ELC Project Name (e.g. Cross-Cutting Epidemiology Capacity , Crosscutting Laboratory Capacity , PulseNet USA) Cross cu tting Epidemiology Personnel Nore: Values should be eme red as whole numbers only, withour any dollar signs($) or commas (e.g . $100,000 = 100000) Original Award (Budget Period 5 (8/1/1 8 • 7/31 /19)) 200000 Proposed carryover (Budge t Period 4 (8/1 /17 • 7/31/18)) 30000 Revised Award (Budget Period 5 (8/1/18 - 7/31/19)) (Calculated from Original Award and Proposed Carryover) 230000 f I View equation Reasonfunds remain available: Expand Justif ication of how funds would be used in current budget period : Important notes:  If there is a proposed/unobligated amount, you will complete two additional fields: “Reason funds remain available” and “Justification of how funds would be used in current budget period.”  The revised amounts for each cost category, the total direct costs, and totals will auto-calculate.  The sample section shown below repeats for each cost category for each project involved in the post award request (determined by the initial question “How many ELC projects are involved in this post award action?”).  Dollar values should be entered as whole numbers only, without any dollar signs ($) or commas (e.g. $100,000 should be entered into REDCap as 100000).  For a redirection, negative numbers can be entered as funds will need to be subtracted from certain cost categories in order to re-direct to other cost categories.  If a supplies request is over $25,000 you will see a reminder to submit a cost estimate along with your request in GrantSolutions.  If there is a new contract, you will be prompted to enter the 6 OGS-required required contract elements.  For each project, a project table will be generated in REDCap based on the information entered. 12/3/2018 Page 2 of 4 TX-DSHS-19-1309-A-000246 REDCap User Guide 1. Project Table: A: Cross Cutting Epidemiology ~ ATEGORY Personnel Fr i nge Benefits Travel Equipment Supplies contractual Other Total Di rect ~ osts I nd ir ect costs Total  Original Award Budget Period 5 (8/ 1/18 • 7/31 /19) Proposed Carryover Budget Period 4 (8/1/17 • ~/31/18) 00000 100000 0000 0000 10000 100000 0000 30000 0 5000 100000 0 200000 100000 30000 00000 5000 20000 0000 00000 50000 500000 1'35000 935000 0000 60000 0 1'35000 0000 95000 Revised Award Once you have completed entering information for the post award request on the “Post Award Request” page and the “Post Award Request Page 2” page (if more than 5 projects are involved), you should mark the Form Status for the “Post Award Request” and “Post Award Request Page 2” forms as Complete. This will change the status icons on the Record Status Dashboard and Record Home page to green. 3 Project Tables [Review] 4 Notify Your ELC Project Officer Once you have entered the request on the “Post Award Request” page and the “Post Award Request Page 2” (if necessary), you can review the summary table and individual project tables on the “Project Tables” page. The “Post Award Request,” “Post Award Request Page 2” pages should be marked as “Complete” and therefore show as green on the dashboard. At this point, you should email your ELC Project Officer to indicate your draft in REDCap is done and is ready for ELC Project Officer and CDC Partner Program review. 5 Program Support After you notify your ELC Project Officer that your draft is complete, your forms will be locked and your ELC Project Officer and CDC Partner Programs will review your request. You can see the steps and updates throughout this process on the “Program Support” and “Program Support Page 2” pages. 6 Notification From your Project Officer After your ELC Project Officer and CDC Partner Programs have reviewed the request, your ELC Project Officer will email you to let you know that the Program Support pages have been completed and you can move forward with the GrantSolutions submission, if necessary. 7 Action Summary Depending on the type of request, the “Redirection/Carryover Action Summary” or “Budget Extension Action Summary” page will generate the text for the letter to submit to GrantSolutions To compile the document for GrantSolutions submission, you should follow the steps below: 1. Copy and Paste the Action Summary from the from REDCap into a Word document. This includes: a. The OGS template text b. The summary table (if >1 project is involved) c. Each Project table d. The justification for each proposed carryover/redirection/unobligated amount e. New contract elements, if applicable 12/3/2018 Page 3 of 4 TX-DSHS-19-1309-A-000247 REDCap User Guide The Copy and Paste formatting will work best if you follow these guidelines:  Highlight starting from the date, continue through the summary table and each project table with accompanying justification.  On some computers, the pasted text may automatically fit within the borders of the word document. However, for others, the table may need to be formatted to fit within the boundaries. This is important because the overflowing table may cut off long pieces of text that extend the full length of the box.  There are multiple options to resize the pasted table and Table Properties X text. One easy method is detailed below: I able Coty mn 1,ltT ext .Bow Ct ll 1. Table Tools: Layout > Table Properties Size Change the Preferred width to 7.6 inches or less !;21Preferred ~ idth : 17,6" Measure in: Iinches El lill The information on the action summary page satisfies many of the requirements. However, the following requirements still need to be completed: ฀ Official agency (health department) letterhead ฀ Two Signatures – Authorized Business Official and Project Director (i.e., ELC Principle Investigator) ฀ Federal Financial Report (FFR) SF 425 [if request is a Budget Extension or Carry-Over (Redirections do not require FFR) to show funding that remains unobligated] ฀ Current Indirect Cost Rate Agreement if requesting changes to indirect costs After the formatting is done, all fields on the template are completed, and the required signatures are included, the letter must be submitted through GrantSolutions to be considered an official request and to start OGS processing. Once you have compiled the OGS letter and submitted to GrantSolutions, indicate the date submitted to GrantSolutions, and mark the action summary page as complete. 8 Record Status Dashboard The link for the Record Status Dashboard is located on the left-hand menu. The dashboard displays your jurisdiction’s records, where each line represents an individual post award request. The dashboard also shows the current status of each page of each record, as indicated by the end user. A record can be opened for editing by clicking on the colored status circle. Your Record Status Dashboard Legend fo r status icons: will look similar to the one below, but will only have post award 19 1Incomplete Q Incomplete (no data saved ) I] () Unverified requests from your jurisdiction. I (f Pos, Pos t Award Req uest Post Awa r d Request 1 Fl - 2018 -12-03 - Ca rryo•,e r (D, 11, , 0 , X, 16,G, )1, )2, J3, K1a, K1t>, M1, N1, V) .2 Fl - 2018 -11-26 - C-arryove r (A, 14, D, 11,0 , .2 Fl 9 """ ") - 2018-07 -1 O - Bud ge t Ex, e sion (B, C, ,., ,,,. , , .. , ) Award Request Project ELC Project Officer Chetklls[ l Complete Program Program Support Redirection/Carryover Page 2 Act·io n Sum mar y Su p port Bud get Exte nsio n Acti on Su mmary Page 2 Ta.bles (i) (i) (j) () (i) (j) (j) () (i) (ii (i) (D (j ) it) 11) 8 (i) (j) (i) 0 I~ ~ (j) (0 ~ Links and Contact Information CDC SAMS Help: samshelp@cdc.gov, 877-681-2901 CDC SAMS: https://sams.cdc.gov CDC REDCap: https://rdcp.cdc.gov For SAMS/REDCap Access or access to the Post Award Action Project contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov) 12/3/2018 Page 4 of 4 TX-DSHS-19-1309-A-000248 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, February 15, 2019 4:06 PM EST To: Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) CC: O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Achim, John (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) Subject: Ebola Funding WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings. As you are aware the budget period for Ebola funds (document number ending in ‘- CK15’) issued in FY15/Budget Period 2, will expire at the end of March 2019, if you previously requested a budget extension. If a budget extension was not requested in 2018, then the budget period for your -CK15 funds has already expired. Given that no additional extensions are permitted, any funds not used by March 30, 2019, will be returned, unfortunately, to the Treasury due to lack of spending after budget close-out (i.e., June 30, 2019). In preparation for the upcoming expiration of the -CK15 funds, the ELC has conducted an internal audit to estimate the amount of funding likely to be returned to help mitigate the negative impact. During this auditing process, other Ebola funds issued in FY16/Budget Period 3 & FY17/Budget Period 4 were found to also be still available in the majority of ELC Recipient accounts. The FY16/Budget Period 3 & FY17/Budget Period 4 Ebola funds were issued to supplement financial assistance in Project B: Cross-cutting Laboratory and, while currently the budget period has expired, are still eligible for a budget extension that would allow the funds to be utilized until July 31, 2019 . Here is a summary of all Ebola funding: Method of Issuance Period of Performance Eligible for Budget Extension If extended, last date for available use CK15 Separate NOA 3/31/15-3/30/18 Yes 3/30/2019 16 EB16 8/1/16-7/31/17 Yes 7/31/2019 17 EBLA17 Separate NOA Included in CDFA #93.323 NOA identified by using separate document number 8/1/17-7/31/18 Yes 7/31/2019 Budget Period Fiscal Year Document Number 2 15 3 4 Suggested next steps: (1) Meet with your budget/finance POC to explore whether or not you have unexpended funds remaining on your Ebola subaccounts ending in - EB16 or -EBLA17. (2) Determine whether all Ebola-associated charges in Project B: Cross-cutting Laboratory were made (i.e., BP3 to -EB16 & BP4 to -EBLA17). (3) If unobligated funds remain on either -EB16 or -EBLA17, work with your ELC Project Officer to get a budget extension submitted as soon as possible so that these funds can be made available for use before the July 31, 2019, budget expiration. Sincerely, The ELC Team TX-DSHS-19-1309-A-000249 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Wednesday, February 20, 2019 10:28 AM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: FY19 ELC Notice of Funding Opportunity (NOFO) Kickoff Webinar: March 14, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ELC Colleagues, We welcome you to attend a kick-off webinar for the ELC FY19 NOFO on March 14, 2019 from 3:00 pm – 4:30pm ET. The purpose of this webinar is for ELC to discuss content and changes in the FY19 ELC NOFO Guidance, the application timeline and requirements, and allow time to answer any questions you may have. Webinar Call-In Information: 1-773-756-0169 or 800-857-4945 Participant passcode: 3092790 For Participants: URL: https://www.mymeetings.com/nc/join/ Conference number: PWXW8757468 Audience passcode: 3092790 Participants can join the event directly at: https://www.mymeetings.com/nc/join.php?i=PWXW8757468&p=3092790&t=c PLEASE NOTE: · The FY19 ELC NOFO is scheduled to be posted on Grants.gov on Friday, March 1, 2019. · The application deadline will be Friday, May 10, 2019 at 11:59 p.m. EST on www.grants.gov. · ELC will send an email notification to the ELC Governance Team members when the Guidance, templates, companion tools, and other resources are accessible in REDCap within 24 hours of the official Guidance posting on Grants.gov. o This email will include a list of the jurisdictional contacts that will have access to the REDCap 2019 ELC Application and Monitoring Portal once the Guidance is posted. Any individuals who has access to an ELC REDCap projects) and individuals who have recently requested it, will have access to the 2019 Application and Monitoring Portal when it goes live. o If you have not already requested access and anticipate needing it, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov) to initiate the process. Thanks and we look forward to speaking with you in a couple of weeks! ELC Team TX-DSHS-19-1309-A-000250 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, February 26, 2019 9:50 AM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Budget Template Webinar WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, ELC will host an ELC Budget Template Webinar on Tuesday, March 19, 2019, from 3p.m. to 4:30 p.m. ET As you know we are soon publishing the FY19 ELC Notice of Funding Opportunity (NOFO). All applications must include a budget template and the ELC is proving a webinar to provide some important information regarding this year’s budget template. The webinar will: • Review the enhanced ELC Budget Template, which will be used in requesting BP1 funding for the new ELC NOFO (CK191904). • • Introduce new features designed to help reduce data entry errors. • Provide guidance on how to ensure that the submitted budget reflects programmatic financial needs. Highlight new functionality such as providing cumulative cost category data to assist in Grants.gov submission. Your attendance at this webinar is highly encouraged as the budget template is required with all FY19 ELC NOFO applications. Webinar Dial-In Information: 1-773-756-0169 or Passcode: 3092790 800-857-4945 URL: https://www.mymeetings.com/nc/join/ Conference number: PWXW8824363 Audience passcode: 3092790 Participants can join the event directly at: https://www.mymeetings.com/nc/join.php?i=PWXW8824363&p=3092790&t=c Please send all questions related to this webinar to elc@cdc.gov. Thank You, The ELC Team TX-DSHS-19-1309-A-000251 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, February 28, 2019 5:17 PM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC FY2019 NOFO is now published on Grants.gov! Attachment(s): "ELC Application Portal Master User List 2_28_19.xlsx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings ELC Recipients, The ELC 2019 Notice of Funding Opportunity (NOFO) is now published on Grants.gov! Similar to last year, template resources will be available within the REDCap ELC Application and Monitoring Portal 2019-2020. We are asking all applicants to submit their completed FY2019 ELC NOFO Application via Grants.gov and upload a courtesy copy via REDCap by Friday, May 10, 2019 at 11:59 P.M. EST. The REDCap project will go live tomorrow, March 1, 2019 and the following documents will be available: • • • • • • 2019 ELC Notice of Funding Opportunity (NOFO) 2019 Budget Template (will be available on March 6, 2019) All 2019 CK19-1904 program and project application templates All program and project companion tools (unlocked Word templates) ELC REDCap Users Master List (attached to this email and located within REDCap File Repository) ELC Application and Monitoring Portal 2019-2020 User Guide (located within REDCap File Repository) In order to assist applicants with completing their ELC FY 2019 NOFO applications, the following webinars will be offered to all ELC Recipients: · Kick-Off FY 2019 ELC NOFO Application Webinar on Thursday, March 14, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide pertinent information regarding the application requirements. Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET.This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. · · Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Date and Time (TBD) Please remember, access to REDCap is needed in order to submit your courtesy copy to ELC. If you or your staff have access to any ELC REDCap project, you will have access to the ELC Application and Monitoring Portal 2019 – 2020 by 2:00 p.m. on March 1, 2019. Attached to this email is the master list of all ELC REDCap Users as of today. If additional access is needed for staff within your jurisdiction, please send an email to Char Njoroge,wkv2@cdc.gov or Megan Light, wpa8@cdc.gov. If you have any questions regarding any of the resources or the application, please send an email toELC@cdc.gov. Thank You, ELC TX-DSHS-19-1309-A-000252 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 A State AK AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AL AMSAM AMSAM AMSAM AR AR AR AR AR AR AR AR AR AR AR AZ AZ AZ AZ AZ AZ AZ AZ AZ CA CA CA CA CA B C REDCap ID First Name 26383  Louisa 473976  Charles 26316  Sherri 384064  Evelyn 490590  Keith 408367  Leigh 404581  Amanda 93824  Tammy 23556  Sharon 30120  Mary 107716  Taishayla 63652  Jennifer 111680  Darryl 119915  Allison 101921  Brenda 109447  Perry 5850  Kelly 434328  Cara 437513  Aretha 397710  Tiffany 71945  Iugafono 80532  Benjamin 496668  Aifili 554638 Benita 43560  Kelley 30086  Dirk 470385  Linda 41809  Herbert 402120  Racheal 470384  bounleut 21656 Katie 34442  Lori 39805  Richard 23638  Janis 398102  Linda 37082  Ken 34134  Eugene 45727  Joseph 18916  Jessica 119403  Kara 93866  Victor 59001  Stacy 380378  Hayley 448922  Laila 490641  Rochelle 490642  Vinesha 34467  Cheryl 31224  James D Last Name Castrodale Crawford Davidson Geeter Higginbotham Hixon Ingram Langlois Massingale McIntyre Mckitt Owes Pendergrass Roebling Ryals Snider Stevens Williams Williams Wilson Sunia Sili Tufa Bosier-Ingram Garner Haselow Henson Matthews Odom phanavanh Seely Simmons Taffner Thompson Getsinger Komatsu Livar Manfrida Rigler Tarter Waddell White Yaglom Khan McLaurin Sarang Starling Watt E Account Suspended? [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000253 2018-2019 Appplication 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 A CHI CHI CHI CHI CNMI CNMI CNMI CO CO CO CO CO CO CO CO CT CT CT CT CT CT CT CT CT CT CT DC DC DC DC DC DC DE DE DE DE DE DE DE FL FL FL FL FL FL FL FL FL FL B 31525  457577  24114  383216  22296  473351  471990  70679  31086  487143  52447  403142  7139  383743  79040  33379  36357  119924  22603  119169  407508  532003  471988  54027  109269  31470  99258  68373  103918  403592  109716  42803  23966  389389  75372  64472  30139  517138  31741  68792  33460  35111  81023  41314  471985  409506  35631  415995  34465  C Stephanie Jennifer Massimo Peter Corazon Corazon Portia Nicole Alicia David Peter Rachel Hugh Natalie Emily Nancy Matthew Karin Diana Michael Claudia Jocelyn Anthony Randall Diane Therese Emily Andrew Preetha Matthew Sasha Kenan Marion Emily Gregory Nhiem Tabatha Debbie Debra Andrea Andrew Russell Julie Lea Mark Juliana Scott Marie-Claire Danielle D Black Levy Pacilli Ruestow Ada Ada Tomokane Comstock Cronquist Crosby Davis Herlihy Maguire Marzec Travanty Barrett Cartter Davis Eaton Fraser Gutierrez Mullins Muyombwe Nelson Noel Rabatsky-Ehr Blake Hennenfent Iyengar McCarroll McGee Zamore Fowler Hanlin Hovan Luong Offutt-Powell Ogden Rutledge Bingham Cannons Eggert Framingham Heberlein-Larson O'Neill Prieto Pritchard Rowlinson Stanek E [account suspended] [account suspended] 2018-2019 Appplication TX-DSHS-19-1309-A-000254 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 A FL FSM GA GA GA GA GA GA GA GUAM GUAM GUAM GUAM HI HI HI HI HI HI HI HI HI HOU HOU HOU HOU HOU IA IA IA IA ID ID ID ID IL IL IL IL IL IL IL IL IN IN IN IN IN IN B 418945  407482  110688  471984  59575  34268  108954  470780  38730  109256  109791  22729  401476  404585  31079  33482  452026  30134  13908  102561  452025  403353  404604  395909  491966  471981  109795  457637  98696  109893  33963  36806  21719  403379  5881  96484  114918  22895  21322  490824  26971  487138  361831  57975  18142  41434  122772  104582  383738  C Marla Lisa Patricia Victoria Julie Jeanne Suresh Chris Jessica Estelle anne Josephine Rosanna Nianest Myra Zeshan eric Michele Sarah Rebecca Gracelda Lincoln Kasimu Tolulope Xiaohui Kirstin Vicente Andrew Julie Drew Ann Christopher Michael Leslie Kathryn Wendy Shana Debbie Judy Megan Heather Erica Elizabeth Mark Eric Andrea Emily Taryn Katlyn D Wallace Barrow Bennie Catoe Gabel Negley Pai Rustin Tuttle Ada marie santos O'Mallan Rabago Alers Barreto Ching-Lee Chisty honda Nakata Park Sciulli Simmons Wells Muhetaer Olumuyiwa Sherry Tang Short Zuno Connet Coughlin Fayram Garvey Ball Stevenson Tengelsen Turner Alexander Altman Freeman Kauerauf Patel Reid Runningdeer Soda Glazier Hawkins Morris Potts Stevens Wainwright E [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000255 2018-2019 Appplication 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 A KS KS KS KS KS KS KY KY KY KY KY KY KY LA LA LA LA LA LA LA LA LA LA LA LA LA LAC LAC LAC LAC MA MA MA MA MA MA MA MD MD MD MD MD MD MD MD MD MD MD MD B 101666  401481  112271  65948  19021  110692  94136  33615  382152  90021  387805  34397  34418  401323  420338  21181  33715  104303  98522  34642  111332  31496  456277  98523  423607  31462  109406  393382  104534  457649  33430  547024  23163  109273  24241  21347  87755  69072  555494 422167  49786  413428  102316  545269  34229  69419  401900  486520  384309  C Karen Brian Caryn N Sheri Michael Leigh andrea Brooke Alice Dimple Carrell Mike Julyana LeAnn Kerri Danielle Raoult Andrea Christine Andrew Theresa Ashley Julius Peter Erica David Van Sadina Yushan Catherine Keisha Ceci Shoolah gillian Patricia Sandra David Echell Monique Katherine Megan Judie Liore Kimberly Robert Amelie Ami Monika D Crawford Hart Masters Myron Gunsalus Jr Tubach Weinkauf Bates flinchum Happ Nyakeriga Patel Rush Schardein Cheng Covington Gerage Haydel Ratard Salinas Scott-Waldron Smith Sokol Terry Tonzel Travis Washington Jensen Ngo Reynaldo Tong Brown Dixon Dunn Escott haney Kludt Smole Blythe Curtis Duwell Feldman Galvin Hyun Klein Mitchell Myers Olga Mafotsing Fopoussi Patel Piccardi E [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000256 2018-2019 Appplication 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 A MD MD MD MD MD ME ME ME ME ME ME MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MI MN MN MN MN MN MN MN MN MN MN B 459311  121846  26378  414180  31212  31567  438030  65610  75047  26302  110434  47255  33358  33389  29501  19074  33407  31530  107729  93426  57428  88435  21157  492694  33618  33994  33705  33792  487177  117825  391346  1798  473281  93997  390571  34439  92338  409294  409290  49606  30051  490431  112049  110682  36656  111313  113124  113098  68026  C Bhoghkumarie Lawrence Stephen Abigail Ruth Richard Jennifer Nick Rita Sara Brittany Carrie Katherine Jennifer Sally Joel Susan Brenda Matthew Joseph Danielle Seth Jay Charde Erik Mary Edward Shannon Macey Sarah Sara Noreen Elisia Sandip Jennifer Kimberly Marty Bryce Mike Kathryn Richard Kristen Emily Dan Ellen Eric Elizabeth Sarah Sara D Rambharat Reid Stanley Taylor Thompson Danforth Liao Matluk Owsiak Robinson Roy Anglewicz Arends Beggs Bidol Blostein Bohm Brennan Buck Coyle Donovan Eckel Fiedler Fisher Foster Grace Stobierski Hartwick Johnson Ladisky Lyon-Callo McNamara Mollon Ray Shah Sidge Signs Soehnlen Spiker Wesenberg Como-Sabetti Danila Ehresmann Moyer Emerson Hammersley Laine Lundquist Schiffman Solarz Vetter E [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000257 2018-2019 Appplication 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 A MN MO MO MO MO MO MO MO MO MO MO MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MS MT MT MT MT MT MT MT MT MT MT NC NC NC NC NC NC NC NC NC NC ND B 109274  416756  109275  399617  21243  488610  490592  7231  18584  50715  118385  19718  20975  457919  457918  30039  96232  68722  98756  23017  501598  459286  437062  405380  492306  104050  89175  549813  33350  422499  490077  487960  2611  393745  554656 21480  90224  68626  383877  218816  53392  30112  394594  34298  21547  418624  34330  34631  26369  C Jacy Molly Linton Jessica Amber Stephen Loretta Howard Randy George Karen Jannifer Degina Carla Danielle Paul Latasha Sheryl Xiaoming Theresa Jessica Deborah James Karin wendy Daphne Vicki Melody Stacey Erika Carrie Molly Debbie Rachel Dani Karl Christine Magdalena Ronna Aaron Anne Jean-Marie Susan Barbie John Rebecca Dee Scott Michelle D Walters Baker Bartlett Bauer Dawn Heathman Gladbach Loethen Pue Schillers Turabelidze Yates Anderson Booker Boutwell Brown Byers Easterling Hand Hester Kittle Morris Sennett Stewart Thurman varnado Ware Williams Winston Anderson Baldry Biskupiak Blanksma Gibson Hinnenkamp Lindeman Milhon Mulgrew Scott Chan Fleischauer Hakenewerth Maillard Orton Page Peebles Pelc Pettit Zimmerman Feist E [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000258 2018-2019 Appplication 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 A ND ND NE NE NE NE NE NH NH NH NH NH NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NM NM NM NM NM NM NM NM NM NM NM NV NV NV NV NV NV NV NV NV NV NV NV B 97469  453046  111633  30094  415132  44030  26334  122627  21091  52577  34175  118135  32725  413710  33672  118015  32430  423753  31144  26398  416234  109404  488844  39147  469917  24858  403359  33356  471763  386768  86592  411707  454706  115799  105191  414512  34053  472818  109277  32204  34077  32810  33575  117144  396103  399054  69726  88127  118030  C Tracy Christie Roxanne Peter Brianna Ming Robin Christine Elizabeth Carolyn Abigail Jill Kimberly Sarmila Rebecca Susan Rosemary Thomas Edward Lisa Susan Marcia hita Christina Chiara Elizabeth Jessica Adam Victoria Joseph Pascale Lixia Sandra Marla Chad Allison Elizabeth Petra Lorne Dustin Kimisha Lei Judy Brian David Christabell Randall Stephanie Lei D Hoke Massen Alter Iwen Loeck Qu Williams Bean Daly Fredette Mathewson Power Cervantes DasGupta Greeley Hannagan Kidder Kirn Lifshitz McHugh Mikorski Pindling-Watkins shah Tan Warehall Zaremski Acosta Aragon Armijo Bareta Leonard Liu Melman Sievers Smelser Treloar VinHatton Bartella Belt Boothe Causey Chen DuMonte Parrish Schmitt-Culp Sotelo-Zecena Todd Van Hooser Zhang E [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000259 2018-2019 Appplication 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 A NY NY NY NY NY NY NY NY NY NY NY NY NY NYC NYC NYC NYC NYC NYC NYC NYC NYC NYC NYC NYC NYC OH OH OH OH OH OH OH OH OH OH OK OK OK OK OK OK OK OR OR OR OR OR OR B 21066  470137  118588  80410  106370  104635  402666  470149  458038  92032  53344  41486  32621  498404  486300  474960  120905  87739  30106  455455  111942  401482  485845  401884  456017  474963  458039  89199  19202  70901  21339  395688  123065  21586  1844  109278  30038  36968  470370  5375  34189  34259  554890 452617  19222  487139  419322  69328  554658 C Meredith Amy Marie Christina Dina CathyJo Daniel William Ronald Michael Wendy Jamie Jennifer Steve Alan Pamela Mary Scott Marcelle Yuming anna Dakai Christine Emily Morgan Afua Quanta Elizabeth Sietske Richard Larry Sarah Alisa Kim Kevin Steven Kristy Laurence Daniel Anthony Mike John Lea Tara Maureen Derrick John Stephen Matther D Conner Dean Desrosiers Egan Hoefer Kile Kuhles Lee Limberger Perry Pulver Sommer White Di Lonardo Dorsinville Evans Lloyd Foote Hughes Layton Li liddicoat Liu Mahle McGibbon Moy Sanders Kim Brown Cross de Fijter Gary King Mitchell Obukhova Quinn Sohner York Bradley Burnsed Edwards Lee McDermott Murray Reynolds Buehring Cassidy Clark Fontana Ladd-Wilson Nowacki E [account suspended] TX-DSHS-19-1309-A-000260 2018-2019 Appplication 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 A OR OR OR OR OR OR OR PA PA PA PA PA PA PA PAL PAL PAL PAL PHL PHL PHL PHL PHL PR PR PR PR RI RI RI RI RI RI RI RMI SC SC SC SC SC SC SC SC SC SD SD SD SD SD B 488617  109279  55947  34030  31211  400244  92466  1913  38504  401940  25342  487198  67472  49635  12815  492906  403589  413711  48581  109887  397730  38241  105006  66261  351947  88133  403588  37117  1700  449885  37910  26396  120857  21776  12866  538243  30033  416316  36131  24701  486804  110685  58885  385874  36621  31259  21190  109280  543134  C Rebecca Gina Lisa Roza Ann Dat Alexia Lisa James Krystal Jeffrey Julie Atmaram Sharon Bernice Myla Eden Cheryl-Ann Steven Tara Malaya Caroline Dana Encijar Elizabeth Marangely Jomil Utpala Michael Richar Ewa Daniela Bridget Cynthia Edlen Michelle Linda Andrea Megan Daniel Christopher Sharanda Shari Brian Christopher Josh Craig Whitney Timothy D Pierce Ramoz Takeuchi Tammer Thomas Tran Zhang Dettinger Lute Mason Miller Miller Nambiar Watkins Elechuus Mira Uchel Udui Alles Cameron Fletcher Johnson Perella Hassan Magnuson Olivero Torres Bandy Gosciminski Huard King Quilliam Teevan Vanner Anzures Barnes Bell Causey Davis Drociuk Evans McCauley Rankin Witrick Carlson Clayton Glander Lutkemeier Southern E [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000261 2018-2019 Appplication 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 479 480 481 482 483 484 485 486 487 488 489 490 A TN TN TN TN TN TN TN TX TX TX TX TX TX TX TX USVI USVI USVI UT UT UT UT UT UT UT UT UT UT UT VA VA VA VA VA VA VA VT VT VT VT VT VT VT WA WA WA WA WA WA B 33873  21185  56595  30097  26287  469860  554639 418171  102161  4075  490424  109891  34358  401353  55543  403378  72462  112697  27414  93827  36640  33486  21121  121085  491077  36562  103646  491076  74312  387820  415246  26468  34127  112741  121442  22138  494121  488794  23273  8469  438026  21531  31214  38737  417397  554633 490809  30074  33045  C Corinne Jim Shannon Timothy Marion Nicole Jennifer Tiffany Kelly Nicole Sharon Natalie Pushker Martha Shawn Brett Esther Irene Ginnylynn Robyn Cindy Kimberly Melissa Angela Joe Allyn Dallin Cheryl Karen Shea Angela LaToya Seth Jennifer Mary Diane Cheryl Charlie Mary Patsy Natalie Joyce Bradley Mike Mary Leann Connie Romesh Hanna D Davis Gibson Harney Jones Kainer McGoodwin Sanchez Aldridge Broussard Evert Golden Perez Raj Thompson Tupy Ellis Ellis Guendel Ambrenac Atkinson Burnett Christensen Dimond Dunn Jackson K Nakashima Peterson Shubert Singson Browne Fritzinger Griffin-Thomas Levine Macdonald Rachael Straver Woolard Achilles Castor Celotti Kelso Kwit Oetjen Tompkins Boysun Chan Christensen Dunn Gautom Oltean E [account suspended] [account suspended] [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000262 2018-2019 Appplication 491 492 493 494 495 496 497 498 499 500 501 502 503 504 505 506 507 508 509 510 A WA WA WA WA WA WI WI WI WI WI WI WI WV WV WV WV WV WY WY WY B 121050  75359  104403  490995  30170  33401  33418  455005  33549  282934  118437  471987  1797  28593  58677  395895  34510  63388  491697  50681  C Michael Sara Denny Madyson Wayne Amy Erin Elizabeth Traci Lina Rebecca Ryan Christi Maria Miguella Jessica Carrie Sarah Noah Clay D Owen Podczervinski Russell Schuh Turnberg Bittrich Bowles Brotheridge DeSalvo Elbadawi Osborn Wozniak Clark del Rosario Mark-Carew Shiltz Thomas Buss Hull Van Houten E [account suspended] [account suspended] [account suspended] TX-DSHS-19-1309-A-000263 2018-2019 Appplication From: Aldridge,Tiffany (DSHS) Sent: Thursday, February 28, 2019 6:17 PM EST To: wvf8@cdc.gov ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; tay7@cdc.gov CC: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: TX Year 4 Carry Over of M2 - Zika Pregnancy Registry Funds Attachment(s): "6NU50CK000378-05 TX DSHS Zika 2017.pdf","RE TX ELC M2 Budget Question.msg","RE M2 ZPR Funding.msg","TX M2 Zika Pregnancy Registry Year 4 Carry Over of Funds.pdf" Good Afternoon, Attached is TX Year 4 M2 Zika Pregnancy Registry Carry Over of funds request and a copy of the submission to GrantSolutions. Please let us know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov TX-DSHS-19-1309-A-000264 TEXAS Texas Department ofStateHealth Services Healthand Human Services JohnHellerstedt,M.D. Commissioner February 28, 2019 Karen Zion, Grants Management Specialist Centers for Disease Control and Prevention Office of Grants Services Infectious Disease Service Branch, Team I 2920 Brandywine Road, MS E-15 Atlanta, GA 30341 Reference: DSHS Doc.# 1918-05-AP-02 Award Number: 6NUS0CK000378-05 CK14-1401, Building and Strengthening Epidemiology, Laboratory, and Health Information Systems Capacity in State and Local Health Departments Prior Approval: Carryforward of Year 4 Zika 2017 to Year 5 Dear Ms. Zion: The Texas Department of State Health Services (DSHS) requests to carryforward Zika 2017 funds of $136,672 from Year 4 to Year 5 of the referenced Award Number as listed above. In Year 4, DSHS hired a contracted Zika Pregnancy Registry (ZPR) Coordinator; however, the position became vacant after a few weeks. A new ZPR Coordinator was hired at the end of Year 4 and has been completing the activities of the position since this time. In Year 5, the Coordinator is completing the data compilation and technical assistance for the Local Health Departments. The Center for Disease Control and Prevention (CDC) hired contracted ZPR Coordinators throughout the regions in Texas. The coordinators provide education and outreach to health care providers in their jurisdictions to import the quality of data within the ZPR. Due to CDC hiring these contractors, DSHS no longer needed to complete this activity. P.O.Box149347 • Austin,Texas78714-9347• Phone:888-963-7111 • TTY:800-735·2889 • www.dshs.texas.gov TX-DSHS-19-1309-A-000265 Zion, Karen February 28, 2019 Page 2 If approved, the funds will continue the contract with the temporary Zika Pregnancy Registry (ZPR) Nurse IV. Activities will include, assistance with the Year 5 grant application for program review and consultation activities; trave l activities to attend Local Health Department site visits to provide techn ical assistance and to attend the Annual Epidemiology, Laboratory, and Health Information Systems Capacity Grantee meeting scheduled for April 2019. [I 11 CATEGORY Personnel Fringe Benefits Travel Equipment Supplies Contractual Other Direct Costs Indirect Costs Total YEARS ORIGINAL AWARD YEAR4 PROJECTM2 CARRYOVER 1,345,852 472,867 125,039 0 1,097,360 5,302,546 119,282 8,462,946 1,456,540 9,919,486 YEARS REVISED AWARD 0 0 0 0 0 115,726 0 115,726 20,946 136,672 1,345,852 472,867 125,039 0 1,097,360 5,418,272 119,282 8,578,672 1,477,486 10,056,158 Please note : The $136,672 funds are located in Year 4. Component: ZIKA Document Number : 000378CK17 Subaccount Title: CK141401COOPAGREFY17 To support this request, please find the SF424A, budget narrative, and Federal Financial Report attached . If you have any questions regarding this request, please feel free to contact me, Imelda Garcia, at {512) 776 - 7679 or via email: ImeldaM.G arcia@dshs.tex as.gov. If you have any financial questions , please contact Sharon Golden, Team Lead, Funds Coordinat ion and Management Branch at 512-776-6562 or email: DSHSAwards@dshs.texas.gov . Sincerely, TX-DSHS-19-1309-A-000266 Zion, Karen February 28, 2019 Page 3 Project Direct Authorized Official Imelda M. Garcia, MPH Associate Commissioner Laboratory and Infectious Disease Services Division Business Official Amanda Hudson Director Budget Section Enclosures cc: De'Lisa Simpson, CDC Project Officer Angelica O'Connor, CDC ELC Program Coordinator TX-DSHS-19-1309-A-000267 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs Grant Program Function or Activity (a) Catalog or Federal Domestic Number (b) 11 TX M2 Zika Pregnancy _, Estimated Unobligate_11nce1. C. TTXED BATES· lf a fixed rate la in th1D Agrca...,nt, it 1a baaed on an e1tl,..ta of the co,ta for the period covered by th• rate. When enc actual coat■ tor thiD perlod are determined, an adjustment will be Nde to a rate of a future ycarlal to eo=penaote for the flxcd rate and actual c0uta. the dlfference between the c:-o1to uaad co eatablloh D 11S£QX QlllEB FEO£B/\J,I\GE!ICJES· The rot e• In thlo Agrec=ant were approved In ecconlance with the authority i n Title 2 or the code of Federal Regulatlona, Part 200 12 CPR 200I, and should be appll~ to granta, =~tracta and other ~9ree&enta covered by 2 CFII 200, subject to any limitat lo~a In A above. The organ1~at1on ..ay provldc copiea of the A!)ree•e nt to other Federal Agencie$ to give them early notitl t:>1tlon of che A;ree,ncnt . E. QiliE&;. i1 '"iiiy""Federal rontracc, 9rant or other agreement is rcilllburaln9 ind lr c:tc01 t1 by a oean• other than the approved catetsl to the .at!.i,cted pr09ram•. and Ill apply the approved i'LSl!l!l _~ rcement , the organiutlcn ahould Ill credit ■uch to the epprcprletc ba1e to ldentlfy the proper amount o[ Indirect costa allocable to che1e prograQI, ratclel =1t• Oil BtHALt OF' TIIE FE:DEMI.1:iOVEIUIHEIIT , DY Tll!a', lNSTITtll'IO!I: Texas Department of State Health Services 0EPM1'11!:IIT OF HEALTII A.'ID HUtWI SERVICES ( IIISTtTI/TlOII) I. .{ • I) Q411tt,.r,. (StcmATUR£l ISI<;!IATl/1\£) INNftl L:rlTLCI J ..J . for Arif Karim IIIAKtl bLW1t •.rne Director. Cost Alloe•tion Service, ITITL'£l lQ/ a•5.ln11J1e ,11112011 (llATEI IOATEl 65H llffS I\EPRESEIITATlVE , Wanda Rayfield [214) 767 · 3261 Page 3 of 3 TX-DSHS-19-1309-A-000275 ... FEDERALFINANCIALREPORT ·FImm k'tslruclladc:ampleteadrhs1 ~dng D~ARTIIENT OF STAR HEALlll Sl!AYlCl!S 1100Wl!ST ,tTH STIIEET, AUSllll, TEXAS7175& o auar1e11y (To 1'91)(111 mu\i,11 gra• I• .,, . FFR Ma Ol.'\'lllrlJ " lntarlm I XAnnu.il ZJKAELCFUNOIY7110 OSHS 32-011364l-A2 10-739-1511 I Pni,ec:1/GtanlPoriod Fn,m [Month Day ;□ Cash iO rltlll X Accrual , 9 ReportJ19Period End Dale v,., ; To (Mon411O.y Y111I 7/31/2018 SM/2017 7/31/2011 •• ofl/301201 B Ciur.l' a\l/9 , 10 Tr.innc:tlont (Vs• liries a-c fer sngJe Fedenl l!..i. rra .-.a Cash...,_ ermult,,le r,ant ropotfttgJ 111utU"'•arants. llaa uu FFR Altacl11nen1: I I b C-,11 la <: Cast, an Hanel(lr,o ■ IIW1US bl /Use/,nes d-o far single i;,anl n,port,ngJ Fe4eral l!oDeftdlbuU and IJnDbllnled Balance: d • f a TatalFodotallunds F-.J of ••"""liluras F•~- o1-........11d """"'tmn1 T"'II F111- ••um al lnea • and 11 h Unc......,od baliacerAF..t~l fund, fined m,,.., • A""'-lent Share: I $1 324.110100 S7M032.el , $ 1K 56&.SS 1!1-WSOI 18 ""~ 19911,1 ' ...,lllllnz9d sh- ToUI --n1 . .. _w,9 ,_.._-nd I R-11111n ol ••-- k "-""' _,._nl Sharl to bo -~ ,.,_ 1nc:om. , 11,ne,,,,_ I ... II 1nc,rec1 sooo SOO!I . e Pen,dft,)ffl ,.... I]-. 1,1~ 8/1/2017 !1'1/2017 8/ll/1017 Foud )l- lrlt.!011 7/ll/2018 713112015 r..,._.. ."'""""'~-- a... d PrOQdTo & sooo SOM - bllm f .. d $000 I ll I Total F-al.........,. oncome ••-::..--' m Pr,t11W21!'1 aneomee1ftanded "'aCCDl¢aneewith t.lt• c,.rt.-,1IOI\ ahem.t i"• n ~rn ancorne... -~ r, •c~• wrth lh• aodeton ■lematN'• ,..........,.ncomellon •lnw,vs"1•m0tk,en 1 a • T- ·- SOM ,,-sr- 18JIO'III •U-1')4 5' !121 UU.11 SUI &.?SJU HUMU 111.nu, 5'22'1163 l71.t07.11 17l.lD7.11 I JO 11 $0 00 12 Remarks. 13. Cer1illcallan: By llgnlng 1h11,...art, I ctt1lfr lhat 1111Info, complew end•"",.,. to Ille but af m,,lulowledo• · I...,.,...,. 11111 _,, fal11 Rr:UIIOIII or fnudullnl lnfant1'111an_,. ,ubl.c1111•to Cl1lnlnal . cl•II ar edmlnl1tn1 .. ~allln . J I.S. Code lido 211 Sedan 10011 a Typlldor PnntldName••d Tit'a Ci( """-• 11f.11f~}.r ,..,._ =I ~ d - ,gOlfyi ~ e Dalo Repcn lCJ ··- 5111,-111 Ad a, om..a.d ,., _,.. f'IAlkrai,onng-fottuc:o1eConot"""""..,,,11 ....sa,,nplttn) ond~og.,. .._.,,...,,lnd-A.dWP_R_P-,:,i1~1,w- _,., _ ~ ~-- fl.lontn 0.ay Year} ' ... 12 J ·201 .fi ,~..,,,.""' I lo tile Popcn,an R-.. red Emalaooress ,it J t-'-- .. .. -1o .. req....., to ,mpon,I Ii> a a>lem>nal _ 5-IQlftlffltob StllldaNUlllllllr 0348-00&I EAl,talloft Dale t0/J 112011 _, .na, ~ ""PWJS' •llodOMSCattn,t N,_,bor The ,1&11 OMII~ - lo, N .,ev••s""""wtaonci,s,,,g..,.,.,,..,..,,g..~ ..'"""llcs.11_... ~--.i,_c11111 lll#dmalfflnt Sent: Wednesday, August 08, 2018 10:19 AM EDT To: Simpson, De'Lisa D. (CDC/OID/NCEZID) ; Aldridge,Tiffany (DSHS) CC: Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) ; Garcia,Imelda M (DSHS) ; King, Kellianne M. (CDC/ONDIEH/NCBDDD) (CTR) Subject: RE: M2 ZPR Funding WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning and please accept my apology for this delayed response. I just want to piggyback on De’Lisa’s comment and state she is correct – the M2 funding is yet to be awarded and is expected around mid-September. What you receive in September will be considered new funds and not carryover. To request the $405K carryover amount, the final FFR for FY17 has to be submitted. Thanks, Tineka From: Simpson, De'Lisa D. (CDC/OID/NCEZID) Sent: Wednesday, August 8, 2018 10:07 AM To: 'Aldridge,Tiffany (DSHS)' Cc: Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) ; Garcia,Imelda M (DSHS) ; Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Subject: RE: M2 ZPR Funding Hello Tiffany, There was no M2 funding awarded in your FY18 continuation award. You will need a final FFR for FY17 to submit a carryover request into GrantSolutions. De’Lisa From: Aldridge,Tiffany (DSHS) Sent: Friday, August 3, 2018 5:26 PM To: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Cc: Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) ; Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/OID/NCEZID) Subject: M2 ZPR Funding Hi Tineka, In our previous conversation, DSHS was to continue using ZPR funding on the basis of the Letter to Incur Costs sent the day before from CDC. We’ve now received our NGA. Once we received the NGA, the letter was no longer valid for us by DSHS. The NGA overrides the letter. I can’t tell in the award how the offset ($405k) was awarded to us because it is not included on the breakdown template or the Excel template from CDC. Per our discussion, the additional $55k would be awarded to us mid-September. Do we have to wait until the FFR is submitted to complete the Carry Forward request in order to use those funds. Do you know if the funds were included in the NGA as offset for Year 5? Please feel free to contact me on my cell if you would like to discuss this further. If you would rather I set up a call, please send me the best times to contact you and I will get the call set up. Thank you in advance for your help with this. Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000277 From: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Sent: Friday, June 01, 2018 4:15 PM EDT To: Aldridge,Tiffany (DSHS) Subject: RE: TX ELC/M2 Budget Question Hello Tiffany, Thank you for sending these and for taking the time to talk to me today. Hope you enjoy your weekend! Tineka From: Aldridge,Tiffany (DSHS) Sent: Friday, June 1, 2018 3:35 PM To: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Subject: RE: TX ELC/M2 Budget Question Hi Tineka, I’ve attached the request for the no-cost extension with the redirection, the NGA, and the Interim FFR submitted as part of the Year 5 application. Please let me know if you have any further questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section Infectious Disease Control Unit MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 (Please note my cell number has changed.) Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) [mailto:tay7@cdc.gov] Sent: Friday, June 1, 2018 1:08 PM To: Aldridge,Tiffany (DSHS) Subject: RE: TX ELC/M2 Budget Question Great! Calling now. From: Aldridge,Tiffany (DSHS) Sent: Friday, June 1, 2018 2:06 PM To: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Cc: Akosa, Amanda (CDC/ONDIEH/NCBDDD) (CTR) ; Garcia,Imelda M (DSHS) Subject: RE: TX ELC/M2 Budget Question Yes, I’m at (512) 776-6658. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section Infectious Disease Control Unit MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 (Please note my cell number has changed.) Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) [mailto:tay7@cdc.gov] Sent: Friday, June 1, 2018 12:58 PM To: Aldridge,Tiffany (DSHS) TX-DSHS-19-1309-A-000278 Cc: Akosa, Amanda (CDC/ONDIEH/NCBDDD) (CTR) ; Garcia,Imelda M (DSHS) Subject: RE: TX ELC/M2 Budget Question Hello Tiffany and thank you for your response. Are you currently available for a brief call? Thanks, Tineka From: Aldridge,Tiffany (DSHS) Sent: Thursday, May 31, 2018 6:45 PM To: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) Cc: Akosa, Amanda (CDC/ONDIEH/NCBDDD) (CTR) ; Garcia,Imelda M (DSHS) Subject: RE: TX ELC/M2 Budget Question Hi Tineka, The $725k requested in the Year 5 ELC application in Project M2 covers the 5 Zika field staff we plan to have in the field. All will be paid at $145k/each. There will be 2 staff in Cameron County (this includes Brownsville) and 1 staff in each El Paso, Hidalgo, and Laredo. The $725k covers 5 staff. We anticipate not spending approximately $405k in the M2 project for Year 4 and plan to request the carry forward/redirection immediately upon submission of the FFR which will be submitted no later than October 31, 2018 (the final submission date. This allows time for any outlying invoices to be paid and allows time for the agency to complete the FFR). After discussion with Imelda we do anticipate there being an offset of the $405k from Year 4 into Year 5. This means we will actually need $320k in Year 5 instead of the $725k (with the carry forward/redirection offset). I’m not sure if this has helped you but if not, I am available before 10 a.m. CST and after noon CST tomorrow. We can address the questions you have below. Please let me know what the best time is to meet and if you would like to call me or I call you. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section Infectious Disease Control Unit MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 (Please note my cell number has changed.) Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Yowe-Conley, Tineka (CDC/ONDIEH/NCBDDD) [mailto:tay7@cdc.gov] Sent: Thursday, May 31, 2018 4:16 PM To: Aldridge,Tiffany (DSHS) Cc: Akosa, Amanda (CDC/ONDIEH/NCBDDD) (CTR) Subject: TX ELC/M2 Budget Question WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hello Tiffany, De’Lisa Simpson, CDC ELC, suggested I contact you regarding TX’s M2 budget. Nicole Fehrenbach and I are reviewing TX’s continuation budget and notice that $725K was requested for contractual expenses. We had anticipated that carryover funds would be requested for these local health department contractual costs. Would you be available tomorrow to discuss? Or emailing to let us know TX’s plans for requesting carryover funds, would be fine too. If you could please address the following: · Approximate amount remaining for the M2 project? · Will carryover funds be requested? If so, when is this anticipated? Thanks in advance for your assistance with this. Tineka TX-DSHS-19-1309-A-000279 Tineka Yowe-Conley, MPA Domestic Zika Pregnancy and Infant Research and Surveillance (Z-PAIRS) Team Zika Transition Unit Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities Email: tay7@cdc.gov Office: 404-498-3941 Schedule: Monday-Friday, 8:00AM-4:30PM *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-000280 GrantSolutions Page 1 of 1 [TAldridge1] GrantSolutions-6.13.6 02/14/2019 Log Out O Grant Solutions. gov Account Management 'v Funding Opportunity Applications Grants 'v Reports 'v Online Data Collection Help/Support Amendment Status Confirmation Grants has marked the following application as submitted: * Please submit signed copies of forms if you have been instructed by your program or grant office. CDC Office of Financial Resources 1600 Clifton Road Atlanta, GA 30329 Applicant Texas Department of State Health Services Grant Number NU50CK000378 Project Title 2014 STATE OF TEXAS APPLICATION FOR EPIDEMIOLOGY AND LABORATORY CAPACITY FOR INFECTIOUS DISEASES COOPERATIVE AGREEMENT FUNDING Action Carryover of Funds Submitted Date 02/28/2019 06:06 PM Eastern Time Application Details Items Item Attachments Type Date Expected Date Received Upload N/A 02/28/2019 SF-424A Budget Information - Non-Construction Application Upload 6NU50CK000378-05 TX DSHS Zika 2017 Application Control Checklist GrantSolutions User Support (202) 401-5282 or (866) 577-0771 help@grantsolutions.gov Contact Us Web Accessibility Privacy and Security Notice Freedom of Information Act Disclaimers Feedback ----- TX-DSHS-19-1309-A-000281 https://www.grantsolutions.gov/gs/servlet/eacc.post.EACCSubmissionConfirmServlet 2/28/2019 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 07, 2019 10:28 AM EST To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Budget Template Now Available on REDCap WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, The 2019 Budget Template has been uploaded to REDCap and is ready for use. Please don’t forget the ELC will host a Budget Template Webinar on Tuesday, March 19, 2019 from 3:00 p.m. – 4:30 p.m. to help applicants navigate and learn important features about the budget template. Below is the call-in information: Webinar Dial-In Information: 1-773-756-0169 or Passcode: 3092790 800-857-4945 URL: https://www.mymeetings.com/nc/join/ Conference number: PWXW8824363 Audience passcode: 3092790 Participants can join the event directly at: https://www.mymeetings.com/nc/join.php?i=PWXW8824363&p=3092790&t=c Please send all questions related to the ELC FY19 NOFO applications to elc@cdc.gov. Thank you, ELC Team TX-DSHS-19-1309-A-000282 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Monday, March 11, 2019 3:58 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Post Award Closing Date WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, As a reminder, all post-award actions requiring pre-approval and processing through GrantSolutions must be submitted no later than March 31, 2019. Per the Notice of Award, Terms and Conditions, post-award actions must be submitted no later than 120 days prior to the end of the budget period. If you have any questions, please contact your ELC Project Officer. Thank you, ELC Team TX-DSHS-19-1309-A-000283 From: ZIKApregnancy (CDC) Sent: Monday, March 11, 2019 4:34 PM EDT To: ZIKApregnancy (CDC) CC: Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) ; King, Kellianne M. (CDC/DDNID/NCBDDD/DCDD) (CTR) ; Reynolds, Megan (CDC/DDNID/NCBDDD/DCDD) ; Tong, Van T. (CDC/DDNID/NCBDDD/DCDD) Subject: ELC 2019 Notice of Funding Opportunity Attachment(s): "ELC_Fact_Sheet_new NOFO 2019_FINAL.docx","ELC_Compare_NOFO_FINAL.docx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon Jurisdictional Partners, We wanted to send a reminder about the kick-off webinar for the ELC FY19 NOFO to be held onMarch 14, 2019 from 3:00pm – 4:30pm ET. This webinar will provide pertinent information regarding the application requirements. The details are below if you didn’t receive the invitation. As a reminder, ELC NOFO CDC-RFA-CK19-1904 ELC 2019 Notice of Funding Opportunity (NOFO) was published February 28, 2019. The section that pertains to our program is “W: Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats.” The deadline to submit your completed application is Friday, May 10, 2019 at 11:59pm ET. Also, please find attached a Fact Sheet about ELC that you might find helpful as well as a 2-pager that cross-walks the changes between the new and former NOFO. Please let us know if you have any questions! Best, Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities Webinar Details: We welcome you to attend a kick-off webinar for the ELC FY19 NOFO on March 14, 2019 from 3:00 pm – 4:30pm ET. The purpose of this webinar is for ELC to discuss content and changes in the FY19 ELC NOFO Guidance, the application timeline and requirements, and allow time to answer any questions you may have. Webinar Call-In Information: 1-773-756-0169 or 800-857-4945 Participant passcode: 3092790 For Participants: URL: https://www.mymeetings.com/nc/join/ Conference number: PWXW8757468 Audience passcode: 3092790 Participants can join the event directly at: https://www.mymeetings.com/nc/join.php?i=PWXW8757468&p=3092790&t=c TX-DSHS-19-1309-A-000284 Next Generation ELC: Changes in the 2019-2023 Notice of Funding Opportunity (NOFO) For nearly a quarter-century, the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Program has provided direct financial support in all 50 states, several large metro areas, and U.S. territories and affiliates to detect, respond to, control, and prevent infectious diseases. New opportunities have been identified in the 2019-2023 Notice of Funding Opportunity (NOFO) to strengthen health department capacity while still maintaining recipient-valued flexibility offered through cross-cutting activities. Starting in 2019, recipients will see a differentiation between public health “programs” (e.g., food, HAI/AR, and vector-borne) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed areas): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed area) within the new public health programs, with an increased focus on integration, leadership, and flexibility: o o o o A B D F ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS C G H1 H2 Health Information Systems Capacity Enhanced Evaluation Capacity Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity B ELC Leadership, Management, and Administration Project– NEW in 2019 C Health Information Systems Capacity Project D Impact and Evaluation Project E Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions TX-DSHS-19-1309-A-000285 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 15 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxed area on page 2). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z K1A OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Injection Safety K2 K3 M1 Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) H Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Coordinated Prevention and Stewardship Antimicrobial Resistance Regional Lab Network West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxed area). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance Parasitic Diseases Enhanced Vaccine Prevention Disease (VPD) Surveillance Legionnaires’ Disease Prevention Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance M Rabies Surveillance N O P Parasitic Diseases Surveillance Enhanced Vaccine-Preventable Disease Legionnaires’ Disease Prevention Q Influenza Surveillance and Diagnostic Testing X T W1 W2 O R1 Y P1 P2 I J TX-DSHS-19-1309-A-000286 Q1 Q2 J1 J2 J3 Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Gonococcal Isolate Surveillance Project (GISP) Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks Human Papillomavirus Surveillance Among Men Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats T U R2 Surveillance for anal human papillomavirus among men V M2 U.S. Zika Pregnancy Registry W TX-DSHS-19-1309-A-000287 For nearly a quarter-century, the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement has provided direct financial support in all 50 states, several cities, and U.S. territories and affiliates to detect, respond to, control, and prevent infectious diseases. Notice of Funding Opportunity: ELC Cooperative Agreement, 2019 - 2023 In March 2019, the Centers for Disease Control and Prevention (CDC) will release a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement. The NOFO announces a new, competitive s year cooperative agreement opportunity open to the 64 jurisdictions currently funded through the ELC. The new cooperative agreement incorporates feedback from recipients and partners that will: • Improve coordination of the cooperative agreement and better support growth, while maintaining valued flexibility. • Establish a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o cross-cutting Epidemiology and Laboratory capacity Program o Foodborne, waterborne, Enteric, and Environmentally Transmitted Diseases Program o Healthcare-associated Infections and Antibiotic Resistance Program o Vector-borne Diseases Program • Offer opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project- New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Utilize a tiered funding approach that will allow for varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas: 0 Surveillance, Response, & Control D Prevention & Intervention TX-DSHS-19-1309-A-000288 DCommunications & Partnerships Ell} NATIDNIIL FUNDING STRATEGY PREVE HTIN IE In [milimla by Slrunqlheninq LIE. Ht-nllh Dc-parlmun E5 Programs Cross-cutting Epidemiology and Laboratory Capacity Program Number of Awards Funding Estimates 64 $25,600,000 56-59 $33,000,000 Healthcare-associated Infections and Antibiotic Resistance Program 57 $48,800,000 Vector-borne Diseases Program 60 $16,000,000 ELC Leadership, Management, and Administration 40 8,000,000 Health Information Systems Capacity 64 $32,000,000 Impact and Evaluation 5 $600,000 Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program Cross-Cutting Projects Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Up to 64 Available for emerging issues Disease Specific Projects Mycotics: Detecting and Preventing Fungal Infections 20 $600,00 Binational Border Infectious Disease Surveillance (BIDS) Program 1-4 $750,000 Global Migration, Border Interventions and Migrant Health 3-5 $250,000 Prion Surveillance 7 $500,000 Rabies Surveillance 2 $125,000 Parasitic Diseases Surveillance 10 $100,000 Enhanced Vaccine-Preventable Disease (VPD) 64 $6,400,000 Legionnaires’ Disease Prevention 25 $3,000,000 Influenza Surveillance and Diagnostic Testing 57 $8,100,000 Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance 10-15 $750,000 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity 8 $5,164,038 Gonococcal Isolate Surveillance Project (GISP) 25 $660,000 Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks 2 $1,400,000 Human Papillomavirus Surveillance Among Men 3 $375,000 Infants with Congenital Exposures: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats 4-9 $3,000,000 TX-DSHS-19-1309-A-000290 FUNDING STRATEGY PREVENTING Infectiuus Disease Threats by ?Faith From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 14, 2019 2:06 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: A Message from HAI/AR: 2019 ELC HAI/AR NOFO Kickoff Webinar Tomorrow, March 15 Attachment(s): "CDC-RFA-CK19-1904_NOFO_Combined_2019_02_13.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings Colleagues, We are pleased to announce the 2019 ELC HAI/AR NOFO Kickoff Webinar to be held on Friday, March 15, 2019 from 2PM-4PM EST. This webinar will be hosted by the Division of Healthcare Quality Promotion (DHQP) and is intended to discuss content in the FY19 ELC HAI/AR Guidance (components G1 and G2), to review the 2019 application process, and to respond to questions from HAI/AR epidemiology and laboratory staff. The 2019 ELC NOFO Guidance is attached for your reference and available on www.Grants.gov. Topics for the webinar are below. • • • • • Overview of HAI/AR Program Review of Content (Components G1 and G2) Funding Priorities Application Guidance and Expectations Q&A Webinar Call-In Information 800-857-5148 Participant passcode: 5762067 For Participants: URL: https://www.mymeetings.com/nc/join/ Conference number: PWXW8814180 Audience passcode: 5762067 Participants can join the event directly at: https://www.mymeetings.com/nc/join.php?i=PWXW8814180&p=5762067&t=c *The webinar will be recorded and made available within 3-5 business days on SharePoint. Please submit any questions or comments pertaining to HAI/AR projects in the 2019 ELC HAI/AR NOFO Guidance to HAIAR@cdc.gov. Sincerely, Division of Healthcare Quality Promotion TX-DSHS-19-1309-A-000292 1 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) CDC-RFA-CK19-1904 National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Estimated Publication Date: March 1, 2019 U.S. Department of Health and Human Services Centers for Disease Control and Prevention 1 TX-DSHS-19-1309-A-000293 2 Contents Part I. Overview ......................................................................................................................................................... 4 A. Federal Agency Name: ...................................................................................................................................... 4 B. Funding Opportunity Title: ................................................................................................................................ 4 C. Announcement Type: New - Type 1 .................................................................................................................. 4 D. Agency Funding Opportunity Number: ............................................................................................................. 4 E. Catalog of Federal Domestic Assistance (CFDA) Number: ................................................................................ 4 F. Dates .................................................................................................................................................................. 4 G. Executive Summary ........................................................................................................................................... 4 Part II. Full Text .......................................................................................................................................................... 5 A. Funding Opportunity Description...................................................................................................................... 5 B. Award Information .......................................................................................................................................... 15 C. Eligibility Information ...................................................................................................................................... 17 D. Application and Submission Information ........................................................................................................ 18 E. Review and Selection Process ......................................................................................................................... 32 F. Award Administration Information ................................................................................................................. 36 G. Agency Contacts .............................................................................................................................................. 42 H. Other Information ........................................................................................................................................... 43 I. Glossary ............................................................................................................................................................ 43 Part III. Program and Project Attachments ............................................................................................................. 50 A. Program and Project Summaries with Tiered Activities ................................................................................... 50 B. Program and Project Detailed Guidance Attachments ..................................................................................... 71 Section I: Cross-Cutting Emerging Infectious Disease Capacity, Systems, and Leadership ............................... 72 A: Cross-Cutting Epidemiology and Laboratory Capacity ............................................................................... 72 B: ELC Leadership, Management and Administration .................................................................................... 81 C: Health Information Systems Capacity ........................................................................................................ 84 D: Impact and Evaluation................................................................................................................................ 91 E: Cross-Cutting Emerging Issues: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions ...................................................................................................................... 94 Section II: Emerging Infectious Disease Programs ............................................................................................. 96 F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention ............................................................................................................ 96 2 TX-DSHS-19-1309-A-000294 3 G: Healthcare-associated Infections and Antibiotic Resistance Program .................................................... 129 G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship..........................131 G2: Antibiotic Resistance Laboratory Network (AR Lab Network) ...............................................................143 H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond ........................................................................................................................................................156 Section III: Disease-Specific Projects ................................................................................................................167 I: Mycotics: Detecting and Preventing Fungal Infections .............................................................................167 J: Binational Border Infectious Disease Surveillance (BIDS) Program ..........................................................172 K: Global Migration, Border Interventions and Migrant Health ...................................................................180 L: Prion Surveillance......................................................................................................................................184 M: Rabies Surveillance ..................................................................................................................................190 N: Parasitic Diseases Surveillance .................................................................................................................193 O: Enhanced Vaccine-Preventable Disease (VPD) ........................................................................................196 P: Legionnaires’ Disease Prevention .............................................................................................................210 Q: Influenza Surveillance and Diagnostic Testing .........................................................................................217 R: Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance ......................................225 S: Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity ..............................230 T: Gonococcal Isolate Surveillance Project (GISP) ........................................................................................241 U: Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks ...................................256 V: Human Papillomavirus Surveillance Among Men ....................................................................................260 W: Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats ....................................................................................................................................264 3 TX-DSHS-19-1309-A-000295 4 Part I. Overview Applicants must go to the synopsis page of this announcement at www.grants.gov and click on the "Send Me Change Notifications Emails" link to ensure they receive notifications of any changes to CDC-RFA-CK19-1904. Applicants also must provide an e-mail address to www.grants.gov to receive notifications of changes. A. Federal Agency Name: Centers for Disease Control and Prevention (CDC) / Agency for Toxic Substance and Disease Registry (ATSDR) B. Funding Opportunity Title: Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) C. Announcement Type: New - Type 1 This announcement is only for non-research activities supported by CDC. If research is proposed, the application will not be considered. For this purpose, research is defined at https://www.gpo.gov/fdsys/pkg/CFR-2007-title42-vol1/pdf/CFR-2007-title42-vol1-sec52-2.pdf. Guidance on how CDC interprets the definition of research in the context of public health can be found at http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-researchnonresearch.pdf. D. Agency Funding Opportunity Number: CDC-RFA-CK19-1904 E. Catalog of Federal Domestic Assistance (CFDA) Number: 93.323 F. Dates 1. Due Date for Letter of Intent (LOI): N/A 2. Due Date for Applications: Applications are due on May 10, 2019, 11:59 p.m. Eastern Standard Time, on www.grants.gov 3. Date for Informational Conference Call: An informational call will be held approximately two weeks after posting. The date and time for this call is March 14, 2019 at 3:00 p.m. ET. Dial-in number: (773) 756-0169 (toll) or (800) 857-4945 (toll free) Passcode: 3092790 G. Executive Summary 1. Summary Paragraph The Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Notice of Funding Opportunity (NOFO) builds upon the program that was initiated in 1995 as one of the key activities under CDC’s plan to address emerging infectious disease threats. The purpose 4 TX-DSHS-19-1309-A-000296 5 of this NOFO is to protect the public health and safety of the American people by enhancing the capacity of public health agencies to effectively detect, respond, prevent and control known and emerging (or re-emerging) infectious diseases. This is accomplished by providing financial and technical resources to (1) strengthen epidemiologic capacity; (2) enhance laboratory capacity; (3) improve information systems; and (4) enhance collaboration among epidemiology, laboratory, and information systems components of public health departments. a. Eligible Applicants: Limited competition b. NOFO Type: Cooperative Agreement c. Approximate Number of Awards: 64 d. Total Period of Performance Funding: $1,000,000,000 Approximately $200M awarded annually e. Average One Year Award Amount: $3,125,000 f. Total Period of Performance Length: 5 g. Estimated Award Date: 08/01/2019 h. Cost Sharing and / or Matching Requirements: N/A Part II. Full Text A. Funding Opportunity Description 1. Background a. Overview The goal of the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) program is to reduce illness and related deaths caused by a wide range of infectious disease threats. The ELC Program provides annual funding, strategic direction and technical assistance to domestic jurisdictions for core capacities in epidemiology, laboratory, and health information technology activities. In addition to strengthening core infectious disease capacities nationwide, this cooperative agreement also supports a myriad of specific infectious disease programs. 5 TX-DSHS-19-1309-A-000297 6 In the last five years, CDC’s National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) extramural funding has increased from $109 million in FY 2013 to $302 million in FY 2017. This increase coincides with increased responsibilities at the state and local level for emerging infectious disease control, notably for emergency responses to Ebola and Zika, and for expanded investment to curb antibiotic resistant infections and modernize public health laboratory capacity. Ebola and Zika funding began as one-time emergency funding, while antibiotic resistance funding is expected to reoccur annually, and base vector-borne disease funding is beginning to grow. Together with food- and waterborne disease program growth, these investments have moved from capacity building to program delivery. In other infectious disease areas, capacity building is still the focus of investments. b. Statutory Authorities Public Health Service Act Sections 301(a) [42 U.S.C. 241(a)] and 317(k) (2) [42 U.S.C. 247b (k) (2)], as amended, and the Patient Protection and Affordable Care Act (PL 111-148), Title IV, Sections 4002 and 4304 (Prevention and Public Health Fund). c. Healthy People 2020 The ELC supports the following activities aligned with Health People 2020 Topics and Objectives: Food Safety, Health Communication and Health Information Technology, Healthcare Associated Infections, Immunization and Infectious Diseases, Public Health Infrastructure, and Respiratory Diseases. d. Other National Public Health Priorities and Strategies ELC supports CDC Agency priorities, including Healthcare Associated Infections (HAI) and Food Safety. Other National Public Health Priorities and Strategies are defined in individual project attachments. e. Relevant Work This ELC NOFO builds upon the program that was initiated in 1995 as one of the first key activities under CDC’s plan to address emerging infectious disease threats. Previous ELC cooperative agreement announcement numbers include CI04-040, CI07-701, CI07-702, CI10-1012, CK12-1201, and CK141401. The program has grown to become one of CDC’s key nationwide cooperative agreements for supporting state and local infectious disease control capacity for 1) cross-cutting epidemiology, laboratory and health information systems, 2) infectious disease programs (Food and Water, Healthcare Associated Infections/Antimicrobial Resistance, and Vector-borne), and 3) disease-specific projects. This also builds upon special funding allocations in the previous NOFO that helped to enhance epidemiology, laboratory, and health information systems to specific disease and health threats. 2. CDC Project Description a. Approach 6 TX-DSHS-19-1309-A-000298 7 CDC-RFA-CK19-1904 OVERALL ROADMAP FOR THE EPIDEMIOLOGY AND LABORATORY CAPACITY FOR PREVENTION AND CONTROL OF EMERGING INFECTIOUS DISEASES (ELC) The ultimate goal of the ELC is to prevent the transmission of future outbreaks of known and emerging (or re-emerging) infectious diseases while reducing the exposure to current infectious disease threats. We achieve this by enhancing the capacity of public health agencies to effectively detect, respond to, control, and prevent known and emerging (or reemerging) infectious diseases threats. Core Areas/Strategies Short-term Mid-term Long-term ELC provides funding to recipients to implement these strategies. ELC recipients produce these outputs as a result of implementing the strategies. As a result of the outputs, ELC recipients will achieve these outcomes. As a result of achieving the midterm outcomes, these longer term outcomes will be achieved. Effective public health workforce prepared to respond to infectious disease threats Improved understanding of the epidemiology and incidence of infectious diseases More efficient and accurate public health reporting Investigations conducted Improved surveillance • Improved completeness of data • Improved timeliness of reporting • Increased distribution and use of data to public health partners 1. Surveillance, Detection and Response • • • • • • • • • 1a: Enhance workforce capacity 1b: Enhance investigation and outbreak response 1c: Improve surveillance and reporting 1d: Strengthen laboratory testing for response 1e: Enhance laboratory testing for surveillance and reporting 1f: Improve laboratory coordination and outreach to improve efficiency 1g: Enhance coordination between epi-lab-HIT 1h: Advance electronic information exchange implementation 1i: Sustain and/or enhance information systems 2. Prevention and Intervention • • 2a: Implement public health interventions and tools 2b: Develop/advance policies to improve public health capabilities Best practices for outbreak management in place Surveillance of infectious disease conducted Best fit and/or modern laboratory diagnostic techniques and capabilities in place Laboratory operations are maintained and improved Coordination between laboratories within the state and/or within laboratory networks are Improved efficiencies between laboratories and their networks, use of public health resources Infectious disease data is automated and efficiently transmitted Electronic mechanisms for data exchange are in place More rapid detection of cases and outbreaks More timely, complete and effective investigation efforts: • Response to outbreaks • Investigation of outbreaks • Implementation of control measures Improved use of data to: • Inform response and control • Improve public health practice • Inform program and policy development • Develop and implement public health best practices and/or guidelines Public and healthcare providers adopt appropriate practices to 7 TX-DSHS-19-1309-A-000299 8 • 2c: Implement health promotion strategies improved Increased interoperability between information systems and entities 3. Communications, Coordination and Partnerships • • 3a: Coordinate and engage with partners 3b: Information dissemination Integrated surveillance systems Development, implementation and evaluation of strong public health interventions Increased awareness among: • Public regarding infectious disease risks and protective actions • Providers regarding appropriate public health actions protect themselves and the public from infectious diseases Enhanced coordination on prevention and control of infectious diseases between partners Partnerships and collaborations formed i. Purpose The purpose of the activities supported through this NOFO is to protect the public health and safety of the American people by enhancing the capacity of public health agencies to effectively detect, respond, prevent and control known and emerging (or re-emerging) infectious diseases. ELC is CDC’s national funding strategy to support state, local, and territorial health departments to battle infectious disease threats in the U.S. This is accomplished by providing financial and technical resources to support the implementation of three core areas; (1) surveillance, detection and response, (2) prevention and intervention, and (3) communications, coordination and partnerships. Any surveillance data collection efforts should leverage existing tools and systems and should adhere to national data and technology standards to support interoperability of system- to-system data exchange. ELC resources may support each of these individually however, it is only through integration that these complementary core areas are optimized. ii. Outcomes As reflected in the ELC Overall Roadmap, recipients are expected to show measurable progress made toward the outcomes for this five-year period of performance. Each of ELC’s Cross-Cutting, Program and disease-specific Projects focus on achieving one or more of the outcomes from the ELC Overall Roadmap (see 2. CDC Project Description, a. Approach section above). Each program and project have specified this information in the ‘Outcomes’ section of each project attachment. As such, the specific outcomes recipients are expected to demonstrate progress for will depend on the Programs or Projects funded. 8 TX-DSHS-19-1309-A-000300 9 The mid-term outcomes will also be achieved during this period of performance: (1) Effective public health workforce better prepared to respond to infectious disease threats; (2) Improved understanding of the epidemiology and incidence of infectious diseases; (3) Improved surveillance: Improved completeness of data, Improved timeliness of reporting, Increased distribution and use of data to public health partners; (4) Improved efficiencies between laboratories and their networks/use of public health resources; (5) Infectious disease data is automated and efficient; (6) Electronic mechanisms for data exchange are in place; (7) Increased awareness of: Public regarding infectious disease risks and protective actions, Providers regarding appropriate public health actions. Long term, ELC will contribute to: (1) More efficient and accurate public health reporting; (2) More rapid detection of cases and outbreaks; (3) More timely, complete and effective investigation efforts: Response to outbreaks, Investigation of outbreaks, and Implementation of control measures; (4) Improved use of data to: Inform public health response and control, Improve public health practice, Inform program and policy development, Develop and implement public health best practices and/or guidelines; (5) Public and healthcare providers adopt appropriate practices to protect themselves and the public from infectious diseases. iii. Strategies and Activities Applicants should apply for programs and projects that will support identified infectious disease detection, prevention, and control needs in their jurisdictions. Note that each program and project has a separate attachment (in Part III, Section B. Program and Project Detailed Guidance Attachments) which details sub-activities, funding strategies other key criteria. Applicants may apply to any program or project, depending on jurisdiction-specific needs. Furthermore, the planning and preparation of your response to this NOFO, and implementation and monitoring/evaluation of all ELC activities must be coordinated via your established ELC Governance Team. This Cooperative Agreement is organized into three major sections of content: Section I: Cross-cutting Emerging Infectious Disease Capacity, Systems and Leadership A. B. C. D. E. Cross-Cutting Epidemiology and Laboratory Capacity ELC Leadership, Management and Administration Health Information Systems Capacity Impact and Evaluation Cross-Cutting Emerging Issues: Enhanced Surveillance, Investigation Response and Reporting, Surge Efforts and Interventions Section II: Emerging Infectious Disease Programs F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention G. Healthcare-associated Infections and Antibiotic Resistance Program 9 TX-DSHS-19-1309-A-000301 10 G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Lab Network) H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Section III: Disease-Specific Projects I. J. K. L. M. N. O. P. Q. R. S. T. U. V. W. Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions and Migrant Health Prion Surveillance Rabies Surveillance Parasitic Diseases Surveillance Enhanced Vaccine-Preventable Disease (VPD) Legionnaires’ Disease Prevention Influenza Surveillance and Diagnostic Testing Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Gonococcal Isolate Surveillance Project (GISP) Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks Human Papillomavirus Surveillance Among Men Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats As described above, ELC is a complex Cooperative Agreement with cross-cutting and large infectious disease programs, as well as a myriad of disease-specific projects. Within each program or project section, the activities will be grouped by key strategies that link back to the mid- and long-term outcomes (see below and Roadmap in Section 2.a). Programs and Projects will vary in the number of strategies applied, and specific activities associated with these strategies are described in the program and project attachments within this NOFO. 1. Surveillance, Detection and Response 1a: Enhance workforce capacity 1b: Enhance investigation and outbreak response 1c: Improve surveillance and reporting 1d: Strengthen laboratory testing for response 1e: Enhance laboratory testing for surveillance and reporting 1f: Improve laboratory coordination and outreach to improve efficiency 1g: Enhance coordination between epi-lab 10 TX-DSHS-19-1309-A-000302 11 1h: Advance electronic information exchange implementation 1i: Sustain and/or enhance information systems 2. Prevention and Intervention Strategies 2a: Implement public health interventions and tools 2b: Develop/advance policies to improve public health capabilities 2c: Implement health promotion strategies 3. Coordination and Partnerships 3a: Coordinate and engage with partners 3b: Information dissemination In this NOFO Programs and Projects have outlined a path to meet minimum expectations, expand or enhance these capacities, and even provide leadership amongst other jurisdictions. Each Program or Project section will include an activities summary table, grouping the activities by three tiers: Tier 1: Core required activities within the program Tier 2: Enhanced or expanded activities Tier 3: Advanced activities, Regional Activities, Centers of Excellence or similar 1. Collaborations a. With other CDC programs and CDC-funded organizations: Funding to support the ELC program as a whole should complement and be closely coordinated, with other CDC programs related to improving surveillance for, and response to, infectious diseases, for example the Emerging Infections Program (EIP) and the Public Health Emergency Preparedness (PHEP) cooperative agreements. Recipients should have a coordinated understanding and approach to all health information systems strengthening and enhancements occurring across the ELC portfolio. ELC recipients should also be aware of, and are strongly encouraged to use, resources designed as management tools that improve efficiency and promote sustainability of Public Health Labs (PHLs) and their services. Two of these resources have been developed in a collaborative fashion between CDC and the Association of Public Health Laboratories (APHL) under the Laboratories Efficiencies Initiative (LEI): (1) the LEI Informatics Self-Assessment Tool for Public Health Laboratories and (2) the online National PHL Test Service Directory. Each Program or Project has its own description of required or suggested collaborations if applicable. This information may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. b. Internal coordination for effective ELC portfolio management 11 TX-DSHS-19-1309-A-000303 12 Since 2012, all ELC recipients were required to implement a governance structure for the management and oversight of the portfolio of ELC activities in their jurisdiction. All ELC recipients are required to maintain an active ELC Governance Team comprised of a Principal Investigator and representatives from epidemiology, laboratory, and health information systems (the PI may serve as a representative for one of these areas). Representatives on the Governance Team should be positioned within the organization such that they may make strategic recommendations and decisions about the activities supported with ELC resources. Members are expected to communicate with other staff regarding various aspects of ELC activities within the jurisdiction. Building upon previous year’s successes and challenges, the role of this Team is to work together to assure sufficient and appropriate oversight and integration of the ELC Cooperative Agreement planning and implementation. c. With organizations not funded by CDC: Each program or project that appears in Part III of this NOFO has its own program guidance that provides collaboration (if applicable) information specific to that CDC program. This information may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. 2. Target Populations Each program or project that appears in Part III of this NOFO has its own program guidance that provides a target population (if applicable) information specific to that CDC program. This information may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. a. Health Disparities Recipients are encouraged to consider underserved populations (e.g., rural, tribal, and ESOL populations, people with disabilities) throughout their ELC portfolio of activities, especially where infectious disease health disparities and high health burdens exist. Each program or project that appears in Part III of this NOFO has its own program guidance that provides additional information about Health Disparities (if applicable) to that CDC program. This information may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. iv. Funding Strategy The dollar amounts listed below are the estimated total annual funding, and number of awards expected for each program or project. More detail on each program or project’s funding strategy may be found in Part III. Section B. Program and Project Detailed Guidance Attachments. Section I: Cross-cutting Emerging Infectious Disease Capacity, Systems and Leadership A. B. C. D. Cross-Cutting Epidemiology and Laboratory Capacity $25,600,000; 64 awards ELC Leadership, Management and Administration $8,000,000 to $11,000,000; 40-50 awards Health Information Systems Capacity $32,000,000; 64 awards Impact and Evaluation $600,000; 5 awards 12 TX-DSHS-19-1309-A-000304 13 E. Cross-Cutting Emerging Issues: Enhanced Surveillance, Investigation Response and Reporting, Surge Efforts and Interventions (estimated) up to $500,000; up to 64 awards Section II: Emerging Infectious Disease Programs F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention $33,000,000; 56-59 awards G. Healthcare-associated Infections and Antibiotic Resistance Program G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship $28,000,000; 57 awards G2. Antibiotic Resistance Laboratory Network (AR Lab Network) $2,250,000; up to 56 awards H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond $16,000,000; 60 awards Section III: Disease-Specific Projects I. J. K. L. M. N. O. P. Q. R. S. T. U. V. W. Mycotics: Detecting and Preventing Fungal Infections $600,000; 20 awards Binational Border Infectious Disease Surveillance (BIDS) Program $750,000; 1-4 awards Global Migration, Border Interventions and Migrant Health $230,000; 3-5 awards Prion Surveillance $500,000; 7 awards Rabies Surveillance $125,000; 2 awards Parasitic Diseases Surveillance $100,000; 10 awards Enhanced Vaccine-Preventable Disease (VPD) $6,400,000; 64 awards Legionnaires’ Disease Prevention $3,000,000; 25 awards Influenza Surveillance and Diagnostic Testing $8,100,000; 57 awards Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance $750,000; 10-15 awards Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity $5,164,038; 8 awards Gonococcal Isolate Surveillance Project (GISP) $660,000; 25 awards Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks $1,400,000; 2 awards Human Papillomavirus Surveillance Among Men $375,000; 3 awards Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats $3,000,000; 4-9 awards b. Evaluation and Performance Measurement i. CDC Evaluation and Performance Measurement Strategy The purpose of evaluation and performance measurement is to help CDC and ELC recipients monitor the extent to which activities planned were successfully completed, demonstrate how capacity building activities contribute towards program outcomes, and inform decisions about future programming that drive continuous program improvement for more efficient and effective program performance. 13 TX-DSHS-19-1309-A-000305 14 Each of the ELC Program or Projects require a detailed Evaluation and Performance Measurement Strategy described in their individual attachment (i.e., requirements for reporting of performance measures.). In addition, an overall Data Management Plan (DMP) is required for each recipient. Funds provided under this cooperative agreement may be used to support activities that assure compliance with CDC’s DMP. A DMP is required if the NOFO involves the collection or generation of public health data. The goal of the policy is to ensure public access to federally funded public health data. This specifically requires the development of Data Management Plans (DMPs) for ELC activities that includes collection of public health data. DMPs should be as complete as possible but CDC can work jointly with ELC recipients within the first 6 months after award to finalize them. Additional details and resources for developing a DMP can be found in Part II, D. 18. Data Management Plan in this NOFO. ii. Applicant Evaluation and Performance Measurement Plan If needed, ELC will work with recipients during the first six months of the period of performance to finalize an evaluation and performance measurement plan to monitor the progress of the activities implemented and outcomes achieved. Each ELC program or project attachment illustrates its specific requirements for the NOFO. c. Organizational Capacity of Recipients to Implement the Approach The successful ELC recipient must have a demonstrated core organizational capacity in order to effectively conduct the activities for which awards are made. This organizational capacity includes skill sets such as program planning and performance management, partnership development, evaluation, performance monitoring, financial reporting, budget management and administration, personnel management (including developing staffing plans, developing and training workforce and developing a sustainability plan). Specific expectations around capacity may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. Applicants also must be fully capable of managing the required procurement efforts, including the ability to write and award contracts in accordance with 45 CFR §75. d. Work Plan Each project the applicant is applying for (see Part III, Section B. Program and Project Detailed Guidance Attachment) must include a work plan. Work plans should be detailed and should focus on the first year of the period of performance with only a high level plan for subsequent years. Work plans should demonstrate alignment among the outcomes, strategies, activities, timelines, and staffing/collaborations. Additional information on performance measures, data sources, and target population can also be included. Specific expectations for the Work Plans may be found in Part II, Section D10. Project Narrative, and Part III, Section B. Program and Project Detailed Guidance Attachments. e. CDC Monitoring and Accountability Approach 14 TX-DSHS-19-1309-A-000306 15 Monitoring activities include routine and ongoing communication between CDC and recipients, site visits, and recipient reporting (including work plans, performance, and financial reporting). Consistent with applicable grants regulations and policies, CDC expects the following to be included in post-award monitoring for grants and cooperative agreements: • • • Tracking recipient progress in achieving the desired outcomes. Ensuring the adequacy of recipient systems that underlie and generate data reports. Creating an environment that fosters integrity in program performance and results. Monitoring may also include the following activities deemed necessary to monitor the award: • • • • Ensuring that work plans are feasible based on the budget and consistent with the intent of the award. Ensuring that recipients are performing at a sufficient level to achieve outcomes within stated timeframes. Working with recipients on adjusting the work plan based on achievement of outcomes, evaluation results and changing budgets. Monitoring performance measures (both programmatic and financial) to assure satisfactory performance levels. Monitoring and reporting activities that assist grants management staff (e.g., grants management officers and specialists, and project officers) in the identification, notification, and management of high-risk recipients. REDCap may be utilized to assist with programmatic documentation of performance. f. CDC Program Support to Recipients In a cooperative agreement, CDC and recipients share responsibility for successfully implementing the award and meeting identified outcomes. The following are potential areas of substantial involvement, others may also be included: 1. 2. 3. Technical assistance in the following: evaluation, performance measurement, work plan development, program planning, and specific subject matter expertise for ELC Program or Projects. National coordination of activities where appropriate. Targeted Electronic Data Exchange (EDX) technical assistance to public health departments and public health labs. B. Award Information 1. Funding Instrument Type: Cooperative Agreement CDC’s substantial involvement in this program appears in the CDC Program Support to Recipients section. 2. Award Mechanism: 15 TX-DSHS-19-1309-A-000307 16 U50 3. Fiscal Year: 2019 4. Approximate Total Fiscal Year Funding: $200,000,000 5. Approximate Period of Performance Funding: $1,000,000,000, subject to the availability of funds. 6. Total Period of Performance Length: Five years 7. Expected Number of Awards: 64 8. Approximate Average Award: $3,125,000, subject to availability of funds. 9. Award Ceiling: None 10. Award Floor: None 11. Estimated Award Date: August 1, 2019 12. Budget Period Length: 12 months 13. Direct Assistance Direct Assistance (DA) is available for this NOFO Extremely limited opportunities for DA may be available through this NOFO. An official state, local or territorial government applicant may request that CDC provide DA as a part of the grant awarded through this NOFO. Recipients may request that CDC provide DA to support assignment of federal staff through CDC fellowships (e.g., Epidemic Intelligence Officers, Laboratory Leadership Service Fellows). If your request for DA is approved as a part of your award, CDC will reduce the funding amount provided directly to you as a part of your award. The amount by which your award is reduced will be used to provide DA; the funding shall be deemed part of the award and as having been paid to you, the recipient. Additional information about available DA may be found in Part III, Section B. Program and Project Detailed Guidance Attachments. 16 TX-DSHS-19-1309-A-000308 17 C. Eligibility Information 1. Eligible Applicants Only current ELC recipients under CK14-1401 are eligible to apply for this announcement. This includes the departments of health for all US states, 6 of the largest locals (Chicago, District of Columbia, Houston, Los Angeles County, New York City, Philadelphia) and all of our US territories and affiliates in the Caribbean and Pacific (American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico, Republic of Palau, US Virgin Islands). 2. Additional Information on Eligibility Specific ELC Programs and Projects may have additional eligibility requirements associated with them. If so, these will be noted in the project-specific attachments. 3. Justification for Less than Maximum Competition The Epidemiology and Laboratory Capacity for the Prevention and Control of Infectious Diseases (ELC) is a cooperative agreement to build the governmental public health system capacity to address emerging infectious disease prevention, detection, and response of our nation. Capacity built and sustained in health departments with jurisdictional authority for public health helps prevent disease through better surveillance of known and emerging infectious diseases, which leads to more rapid response to disease outbreaks and better development, implementation and evaluation of public health interventions. The ELC program targets partnerships with states, and some of the nation's largest local health departments, U.S. territories and affiliates because these governmental organizations are constitutionally empowered and are responsible for the protection of the health and welfare of their respective communities. Governmental public health agencies execute this responsibility through their unique access to health information, laboratory samples, and their legal powers to investigate diseases through interactions with patients, the health care system, other governmental agencies (e.g., environmental agencies, emergency response agencies), and the law enforcement abilities of state and local government. In addition to these legal authorities, eligible applicants must have functional infectious disease detection, prevention, and control programs; and already existing public health outbreak response infrastructure and capacity. Established capacity and infrastructure to detect, prevent and control infectious disease outbreaks are critical requirements, to enable recipients to act expeditiously to implement the activities in this cooperative agreement. Since 2012, under CK12-1201 the ELC has supported public health capacity building activities in all US states, 6 of the largest locals (Chicago, District of Columbia, Houston, Los Angeles County, New York City, Philadelphia) and all of our US territories and affiliates in the Caribbean and Pacific (American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Puerto Rico, Republic of the Marshall Islands, Republic of Palau, US Virgin Islands). State recipients are required to document their partnerships and support for local health departments that are not receiving federal funds directly, and award amounts to states take into account the needs of the local jurisdictions 17 TX-DSHS-19-1309-A-000309 18 within the state. For local jurisdictions, these health departments represent the largest population centers and align with related public health programs, including the Public Health Emergency Preparedness (PHEP) program and the Public Health Crisis Response cooperative agreement. By aligning these three programs, local jurisdictions can best leverage existing capacities and coordinate efforts both for public health emergencies and for ongoing infectious disease response efforts. These governmental entities continue to be critical partners to respond to infectious disease threats across the nation. Under CK121201, ELC recipients were required to build local infrastructure for the coordination of all future ELCfunded programs. The infrastructure and relationships built in funded jurisdictions through ELC since 2012 are a critical prerequisite to the achievement of program goals, to sound fiscal stewardship, and to maximize the benefit to the Nation's public health in 2019-2024. The ELC is approved to limit eligibility for CK19-1904 to only those governmental public health agencies previously funded to ensure successful progress in meeting ELC program outcomes. There are significant programmatic needs, which only the prior-funded 64 jurisdictions have the legal authorities, intergovernmental relationships, and capacity for adequately addressing. Should this request to limit eligibility not be approved, the intended outcomes under the ELC Cooperative Agreement, CK19-1904, are at significant risk of not being completed due to entrance of additional site that lack the responsibilities, authorities, and technical capability necessary to be successful. Such an outcome would jeopardize the nation's system for responding to infectious disease threats. 4. Cost Sharing or Matching No. Cost sharing or matching funds are not required for this program. Although no statutory matching requirement for this NOFO exists, leveraging other resources and related ongoing efforts to promote sustainability is strongly encouraged. 5. Maintenance of Effort Maintenance of effort is not required for this program. D. Application and Submission Information 1. Required Registrations An organization must be registered at the three following locations before it can submit an application for funding at www.grants.gov. a. Data Universal Numbering System: All applicant organizations must obtain a Data Universal Numbering System (DUNS) number. A DUNS number is a unique nine-digit identification number provided by Dun & Bradstreet (D&B). It will be used as the Universal Identifier when applying for federal awards or cooperative agreements. The applicant organization may request a DUNS number by telephone at 1-866-705-5711 (toll free) or internet at http://fedgov.dnb.com/webform/displayHomePage.do. The DUNS number will be provided at no charge. 18 TX-DSHS-19-1309-A-000310 19 If funds are awarded to an applicant organization that includes sub-recipients, those sub-recipients must provide their DUNS numbers before accepting any funds. b. System for Award Management (SAM): The SAM is the primary registrant database for the federal government and the repository into which an entity must submit information required to conduct business as an recipient. All applicant organizations must register with SAM, and will be assigned a SAM number. All information relevant to the SAM number must be current at all times during which the applicant has an application under consideration for funding by CDC. If an award is made, the SAM information must be maintained until a final financial report is submitted or the final payment is received, whichever is later. The SAM registration process can require 10 or more business days, and registration must be renewed annually. Additional information about registration procedures may be found at www.SAM.gov. c. Grants.gov: The first step in submitting an application online is registering your organization at www.grants.gov, the official HHS E-grant Web site. Registration information is located at the “Applicant Registration” option at www.grants.gov. All applicant organizations must register at www.grants.gov. The one-time registration process usually takes not more than five days to complete. Applicants should start the registration process as early as possible. Step System Requirements Duration Follow Up 1 Data Universal Number System (DUNS) 1. Click on http://fedgov.dnb.com/webform 2. Select Begin DUNS search/request process 3. Select your country or territory and follow the instructions to obtain your DUNS 9-digit # 4. Request appropriate staff member(s) to obtain DUNS number, verify & update information under DUNS number 1. Retrieve organizations DUNS number 1-2 Business Days To confirm that you have been issued a new DUNS number check online at 2 System for Award Management (SAM) formerly Central Contractor Registration (CCR) 2. Go to www.sam.gov and designate an E-Biz POC (note CCR username will not work in SAM and you will need to have an active SAM account before you can register on grants.gov) (http://fedgov.dnb.com/webf orm) or call 1-866-705-5711 3-5 Business Days but up to 2 weeks and must be renewed once a year For SAM Customer Service Contact https://fsd.gov/fsdgov/home.do Calls: 866606-8220 19 TX-DSHS-19-1309-A-000311 20 3 Grants.gov 1. Set up an individual account in Grants.gov using organization new DUNS number to become an authorized organization representative (AOR) 2. Once the account is set up the E-BIZ POC will be notified via email 3. Log into grants.gov using the password the E-BIZ POC received and create new password 4. This authorizes the AOR to submit applications on behalf of the organization Same day but can take 8 weeks to be fully registered and approved in the system (note, applicants MUST obtain a DUNS number and SAM account before applying on grants.gov) Register early! Log into grants.gov and check AOR status until it shows you have been approved 2. Request Application Package Applicants may access the application package at www.grants.gov. 3. Application Package Applicants must download the SF-424, Application for Federal Assistance, package associated with this funding opportunity at www.grants.gov. If Internet access is not available, or if the online forms cannot be accessed, applicants may call the CDC OGS staff at 770-488-2700 or e-mail OGS ogstims@cdc.gov for assistance. Persons with hearing loss may access CDC telecommunications at TTY 1-888-232-6348. 4. Submission Dates and Times If the application is not submitted by the deadline published in the NOFO, it will not be processed. Office of Grants Services (OGS) personnel will notify the applicant that their application did not meet the deadline. The applicant must receive pre-approval to submit a paper application (see Other Submission Requirements section for additional details). If the applicant is authorized to submit a paper application, it must be received by the deadline provided by OGS. a. Letter of Intent Deadline (must be emailed or postmarked by) N/A b. Application Deadline Applications are due on May 10, 2019, 11:59 p.m. Eastern Standard Time, on www.grants.gov An informational call will be held approximately two weeks after posting. The date and time for this call is March 14, 2019 at 3:00 p.m. Dial-in number: (773) 756-0169 (toll) or (800) 857-4945 (toll free) Passcode: 3092790 20 TX-DSHS-19-1309-A-000312 21 5. CDC Assurances and Certifications All applicants are required to sign and submit “Assurances and Certifications” documents indicated at http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx. Applicants may follow either of the following processes: • • Complete the applicable assurances and certifications with each application submission, name the file “Assurances and Certifications” and upload it as a PDF file with at www.grants.gov Complete the applicable assurances and certifications and submit them directly to CDC on an annual basis at http://wwwn.cdc.gov/grantassurances/(S(mj444mxct51lnrv1hljjjmaa))/Homepage.aspx Assurances and certifications submitted directly to CDC will be kept on file for one year and will apply to all applications (ELC or others) submitted to CDC by the applicant within one year of the submission date. Risk Assessment Questionnaire Requirement CDC is required to conduct pre-award risk assessments to determine the risk an applicant poses to meeting federal programmatic and administrative requirements by taking into account issues such as financial instability, insufficient management systems, non-compliance with award conditions, the charging of unallowable costs, and inexperience. The risk assessment will include an evaluation of the applicant’s CDC Risk Questionnaire as well as a review of the applicant’s history in all available systems; including OMB-designated repositories of government-wide eligibility and financial integrity systems (see 45 CFR 75.205(a)), and other sources of historical information. These systems include, but are not limited to: FAPIIS (https://www.fapiis.gov), including past performance on federal contracts as per Duncan Hunter National Defense Authorization Act of 2009; Do Not Pay list; and System for Award Management (SAM) exclusions. CDC requires all applicants to complete the CDC Risk Questionnaire, OMB Control Number 0920-1132 annually. The questionnaire, which is located at https://www.cdc.gov/grants/documents/PPMR-G-CDCRisk-Questionnaire.pdf, along with supporting documentation must be submitted with your application by the closing date of the Notice of Funding Opportunity Announcement. If your organization has completed CDC’s Risk Questionnaire within the past 12 months of the closing date of this NOFO, then you must submit a copy of that questionnaire, or submit a letter signed by the authorized organization representative to include the original submission date, organization’s EIN and DUNS. When uploading supporting documentation for the Risk Questionnaire into this application package, clearly label the documents for easy identification of the type of documentation. For example, a copy of Procurement policy submitted in response to the questionnaire may be labeled using the following format: Risk Questionnaire Supporting Documents _ Procurement Policy. 21 TX-DSHS-19-1309-A-000313 22 Duplication of Efforts Applicants are responsible for reporting if this application will result in programmatic, budgetary, or commitment overlap with another application or award (i.e. grant, cooperative agreement, or contract) submitted to another funding source in the same fiscal year. Programmatic overlap occurs when (1) substantially the same project is proposed in more than one application or is submitted to two or more funding sources for review and funding consideration or (2) a specific objective and the project design for accomplishing the objective are the same or closely related in two or more applications or awards, regardless of the funding source. Budgetary overlap occurs when duplicate or equivalent budgetary items (e.g.. equipment, salaries) are requested in an application but already are provided by another source. Commitment overlap occurs when an individual’s time commitment exceeds 100 percent, whether or not salary support is requested in the application. Overlap, whether programmatic, budgetary, or commitment of an individual’s effort greater than 100 percent, is not permitted. Any overlap will be resolved by the CDC with the applicant and the PD/PI prior to award. Report Submission: The applicant must upload the report in Grants.gov under “Other Attachment Forms.” The document should be labeled: "Report on Programmatic, Budgetary, and Commitment Overlap.” 6. Content and Form of Application Submission Applicants are required to include all of the following documents with their application package at www.grants.gov. 7. Letter of Intent LOI is not requested or required as part of the application for this NOFO. 8. Table of Contents There is no page limit. The table of contents is not included in the project narrative page limit. 9. Project Abstract Summary (Maximum 1 page) A Project Abstract is not required for submission of the application. 10. Project Narrative 2019 ELC Project Narrative Guidance: The ELC application must be written according to the following outline. The entire application should contain a single, overarching ‘Background & Overview’ (see sections a. i-iv in this section below, for more detail). Applications must include a Project Approach for each ELC program and project applied for that includes a problem statement, justification, and applicant capacity (see section b in this section below, for more detail). Each Project Approach must be succinct, easily understood, and in the order outlined in this section, which will be reflected in the application template tools distributed by ELC. The Project Approaches must address outcomes and activities to be conducted over the next budget period, 22 TX-DSHS-19-1309-A-000314 23 but should also address the entire period of performance as identified in Part III, Section B. Program and Project Detailed Guidance Attachments. ELC highly recommends recipients use the application template tools provided by ELC for NOFO submission. These tools will capture all required information for each ELC program and project and will be distributed to applicants at the time this NOFO is published. a. Background & Overview (Only one per application): Applicants must provide a description of relevant background information that includes the context of the problem. Specifically: i. Jurisdictional Overview and Main Challenges: Provide information on the jurisdiction’s population size, demographic characteristics, and morbidity and mortality related to infectious diseases (e.g., priority infectious diseases in the jurisdiction). ii. Structure and Organization: Provide an overview of the structure of jurisdiction’s health department (e.g. centralized, decentralized, hybrid) and where leadership involved in this ELC Cooperative Agreement reside within the health department’s structure and describe the current process for supporting local public health concerns (including tribal governments within the jurisdiction, if applicable) and associated health departments. Next, describe challenges or limitations expected across organizational (especially as it relates to the integration of epidemiology, laboratory and health IT), fiscal, administrative, and/or programmatic areas in the jurisdiction. Also include measures to overcome these challenges, to achieve full implementation of the activities proposed in this application. This could include references to resources being requested through ELC’s new “Leadership, Management and Administration” project. Describe plans to ensure adequate planning and implementation of activities (e.g., hiring, contracting, procurement, collaborations, etc.) are quickly executed with rigorous tracking and oversight to avoid delays and reduce the potential for unobligated funds remaining at the end of the budget and period of performance. iii. ELC Program Leadership, Governance, Integration, and Tracking and Reporting: i. ELC Governance Team: Each recipient shall maintain an active ELC Governance Team that consists of three individuals who have leadership roles for the health department in epidemiology, laboratory, and health information systems (i.e., one person representing each area); plus the Principal Investigator (PI) if the PI is someone other than one of the three above individuals (the Team thus will include 3 or 4 persons). Persons appointed to the Governance Team should have authority over their respective areas (e.g., the State Laboratory Director, State Epidemiologist, IT/Informatics Director or persons specifically designated and empowered by these authorities). The required role of this Team is to work together to assure sufficient and appropriate oversight and integration of epidemiology, laboratory, and health information systems in the jurisdiction’s ELC planning and implementation. 23 TX-DSHS-19-1309-A-000315 24 iv. v. vi. vii. For this section of the Background narrative: 1. List the ELC Governance Team members, including name, position/title, and contact information. 2. Provide as an attachment to this application, Statement of the ELC Governance Team, signed by all Governance Team members, explicitly stating their agreement to serve on the Team and confirming their understanding and support of the overall content of the application. ii. Epidemiology, laboratory and health information systems integration. For the FY 2019-2023 period of performance, provide a plan to document efforts to maintain and/or strengthen epidemiology, laboratory and health information systems integration. Include a clear description of the process for engaging the jurisdiction’s ELC Governance Team during the course of the ELC period of performance for general oversight, planning, review and agreement on annual continuation applications, review and agreement on significant ELC process actions such as carryover, redirection, and supplemental requests, etc. This should include periodic regular meetings of the Governance Team to discuss ELC plans, activities, awards, progress report, evaluation and performance measures, etc. Strong applications will include the shared decision-making process of the ELC Governance Team. Plan to make the Governance Team available for quarterly conference calls with CDC ELC staff. Local engagement: CDC’s ELC Cooperative Agreement depends upon health departments working with local stakeholders to meet local needs and for larger health departments to request resources for other health departments within their jurisdiction. In this section, please describe the engagement with local health departments that will assist in achieving goals described earlier in this narrative (including tribal governments within the jurisdiction, as applicable). This discussion should include information on how collaboration between the state health department and the local health departments will help assess and mitigate gaps; including needs related to financial and technical assistance available from ELC that could be requested for the local health department by the state. Programs/Projects: List of the Program/Project component activities being addressed in the application. Success Stories: Please provide stories, using the ELC Success Story template available on REDCap, to capture recent accomplishments that highlight the impact of the ELC Cooperative Agreement in the jurisdiction. They will be used to educate stakeholders, decision makers, and policymakers about the impact of ELC. DMP: A Data Management Plans (DMP) is required if the NOFO involves the collection or generation of public health data. The goal of the policy is to ensure public access to federally funded public health data. This specifically requires the development of DMPs for ELC activities that includes collection of public health data. One overall DMP is requested per application. DMPs should be as complete as possible but CDC can work jointly with ELC recipients within the first 6 24 TX-DSHS-19-1309-A-000316 25 months after award to finalize them. They can be updated as appropriate throughout the life cycle of the data. b. Project Approach (for each ELC Program or Project): i. Problem Statement: Applicants must describe core information around the needs of the jurisdiction or populations being served relative to the specific ELC program or project. The core information must help reviewers understand how the applicant’s response to the NOFO will address the public health problem and support public health priorities (See Part III, Section B. Program and Project Detailed Guidance Attachments). ii. Justification: Explain the importance of the proposed activities, including why its implementation would address specific gaps mentioned in the ‘Problem Statement,’ and advance and/or improve public health in the jurisdiction. For each ELC program or project applied for, applicants must provide a clear and concise description of the strategic approach they will to use to achieve the period of performance outcomes. iii. Applicant Capacity: Describe the current resources, processes, and steps planned to implement this activity and achieve expected milestones.  Current Capacity: For each program or project component applied, address the recipient’s current capacity to successfully implement the proposed strategies and activities. If the recipient was funded for a project component in previous funding periods, capacities attained during these periods (including describing staff and other infrastructure already in place that will be built upon) should be reported.  Major Achievements:  Describe major activities conducted in past periods of performance, the progress of those activities, and significant milestones accomplished as a result of those activities.  If applicable, describe any barriers encountered, and how the barriers were addressed during implementation of these activities. iv. Evaluation Plan for 2019: If needed, ELC will work with recipients during the first six months of the period of performance to finalize an evaluation and performance measurement plan to monitor the progress of the activities implemented and outcomes achieved. Applicants must provide an overall recipient evaluation and performance measurement plan for each program/project. This plan must address the following points: • • • Identify key program staff who will participate in collecting and reporting performance measurement data. Demonstrates experience and capacity to implement the evaluation plan. Describe your plans and ability to collect data and report on the performance measures listed in the 2019 Notice of Funding Opportunity. 25 TX-DSHS-19-1309-A-000317 26 • • Discuss how you and your program staff will use (e.g., to inform program improvement, identify gaps, program management, etc.) and share performance measurement data collected. If applicable: Discuss any barriers or challenges expected for collecting data (i.e., responding to performance measures), and reporting on results. Describe how these potential barriers would be overcome. In addition, applicants may also describe other measures to be developed or additional data sources and data collection methods that applicants will use to evaluate their activities and outcomes. c. Work Plan (comprised of an implementation plan for each activity in ELC Program or Project) The work plan integrates and delineates more specifically how the recipient plans to carry out achieving the period of performance outcomes, strategies and activities, evaluation and performance measurement. Applicants should include the following detail on implementation plans for each ELC program or project activity: i. Purpose: Describe in 2-3 sentences specifically how the work plan will address the problem as described in the component program’s or project’s ‘Problem Statement.’ ii. Outcomes: Clearly identify the expected outcomes to be achieved by the end of the period of performance. Refer to outcomes listed in the component program’s or project’s ‘Outcomes’ section. Outcomes are the results that the program intends to achieve. All outcomes must indicate the intended direction of change (i.e., increase, decrease, maintain, complete) (see Overall Roadmap in Part II, 2. CDC Project Description a. Approach). In addition to the period of performance outcomes required by CDC, applicants should include any additional outcomes they anticipate. iii. Milestones: For each ELC program or project applied for, applicants must provide a clear and concise description of the period of performance milestones. Briefly introduce the activity(ies) being proposed and describe what the expected outputs (e.g., milestones) and outcomes will be over the first 12-month budget period. Also provide a brief discussion of what will be achieved (i.e., expected outputs and outcomes) over the entire five-year period of performance (see Part III, Section B. Program and Project Detailed Guidance Attachments). Finally, include a Work Plan (described in detail below Section D. Application and Submission Information; Section 11: Work Plan) iv. If applicable, describe collaborations with programs and organizations either internal or external to CDC and describe the extent to which the strategies and activities will target specific population(s) in their jurisdiction. d. Budget Narrative (One for each ELC Program and Project) Applicants must submit a discrete and separate itemized budget and budget narrative for each ELC program or project they are applying for. When developing the budget narrative, applicants must consider whether the proposed budget is reasonable and 26 TX-DSHS-19-1309-A-000318 27 consistent with the purpose, outcomes, and program strategy outlined in the project narrative. Be sure to consider and include requests for travel that are required for proposed activities. Please include travel for ELC Governance Team members and a financial representative to the ELC Annual Meeting. Travel that is approved and funded by CDC will be considered a required activity. The budget must include: • Salaries and wages • Fringe benefits • Equipment • Supplies • Travel • Other categories • Contractual costs • Total Direct costs • Total Indirect costs For guidance on completing a detailed budget, see Budget Preparation Guidelines at: https://www.cdc.gov/grants/documents/Budget-Preparation-Guidance.pdf Applicants must submit a Budget Summary. Please name this file “Budget Narrative Summary” and upload it as a PDF file at www.grants.gov. A detailed Budget request and accompanying justification should be submitted using the ELC template. If requesting indirect costs in the budget, a copy of the indirect cost-rate agreement is required. If the indirect cost rate is a provisional rate, the agreement must have been made less than 12 months earlier. Applicants must name this file “Indirect Cost Rate” and upload it at www.grants.gov. 1. Collaborations Applicants must describe how they will collaborate with programs and organizations either internal or external to CDC. Applicants must address the collaboration requirements as described in Part III, Section B. Program and Project Detailed Guidance Attachments. 2. Target Populations and Health Disparities Applicants must describe the specific target population(s) in their jurisdiction and explain how activities will achieve the goals of the award and/or alleviate health disparities. The applicants must also address how they will include specific populations that can benefit from the program. Applicants must address specific Target Populations and Health Disparities requirements described in Part III, Section B. Program and Project Detailed Guidance Attachments. c. Applicant Evaluation and Performance Measurement Plan Performance measures for each program or project are included in Part III, Section B. Program and Project Detailed Guidance Attachments. 27 TX-DSHS-19-1309-A-000319 28 • The Paperwork Reduction Act of 1995 (PRA): Applicants are advised that any activities involving information collections (e.g., surveys, questionnaires, applications, audits, data requests, reporting, recordkeeping and disclosure requirements) from 10 or more individuals or non-Federal entities, including State and local governmental agencies, and funded or sponsored by the Federal Government are subject to review and approval by the Office of Management and Budget. For further information about CDC’s requirements under PRA see http://www.hhs.gov/ocio/policy/collection/. 11. Work Plan The work plan integrates and delineates more specifically how the recipient plans to carry out achieving the period of performance outcomes, strategies and activities, evaluation and performance measurement. See Part II, Section D. 10 Project Narratives, above, for more detail on Work Plan requirements for each activity within ELC Programs and Projects. 12. Budget Narrative Applicants must submit a discrete and separate itemized budget and budget narrative for each ELC project they are applying for. When developing the budget narrative, applicants must consider whether the proposed budget is reasonable and consistent with the purpose, outcomes, and program strategy outlined in the project narrative. See Part II, Section D. 10 Project Narratives, above, for more detail on Budget Narrative requirements for each ELC Program and Project. 13. Funds Tracking Proper fiscal oversight is critical to maintaining public trust in the stewardship of federal funds. Effective October 1, 2013, a new HHS policy on subaccounts requires the CDC to set up payment subaccounts within the Payment Management System (PMS) for all new grant awards. Funds awarded in support of approved activities and drawdown instructions will be identified on the Notice of Award in a newly established PMS subaccount (P subaccount). Recipients will be required to draw down funds from award-specific accounts in the PMS. Ultimately, the subaccounts will provide recipients and CDC a more detailed and precise understanding of financial transactions. The successful applicant will be required to track funds by P-accounts/sub accounts for each project/cooperative agreement awarded. Applicants are encouraged to demonstrate a record of fiscal responsibility and the ability to provide sufficient and effective oversight. Financial management systems must meet the requirements as described 2 CFR 200 which include, but are not limited to, the following: • • • • Records that identify adequately the source and application of funds for federally-funded activities. Effective control over, and accountability for, all funds, property, and other assets. Comparison of expenditures with budget amounts for each Federal award. Written procedures to implement payment requirements. 28 TX-DSHS-19-1309-A-000320 29 • • Written procedures for determining cost allowability. Written procedures for financial reporting and monitoring. 14. Intergovernmental Review The application is subject to Intergovernmental Review of Federal Programs, as governed by Executive Order 12372, which established a system for state and local intergovernmental review of proposed federal assistance applications. Applicants should inform their state single point of contact (SPOC) as early as possible that they are applying prospectively for federal assistance and request instructions on the state’s process. The current SPOC list is available: https://www.whitehouse.gov/wpcontent/uploads/2017/11/SPOC-Feb.-2018.pdf 15. Pilot Program for Enhancement of Employee Whistleblower Protections Pilot Program for Enhancement of Employee Whistleblower Protections: All applicants will be subject to a term and condition that applies the terms of 48 Code of Federal Regulations (CFR) section 3.908 to the award and requires that recipients inform their employees in writing (in the predominant native language of the workforce) of employee whistleblower rights and protections under 41 U.S.C. 4712. 16. Copyright Interests Provisions This provision is intended to ensure that the public has access to the results and accomplishments of public health activities funded by CDC. Pursuant to applicable grant regulations and CDC’s Public Access Policy, Recipient agrees to submit into the National Institutes of Health (NIH) Manuscript Submission (NIHMS) system an electronic version of the final, peer-reviewed manuscript of any such work developed under this award upon acceptance for publication, to be made publicly available no later than 12 months after the official date of publication. Also at the time of submission, Recipient and/or the Recipient’s submitting author must specify the date the final manuscript will be publicly accessible through PubMed Central (PMC). Recipient and/or Recipient’s submitting author must also post the manuscript through PMC within twelve (12) months of the publisher's official date of final publication; however the author is strongly encouraged to make the subject manuscript available as soon as possible. The recipient must obtain prior approval from the CDC for any exception to this provision. The author's final, peer-reviewed manuscript is defined as the final version accepted for journal publication, and includes all modifications from the publishing peer review process, and all graphics and supplemental material associated with the article. Recipient and its submitting authors working under this award are responsible for ensuring that any publishing or copyright agreements concerning submitted articles reserve adequate right to fully comply with this provision and the license reserved by CDC. The manuscript will be hosted in both PMC and the CDC Stacks institutional repository system. In progress reports for this award, recipient must identify publications subject to the CDC Public Access Policy by using the applicable NIHMS identification number for up to three (3) months after the publication date and the PubMed Central identification number (PMCID) thereafter. 17. Funding Restrictions 29 TX-DSHS-19-1309-A-000321 30 Restrictions that must be considered while planning the programs and writing the budget are: • • • • • • • • • Recipients may not use funds for research. Recipients may not use funds for clinical care except as allowed by law. Recipients may use funds only for reasonable program purposes, including personnel, travel, supplies, and services. Generally, recipients may not use funds to purchase furniture or equipment. Any such proposed spending must be clearly identified in the budget. Reimbursement of pre-award costs generally is not allowed, unless the CDC provides written approval to the recipient. These requests are reviewed by the Grants Specialist on a case-by-case basis. Other than for normal and recognized executive-legislative relationships, no funds may be used for: o publicity or propaganda purposes, for the preparation, distribution, or use of any material designed to support or defeat the enactment of legislation before any legislative body o the salary or expenses of any grant or contract recipient, or agent acting for such recipient, related to any activity designed to influence the enactment of legislation, appropriations, regulation, administrative action, or Executive order proposed or pending before any legislative body See Additional Requirement (AR) 12 for detailed guidance on this prohibition and additional guidance on lobbying for CDC recipients. The direct and primary recipient in a cooperative agreement program must perform a substantial role in carrying out project outcomes and not merely serve as a conduit for an award to another party or provider who is ineligible. In accordance with the United States Protecting Life in Global Health Assistance policy, all nongovernmental organization (NGO) applicants acknowledge that foreign NGOs that receive funds provided through this award, either as a prime recipient or subrecipient, are strictly prohibited, regardless of the source of funds, from performing abortions as a method of family planning or engaging in any activity that promotes abortion as a method of family planning, or to provide financial support to any other foreign non-governmental organization that conducts such activities. See Additional Requirement (AR) 35 for applicability (https://www.cdc.gov/grants/additionalrequirements/ar-35.html). 18. Data Management Plan An overall Data Management Plan (DMP) is required for each recipient. Funds provided under this cooperative agreement may be used to support activities that assure compliance with CDC’s DMP. A DMP is required if the NOFO involves the collection or generation of public health data. The goal of the policy is to ensure public access to federally funded public health data. This specifically requires the development of DMPs for ELC activities that includes collection of public health data. DMPs should be 30 TX-DSHS-19-1309-A-000322 31 as complete as possible but CDC can work jointly with ELC recipients within the first 6 months after award to finalize them. They can be updated as appropriate throughout the life cycle of the data. DMPs should include: • Descriptions of the data to be produced • How access will be provided to the data (including provisions for protection of privacy, confidentiality, security, intellectual property, or other rights) • Use of data standards that ensure all released data have appropriate documentation that describes the method of collection, what the data represents, and potential limitations for use • Plans for archival and long-term preservation of the data, or explanation of why long-term preservation and access cannot be provided. The DMP may be submitted as a checklist, paragraph, or other format, as currently, HHS/CDC does not have a standardized DMP template or checklist due to PRA requirements. However, below are DMP examples that applicants can refer to as they develop their DMP: • University of California: http://dmp.cdlib.org/ • USGS: http://www.usgs.gov/datamanagement/plan/dmplans.php • ICPSR:http://www.icpsr.umich.edu/icpsrweb/content/datamanagement/dmp/plan.html 19. Other Submission Requirements a. Electronic Submission: Applications must be submitted electronically by using the forms and instructions posted for this notice of funding opportunity at www.grants.gov. Applicants can complete the application package using Workspace, which allows forms to be filled out online or offline. All application attachments must be submitted to www.grants.gov using a PDF file format. Instructions and training for using Workspace can be found at www.grants.gov under the "Workspace Overview" option. Courtesy copies of the completed application templates should be uploaded into each respective recipient’s ELC REDCap workspace. If Internet access is not available or if the forms cannot be accessed online, applicants may contact the OGS TIMS staff at 770- 488-2700 or by e-mail at ogstims@cdc.gov, Monday through Friday, 7:30 a.m.–4:30 p.m., except federal holidays. Electronic applications will be considered successful if they are available to OGS TIMS staff for processing from www.grants.gov on the deadline date. b. Tracking Number: Applications submitted through www.grants.gov are time/date stamped electronically and assigned a tracking number. The applicant’s Authorized Organization Representative (AOR) will be sent an e-mail notice of receipt when www.grants.gov receives the application. The tracking number documents that the application has been submitted and initiates the required electronic validation process before the application is made available to CDC. c. Validation Process: Application submission is not concluded until the validation process is completed successfully. After the application package is submitted, the applicant will receive a “submission receipt” e-mail generated by www.grants.gov. A second e-mail message to applicants will then be 31 TX-DSHS-19-1309-A-000323 32 generated by www.grants.gov that will either validate or reject the submitted application package. This validation process may take as long as two business days. Applicants are strongly encouraged to check the status of their application to ensure that submission of their package has been completed and no submission errors have occurred. Applicants also are strongly encouraged to allocate ample time for filing to guarantee that their application can be submitted and validated by the deadline published in the NOFO. Non-validated applications will not be accepted after the published application deadline date. If you do not receive a “validation” e-mail within two business days of application submission, please contact www.grants.gov. For instructions on how to track your application, refer to the e-mail message generated at the time of application submission or the Grants.gov Online User Guide. http://www.grants.gov/help/html/help/index.htm?callingApp=custom#t=Get_Started%2FGet_Started.ht m d. Technical Difficulties: If technical difficulties are encountered at www.grants.gov, applicants should contact Customer Service at www.grants.gov. The www.grants.gov Contact Center is available 24 hours a day, 7 days a week, except federal holidays. The Contact Center is available by phone at 1-800-5184726 or by e-mail at support@grants.gov. Application submissions sent by e-mail or fax, or on CDs or thumb drives will not be accepted. Please note that www.grants.gov is managed by HHS. e. Paper Submission: Paper submissions will not be accepted. If technical difficulties are encountered at www.grants.gov, applicants should call the www.grants.gov Contact Center at 1-800-518-4726 or e-mail them at support@grants.gov for assistance. After consulting with the Contact Center, if the technical difficulties remain unresolved and electronic submission is not possible, applicants may e-mail CDC GMO/GMS, before the deadline, and request permission to submit an electronic copy of the application Such requests are handled on a case-by-case basis. An applicant’s request for permission to submit a paper application must: 1. Include the www.grants.gov case number assigned to the inquiry 2. Describe the difficulties that prevent electronic submission and the efforts taken with the www.grants.gov Contact Center to submit electronically; and 3. Be received via e-mail to the GMS/GMO listed below at least three calendar days before the application deadline. Applications submitted using this method will not be considered without prior GMS/GMO approval. If a paper application is authorized, OGS will advise the applicant of specific instructions for submitting the application. E. Review and Selection Process 1. Review and Selection Process: Applications will be reviewed in three phases a. Phase 1 Review 32 TX-DSHS-19-1309-A-000324 33 All applications will be initially reviewed for eligibility and completeness by CDC Office of Grants Services. Complete applications will be reviewed for responsiveness by the Grants Management Officials and Program Officials. Non-responsive applications will not advance to Phase II review. Applicants will be notified that their applications did not meet eligibility and/or published submission requirements. b. Phase II Review An objective merit review utilizing subject matter experts (SMEs) will be conducted to evaluate complete and responsive applications according to the criteria listed in the three broad sections below. At minimum, the review will be conducted by program staff in the National Center for Zoonotic and Emerging Infectious Diseases (NCEZID), the National Center for Immunization and Respiratory Diseases (NCIRD), and the Center for Surveillance, Epidemiology and Laboratory Services (CSELS). Not more than thirty days after the Phase II review is completed, applicants will be notified electronically if their application does not meet eligibility or published submission requirements. i. Background Background and overview (one for entire ELC application) • • • I 15 points Fully describes (see section D. 10. Project Narrative for more detail): o Jurisdictional overview o Structure and organization o ELC Program Leadership, Governance, Integration, and Tracking and Reporting. o Local engagement o List of programs/projects applied for o Impact communicated in success stories o Data management plan (DMP) Provides plan to document efforts to maintain and/or strengthen epidemiology, laboratory and health information systems integration. Clear description of process to engage the recipient’s ELC Governance Team during the course of the ELC period of performance for general oversight, planning, review and agreement on annual continuation applications, review and agreement on significant ELC process actions i. Approach Project approach and work plan (one for each ELC Program or Project) • Maximum Points: I Maximum Points: 40 points Fully describes (see section D. 10. Project Narrative for more detail): o Problem statement 33 TX-DSHS-19-1309-A-000325 34 • • • • • o Justification o Work plan (comprised of an implementation plan for each activity in ELC Program or Project) Presents outcomes that are consistent with the period of performance outcomes described in the CDC Project Description and Roadmap. Describes an overall strategy and activities consistent with the CDC Project Description and ELC Overall Roadmap. Describes strategies and activities that are achievable, appropriate to achieve the outcomes of the project, and evidence-based (to the degree practicable). Shows that the proposed use of funds is an efficient and effective way to implement the strategies and activities and attain the period of performance outcomes. Presents a work plan that is aligned with the strategies/activities, outcomes, and performance measures in the approach and is consistent with the content and format proposed by CDC. ii. Evaluation and Performance Measurement Maximum Points: I Evaluation and Performance Measurement Plan (one for each ELC Program or Project) 20 points • • • • • • Identify key program staff who will participate in collecting and reporting performance measurement data. Demonstrates experience and capacity to implement the evaluation plan. Describe your plans and ability to collect data and report on the performance measures listed in the 2019 Notice of Funding Opportunity. Discuss how you and your program staff will use (e.g., to inform program improvement, identify gaps, program management, etc.) and share performance measurement data collected. If applicable: Discuss any barriers or challenges expected for collecting data (i.e., responding to performance measures), and reporting on results. Describe how these potential barriers would be overcome. In addition, applicants may also describe other measures to be developed or additional data sources and data collection methods that applicants will use to evaluate their activities and outcomes. Measures developed are relevant and impactful for the specific program or project in this NOFO iii. Applicant Capacity Maximum Points: I Applicant capacity to implement approach (one for each ELC Program or Project) • 25 points Describe the current resources, processes, and steps planned to implement this activity and achieve expected milestones 34 TX-DSHS-19-1309-A-000326 35 • • Current Capacity: For each program or project component applied, address the recipient’s current capacity to successfully implement the proposed strategies and activities. If the recipient was funded for a project component in previous funding periods, capacities attained during these periods (including describing staff and other infrastructure already in place that will be built upon) should be reported. Major Achievements: o Describe major activities conducted, the progress of those activities, and significant milestones accomplished as a result of those activities. o If applicable, describe any barriers encountered, and how the barriers were addressed during implementation of these activities Budget (not scored) When reviewing budgets, CDC programs must assess whether the budget aligns with the proposed work plan. For additional guidance, check with the CIO extramural program office, GMO, or GMS. c. Phase III Review Prior to making a Federal award, CDC is required by 31 U.S.C. 3321 and 41 U.S.C. 2313 to review information available through any OMB-designated repositories of government-wide eligibility qualification or financial integrity information as appropriate. See also suspension and debarment requirements at 2 CFR parts 180 and 376. In accordance 41 U.S.C. 2313, CDC is required to review the non-public segment of the OMBdesignated integrity and performance system accessible through SAM (currently the Federal Recipient Performance and Integrity Information System (FAPIIS)) prior to making a Federal award where the Federal share is expected to exceed the simplified acquisition threshold, defined in 41 U.S.C. 134, over the period of performance. At a minimum, the information in the system for a prior Federal award recipient must demonstrate a satisfactory record of executing programs or activities under Federal grants, cooperative agreements, or procurement awards; and integrity and business ethics. CDC may make a Federal award to a recipient who does not fully meet these standards, if it is determined that the information is not relevant to the current Federal award under consideration or there are specific conditions that can appropriately mitigate the effects of the non-Federal entity's risk in accordance with 45 CFR §75.207. CDC’s framework for evaluating the risks posed by an applicant may incorporate results of the evaluation of the applicant's eligibility or the quality of its application. If it is determined that a Federal award will be made, special conditions that correspond to the degree of risk assessed may be applied to the Federal award. The evaluation criteria is described in this Notice of Funding Opportunity 35 TX-DSHS-19-1309-A-000327 36 In evaluating risks posed by applicants, CDC will use a risk-based approach and may consider any items such as the following: (1) Financial stability; (2) Quality of management systems and ability to meet the management standards prescribed in this part; (3) History of performance. The applicant's record in managing Federal awards, if it is a prior recipient of Federal awards, including timeliness of compliance with applicable reporting requirements, conformance to the terms and conditions of previous Federal awards, and if applicable, the extent to which any previously awarded amounts will be expended prior to future awards; (4) Reports and findings from audits performed under subpart F 45 CFR 75 or the reports and findings of any other available audits; and (5) The applicant's ability to effectively implement statutory, regulatory, or other requirements imposed on non-Federal entities. CDC must comply with the guidelines on government-wide suspension and debarment in 2 CFR part 180, and require non-Federal entities to comply with these provisions. These provisions restrict Federal awards, subawards and contracts with certain parties that are debarred, suspended or otherwise excluded from or ineligible for participation in Federal programs or activities. 2. Announcement and Anticipated Award Dates Awards will be communicated by the CDC Office of Grants Services via official Notice of Award to be released no later than August 1, 2019. F. Award Administration Information 1. Award Notices Recipients will receive an electronic copy of the Notice of Award (NOA) from CDC OGS. The NOA shall be the only binding, authorizing document between the recipient and CDC. The NOA will be signed by an authorized GMO and emailed to the Recipient Business Officer listed in application and the Program Director. Any applicant awarded funds in response to this NOFO will be subject to the DUNS, SAM Registration, and Federal Funding Accountability And Transparency Act Of 2006 (FFATA) requirements. Unsuccessful applicants will receive notification of these results by e-mail with delivery receipt or by U.S. mail. 2. Administrative and National Policy Requirements 36 TX-DSHS-19-1309-A-000328 37 Recipients must comply with the administrative and public policy requirements outlined in 45 CFR Part 75 and the HHS Grants Policy Statement, as appropriate. Brief descriptions of relevant provisions are available at http://www.cdcgov/grants/additionalrequirements/index.html#ui-id-17. The HHS Grants Policy Statement is available at http://www.hhs.gov/sites/default/files/grants/grants/policies-regulations/hhsgps107.pdf. Administrative and National Policy Requirements, Additional Requirements (ARs) outline the administrative requirements found in 45 CFR Part 75 and the HHS Grants Policy Statement and other requirements as mandated by statute or CDC policy. CDC programs must indicate which ARs are relevant to the NOFO. All NOFOs from the Center for Global Health must include AR-35. The ARs are listed in the Template for CDC programs. Recipients must then comply with the ARs listed in the NOFO. Do not include any ARs that do not apply to this NOFO. Recipients must comply with administrative and national policy requirements as appropriate. For more information on the Code of Federal Regulations, visit the National Archives and Records Administration: http://www.access.gpo.gov/nara/cfr/cfr-table-search.html. The following Administrative Requirements (AR) apply to this project: Generally applicable ARs: • AR-7: Executive Order 12372 • AR-9: Paperwork Reduction Act • AR-10: Smoke-Free Workplace • AR-11: Healthy People 2010 • AR-12: Lobbying Restrictions • AR-14: Accounting System Requirements • AR-24: Health Insurance Portability and Accountability Act • AR-25: Release and Sharing of Data • AR-29: Compliance with EO13513, “Federal Leadership on Reducing Text Messaging while Driving,” October 1, 2009 • AR-30: Compliance with Section 508 of the Rehabilitation Act of 1973 • AR-33: Plain Writing Act of 2010 • AR-34: Patient Protection and Affordable Care Act (e.g., a tobacco-free campus policy and a lactation policy consistent with S4207) 37 TX-DSHS-19-1309-A-000329 38 For more information on the C.F.R., visit the National Archives and Records Administration at http://www.access.gpo.gov/nara/cfr/cfr-table-search.html. The full text of the Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards 45 CFR 75, can be found at https://www.ecfr.gov/cgi-bin/text-idx?node=pt45.1.75. 3. Reporting Reporting provides continuous program monitoring and identifies successes and challenges that recipients encounter throughout the period of performance. Also, reporting is a requirement for recipients who want to apply for yearly continuation of funding. Reporting helps CDC and recipients because it: • • • • Helps target support to recipients; Provides CDC with periodic data to monitor recipient progress toward meeting the NOFO outcomes and overall performance; Allows CDC to track performance measures and evaluation findings for continuous quality and program improvement throughout the period of performance and to determine applicability of evidence-based approaches to different populations, settings, and contexts; and Enables CDC to assess the overall effectiveness and influence of the NOFO. The table below summarizes required and optional reports. All required reports must be sent electronically to GMS listed in the “Agency Contacts” section of the NOFO copying the CDC Project Officer. Report When? Required? Recipient Evaluation and Performance Measurement Plan, including Data Management Plan (DMP) Annual Performance Report (APR) Data on Performance Measures 6 months into award Yes APR is submitted as a part of the continuation application. See Attachments Yes Federal Financial Reporting Forms Interim FFR (or equivalent) reporting of projected unobligated at the end of the budget period is due at the time of the continuation application. Annual FFR due 90 days after the end of the budget period 90 days after end of period of performance Yes Final Performance and Financial Report Yes Yes 38 TX-DSHS-19-1309-A-000330 39 Payment Management System (PMS) Reporting Quarterly reports due January 30; April 30; July 30; and October 30 Yes a. Recipient Evaluation and Performance Measurement Plan (required) With support from CDC, recipients must elaborate on their initial applicant evaluation and performance measurement plan. This plan must be no more than 20 pages; recipients must submit the plan 6 months into the award. HHS/CDC will review and approve the recipient’s monitoring and evaluation plan to ensure that it is appropriate for the activities to be undertaken as part of the agreement, for compliance with the monitoring and evaluation guidance established by HHS/CDC, or other guidance otherwise applicable to this Agreement. Recipient Evaluation and Performance Measurement Plan (required): This plan should provide additional detail on the following: Performance Measurement: • • • • • • • • Performance measures and targets The frequency that performance data are to be collected. How performance data will be reported. How quality of performance data will be assured. How performance measurement will yield findings to demonstrate progress towards achieving NOFO goals (e.g., reaching target populations or achieving expected outcomes). Dissemination channels and audiences. Other information requested as determined by the CDC program. Evaluation: • • • • • • The types of evaluations to be conducted (e.g. process or outcome evaluations). The frequency that evaluations will be conducted. How evaluation reports will be published on a publicly available website. How evaluation findings will be used to ensure continuous quality and program improvement. • How evaluation will yield findings to demonstrate the value of the NOFO (e.g., effect on improving public health outcomes, effectiveness of NOFO, cost-effectiveness or cost-benefit). Dissemination channels and audiences. HHS/CDC or its designee will also undertake monitoring and evaluation of the defined activities within the agreement. The recipient must ensure reasonable access by HHS/CDC or its designee to all necessary sites, documentation, individuals and information to monitor, evaluate and verify the appropriate implementation the activities and use of HHS/CDC funding under this Agreement. b. Annual Performance Report (APR) (required) 39 TX-DSHS-19-1309-A-000331 40 The recipient must submit the APR along with the continuation application www.grantsolutions.gov. Performance measures will be collected per schedules set in the specific program or project areas (see Attachments). Topics typically covered in this report include but are not limited to: • • • • • • Evaluation Results: Recipients must report evaluation results for the work completed to date (including findings from process or outcome evaluations). Work Plan: Recipients must update work plan each budget period to reflect any changes in period of performance outcomes, activities, timeline, etc. Successes o Recipients must report progress on completing activities and progress towards achieving the period of performance outcomes described in the Roadmap and work plan. o Recipients must describe any additional successes (e.g. identified through evaluation results or lessons learned) achieved in the past year. o Recipients must describe success stories. Challenges o Recipients must describe any challenges that hindered or might hinder their ability to complete the work plan activities and achieve the period of performance outcomes. o Recipients must describe any additional challenges (e.g., identified through evaluation results or lessons learned) encountered in the past year. CDC Program Support to Recipients o Recipients must describe how CDC could help them overcome challenges to complete activities in the work plan and achieving period of performance outcomes. Administrative Reporting (No page limit) o SF-424A Budget Information-Non-Construction Programs. The section Estimated Unobligated Funds should be completed (and all unliquidated obligations projected). o Budget Narrative – Must include the content outlined in "Content and Form of Application Submission, Budget Narrative" section. The ELC Budget template should be utilized for the submission of the Budget and accompanying Budget Narrative. o Indirect Cost Rate Agreement. The recipients must submit the Annual Performance Report via www.grantsolutions.gov along with the application for continuation funding. Recipients must report on performance measures for each budget period and update measures, if needed. Measures should be reported upon per the frequency outlined in each program or project description (see Attachments). ELC application and performance measure templates should be used where directed to ensure clear communication of report information. c. Performance Measure Reporting (required) 40 TX-DSHS-19-1309-A-000332 41 CDC Programs and Projects may require more frequent reporting of performance measures than annually in the APR. If this is the case, CDC Programs and Projects will collect this information directly, and will specify reporting frequency, data fields, format, and submission information for recipients, at the beginning of the award period. d. Federal Financial Reporting (FFR) (required) Beginning in budget period 2, an interim FFR (or approved equivalent) that illustrates the projected amount of unobligated funds at the end of the budget period is required to be submitted with the continuation application. The annual FFR form (SF-425) is required and must be submitted no later than 90 days after the end of the budget period. The report must include only those funds authorized and disbursed during the timeframe covered by the report. The final FFR must indicate the exact balance of unobligated funds, and may not reflect any unliquidated obligations. There must be no discrepancies between the final FFR expenditure data and the Payment Management System’s (PMS) cash transaction data. Failure to submit the required information by the due date may adversely affect the future funding of the project. If the information cannot be provided by the due date, recipients are required to submit a letter of explanation to OGS and include the date by which the Grants Officer will receive information. e. Final Performance and Financial Report (required) This report is due 90 days after the end of the period of performance. This report covers the entire period of performance and can include information previously reported in APRs. At a minimum, this report must include the following: • • • • • Performance Measures – Recipients must report final performance data for all process and outcome performance measures. Evaluation Results – Recipients must report final evaluation results for the period of performance for any evaluations conducted. Impact/Results/Success Stories – Recipients must use their performance measure results and their evaluation findings to describe the effects or results of the work completed over the period of performance, and can include some success stories. A final Data Management Plan that includes the location of the data collected during the funded period, for example, repository name and link data set(s) Additional forms as described in the Notice of Award (e.g., Equipment Inventory Report, Final Invention Statement). 4. Federal Funding Accountability and Transparency Act of 2006 (FFATA) Federal Funding Accountability and Transparency Act of 2006 (FFATA), P.L. 109–282, as amended by section 6202 of P.L. 110–252 requires full disclosure of all entities and organizations receiving Federal funds including awards, contracts, loans, other assistance, and payments through a single publicly accessible Web site, http://www.USASpending.gov. 41 TX-DSHS-19-1309-A-000333 42 Compliance with this law is primarily the responsibility of the Federal agency. However, two elements of the law require information to be collected and reported by applicants: 1) information on executive compensation when not already reported through the SAM, and 2) similar information on all subawards/subcontracts/consortiums over $25,000. For the full text of the requirements under the FFATA and HHS guidelines, go to: • • • https://www.gpo.gov/fdsys/pkg/PLAW-109publ282/pdf/PLAW-109publ282.pdf https://www.fsrs.gov/documents/ffata_legislation_110_252.pdf http://www.hhs.gov/grants/grants/grants-policies-regulations/index.html#FFATA G. Agency Contacts CDC encourages inquiries concerning this NOFO. Program Office Contact For programmatic technical assistance, contact: Angelica O’Connor, ELC Program Coordinator Centers for Disease Control and Prevention 1600 Clifton Road, NE Atlanta, GA 30333 Telephone: 404.639.7379 Email: AMOConnor@cdc.gov Grants Staff Contact For financial, awards management, or budget assistance, contact: Shirley Byrd, Lead Grants Management Specialist CDC Grants Services Office 2920 Brandywine Road, MS Atlanta, GA 30341 Telephone: 770.488.2591 Email: SKByrd@cdc.gov For assistance with submission difficulties related to www.grants.gov, contact the Contact Center by phone at 1-800-518-4726. Hours of Operation: 24 hours a day, 7 days a week, except on federal holidays. For all other submission questions, contact: Technical Information Management Section 42 TX-DSHS-19-1309-A-000334 43 Department of Health and Human Services CDC Office of Financial Resources Office of Grants Services 2920 Brandywine Road, MS E-14 Atlanta, GA 30341 Telephone: 770-488-2700 E-mail: ogstims@cdc.gov CDC Telecommunications for persons with hearing loss is available at: TTY 1-888-232-6348 H. Other Information Following is a list of acceptable attachments applicants can upload as PDF files as part of their application at www.grants.gov. Applicants may not attach documents other than those listed; if other documents are attached, applications will not be reviewed. • • • • • • • • • • Project Abstract Project Narrative Budget Narrative CDC Assurances and Certifications Report on Programmatic, Budgetary and Commitment Overlap Table of Contents for Entire Submission For international NOFOs: SF424 SF424A Funding Preference Deliverables Optional attachments, as determined by CDC Programs and Projects. I. Glossary Activities: The actual events or actions that take place as a part of the program. Administrative and National Policy Requirements, Additional Requirements AR: Antibiotic resistance (ARs): Administrative requirements found in 45 CFR Part 75 and other requirements mandated by statute or CDC policy. All ARs are listed in the Template for CDC programs. CDC programs must indicate which ARs are relevant to the NOFO; recipients must comply with the ARs listed in the NOFO. To view brief descriptions of relevant provisions, see http://www.cdc.gov/grants/additionalrequirements/index.html. Note that 2 CFR 200 supersedes the 43 TX-DSHS-19-1309-A-000335 44 administrative requirements (A-110 & A-102), cost principles (A-21, A-87 & A-122) and audit requirements (A-50, A-89 & A-133). Approved but Unfunded: Approved but unfunded refers to applications recommended for approval during the objective review process; however, they were not recommended for funding by the program office and/or the grants management office. Assistance Listings (CFDA): A government-wide compendium published by the General Services Administration (available on-line in searchable format as well as in printable format as a .pdf file) that describes domestic assistance programs administered by the Federal Government. Assistance Listings (CFDA) Number: A unique number assigned to each program and NOFO throughout its lifecycle that enables data and funding tracking and transparency Award: Financial assistance that provides support or stimulation to accomplish a public purpose. Awards include grants and other agreements (e.g., cooperative agreements) in the form of money, or property in lieu of money, by the federal government to an eligible applicant. Budget Period or Budget Year: The duration of each individual funding period within the period of performance. Traditionally, budget periods are 12 months or 1 year. Carryover: Unobligated federal funds remaining at the end of any budget period that, with the approval of the GMO or under an automatic authority, may be carried over to another budget period to cover allowable costs of that budget period either as an offset or additional authorization. Obligated but liquidated funds are not considered carryover. CDC Assurances and Certifications: Standard government-wide grant application forms. Competing Continuation Award: A financial assistance mechanism that adds funds to a grant and adds one or more budget periods to the previously established period of performance (i.e., extends the “life” of the award). Continuous Quality Improvement: A system that seeks to improve the provision of services with an emphasis on future results. Contracts: An award instrument used to acquire (by purchase, lease, or barter) property or services for the direct benefit or use of the Federal Government. Cooperative Agreement: A financial assistance award with the same kind of interagency relationship as a grant except that it provides for substantial involvement by the federal agency funding the award. Substantial involvement means that the recipient can expect federal programmatic collaboration or participation in carrying out the effort under the award. 44 TX-DSHS-19-1309-A-000336 45 Cost Sharing or Matching: Refers to program costs not borne by the Federal Government but by the recipients. It may include the value of allowable third-party, in-kind contributions, as well as expenditures by the recipient. Direct Assistance: A financial assistance mechanism, which must be specifically authorized by statute, whereby goods or services are provided to recipients in lieu of cash. DA generally involves the assignment of federal personnel or the provision of equipment or supplies, such as vaccines. DA is primarily used to support payroll and travel expenses of CDC employees assigned to state, tribal, local, and territorial (STLT) health agencies that are recipients of grants and cooperative agreements. Most legislative authorities that provide financial assistance to STLT health agencies allow for the use of DA. http://www.cdc.gov/grants/additionalrequirements/index.html. DUNS: The Dun and Bradstreet (D&B) Data Universal Numbering System (DUNS) number is a ninedigit number assigned by Dun and Bradstreet Information Services. When applying for Federal awards or cooperative agreements, all applicant organizations must obtain a DUNS number as the Universal Identifier. DUNS number assignment is free. If requested by telephone, a DUNS number will be provided immediately at no charge. If requested via the Internet, obtaining a DUNS number may take one to two days at no charge. If an organization does not know its DUNS number or needs to register for one, visit Dun & Bradstreet at http://fedgov.dnb.com/webform/displayHomePage.do. Evaluation (program evaluation): The systematic collection of information about the activities, characteristics, and outcomes of programs (which may include interventions, policies, and specific projects) to make judgments about that program, improve program effectiveness, and/or inform decisions about future program development. Evaluation Plan: A written document describing the overall approach that will be used to guide an evaluation, including why the evaluation is being conducted, how the findings will likely be used, and the design and data collection sources and methods. The plan specifies what will be done, how it will be done, who will do it, and when it will be done. The NOFO evaluation plan is used to describe how the recipient and/or CDC will determine whether activities are implemented appropriately and outcomes are achieved. Federal Funding Accountability and Transparency Act of 2006 (FFATA): Requires that information about federal awards, including awards, contracts, loans, and other assistance and payments, be available to the public on a single website at www.USAspending.gov. Fiscal Year: The year for which budget dollars are allocated annually. The federal fiscal year starts October 1 and ends September 30. Grant: A legal instrument used by the federal government to transfer anything of value to a recipient for public support or stimulation authorized by statute. Financial assistance may be money or property. The definition does not include a federal procurement subject to the Federal Acquisition Regulation; 45 TX-DSHS-19-1309-A-000337 46 technical assistance (which provides services instead of money); or assistance in the form of revenue sharing, loans, loan guarantees, interest subsidies, insurance, or direct payments of any kind to a person or persons. The main difference between a grant and a cooperative agreement is that in a grant there is no anticipated substantial programmatic involvement by the federal government under the award. Grants.gov: A "storefront" web portal for electronic data collection (forms and reports) for federal grant-making agencies at www.grants.gov. Grants Management Officer (GMO): The individual designated to serve as the HHS official responsible for the business management aspects of a particular grant(s) or cooperative agreement(s). The GMO serves as the counterpart to the business officer of the recipient organization. In this capacity, the GMO is responsible for all business management matters associated with the review, negotiation, award, and administration of grants and interprets grants administration policies and provisions. The GMO works closely with the program or project officer who is responsible for the scientific, technical, and programmatic aspects of the grant. Grants Management Specialist (GMS): A federal staff member who oversees the business and other non-programmatic aspects of one or more grants and/or cooperative agreements. These activities include, but are not limited to, evaluating grant applications for administrative content and compliance with regulations and guidelines, negotiating grants, providing consultation and technical assistance to recipients, post-award administration and closing out grants. Health Disparities: Differences in health outcomes and their determinants among segments of the population as defined by social, demographic, environmental, or geographic category. Health Equity: Striving for the highest possible standard of health for all people and giving special attention to the needs of those at greatest risk of poor health, based on social conditions. Health Inequities: Systematic, unfair, and avoidable differences in health outcomes and their determinants between segments of the population, such as by socioeconomic status (SES), demographics, or geography. Healthy People 2020: National health objectives aimed at improving the health of all Americans by encouraging collaboration across sectors, guiding people toward making informed health decisions, and measuring the effects of prevention activities. Inclusion: Both the meaningful involvement of a community’s members in all stages of the program process and the maximum involvement of the target population that the intervention will benefit. Inclusion ensures that the views, perspectives, and needs of affected communities, care providers, and key partners are considered. 46 TX-DSHS-19-1309-A-000338 47 Indirect Costs: Costs that are incurred for common or joint objectives and not readily and specifically identifiable with a particular sponsored project, program, or activity; nevertheless, these costs are necessary to the operations of the organization. For example, the costs of operating and maintaining facilities, depreciation, and administrative salaries generally are considered indirect costs. Intergovernmental Review: Executive Order 12372 governs applications subject to Intergovernmental Review of Federal Programs. This order sets up a system for state and local governmental review of proposed federal assistance applications. Contact the state single point of contact (SPOC) to alert the SPOC to prospective applications and to receive instructions on the State’s process. Visit the following web address to get the current SPOC list: https://www.whitehouse.gov/wpcontent/uploads/2017/11/Intergovernmental_-Review-_SPOC_01_2018_OFFM.pdf Letter of Intent (LOI): A preliminary, non-binding indication of an organization’s intent to submit an application. Lobbying: Direct lobbying includes any attempt to influence legislation, appropriations, regulations, administrative actions, executive orders (legislation or other orders), or other similar deliberations at any level of government through communication that directly expresses a view on proposed or pending legislation or other orders, and which is directed to staff members or other employees of a legislative body, government officials, or employees who participate in formulating legislation or other orders. Grass roots lobbying includes efforts directed at inducing or encouraging members of the public to contact their elected representatives at the federal, state, or local levels to urge support of, or opposition to, proposed or pending legislative proposals. Logic Model: A visual representation showing the sequence of related events connecting the activities of a program with the programs’ desired outcomes and results. In this NOFO, the logic model is referred to as Overall Roadmap. Maintenance of Effort: A requirement contained in authorizing legislation, or applicable regulations that a recipient must agree to contribute and maintain a specified level of financial effort from its own resources or other non-government sources to be eligible to receive federal grant funds. This requirement is typically given in terms of meeting a previous base-year dollar amount. Memorandum of Understanding (MOU) or Memorandum of Agreement (MOA): Document that describes a bilateral or multilateral agreement between parties expressing a convergence of will between the parties, indicating an intended common line of action. It is often used in cases where the parties either do not imply a legal commitment or cannot create a legally enforceable agreement. Nonprofit Organization: Any corporation, trust, association, cooperative, or other organization that is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; is not organized for profit; and uses net proceeds to maintain, improve, or expand the operations 47 TX-DSHS-19-1309-A-000339 48 of the organization. Nonprofit organizations include institutions of higher educations, hospitals, and tribal organizations (that is, Indian entities other than federally recognized Indian tribal governments). Notice of Award (NoA): The official document, signed (or the electronic equivalent of signature) by a Grants Management Officer that: (1) notifies the recipient of the award of a grant; (2) contains or references all the terms and conditions of the grant and Federal funding limits and obligations; and (3) provides the documentary basis for recording the obligation of Federal funds in the HHS accounting system. Objective Review: A process that involves the thorough and consistent examination of applications based on an unbiased evaluation of scientific or technical merit or other relevant aspects of the proposal. The review is intended to provide advice to the persons responsible for making award decisions. Outcome: The results of program operations or activities; the effects triggered by the program. For example, increased knowledge, changed attitudes or beliefs, reduced tobacco use, reduced morbidity and mortality. Overall Roadmap: See “Logic Model,” for the purposes of this NOFO. Performance Measurement: The ongoing monitoring and reporting of program accomplishments, particularly progress toward pre-established goals, typically conducted by program or agency management. Performance measurement may address the type or level of program activities conducted (process), the direct products and services delivered by a program (outputs), or the results of those products and services (outcomes). A “program” may be any activity, project, function, or policy that has an identifiable purpose or set of objectives. Period of Performance – formerly known as the project period: The time during which the recipient may incur obligations to carry out the work authorized under the Federal award. The start and end dates of the period of performance must be included in the Federal award. Period of Performance Outcome: An outcome that will occur by the end of the period of performance. Plain Writing Act of 2010: Plain Writing Act of 2010, Public Law 111-274 requires federal agencies to communicate with the public in plain language to make information more accessible and understandable by intended users, especially people with limited health literacy skills or limited English proficiency. The Plain Writing Act is available at www.plainlanguage.gov. Program Strategies: Strategies are groupings of related activities, usually expressed as general headers (e.g., Partnerships, Assessment, Policy) or as brief statements (e.g., Form partnerships, Conduct assessments, Formulate policies). Program Official: Person responsible for developing the NOFO; can be either a project officer, program manager, branch chief, division leader, policy official, center leader, or similar staff member. 48 TX-DSHS-19-1309-A-000340 49 Period of performance - formerly known as the project period: The time during which the recipient may incur obligations to carry out the work authorized under the Federal award. The start and end dates of the period of performance must be included in the Federal award Period of performance Outcome: An outcome that will occur by the end of the NOFO’s funding period. Public Health Accreditation Board (PHAB): A nonprofit organization that works to promote and protect the health of the public by advancing the quality and performance of public health departments in the U.S. through national public health department accreditation http://www.phaboard.org. Social Determinants of Health: Conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. Statute: An act of the legislature; a particular law enacted and established by the will of the legislative department of government, expressed with the requisite formalities. In foreign or civil law any particular municipal law or usage, though resting for its authority on judicial decisions, or the practice of nations. Statutory Authority: Authority provided by legal statute that establishes a federal financial assistance program or award. System for Award Management (SAM): The primary vendor database for the U.S. federal government. SAM validates applicant information and electronically shares secure and encrypted data with federal agencies' finance offices to facilitate paperless payments through Electronic Funds Transfer (EFT). SAM stores organizational information, allowing www.grants.gov to verify identity and pre-fill organizational information on grant applications. Technical Assistance: Advice, assistance, or training pertaining to program development, implementation, maintenance, or evaluation that is provided by the funding agency. Work Plan: The summary of period of performance outcomes, strategies and activities, personnel and/or partners who will complete the activities, and the timeline for completion. The work plan will outline the details of all necessary activities that will be supported through the approved budget. 49 TX-DSHS-19-1309-A-000341 Part III. Program and Project Attachments A. Program and Project Summaries with Tiered Activities In this NOFO Programs and Projects have outlined a path to meet minimum expectations, expand or enhance these capacities, and even provide leadership amongst other jurisdictions. This section provides a summary activity table for each program and project, organizing the activities within the following three tiers: Tier 1: Core Activities Tier 2: Enhanced or Expanded Activities Tier 3: Advanced or Regional Activities TX-DSHS-19-1309-A-000342 50 Section I: Cross-cutting Emerging Infectious Disease Capacity, Systems, and Leadership A: Cross-Cutting Epidemiology and Laboratory Capacity • • • • • • • • I • • • • • • • • • • • • Tier 1: Core Required Activities Conduct needs assessments to identify gaps and/or training needs in epidemiology and laboratory activities Develop and implement a training plan based on the findings from the needs assessment. Enhance skills and maintain pace with novel laboratory and epidemiology techniques by participating in trainings or creating training opportunities for professional development (e.g., forums, seminars, workshops) for staff Lead/assist in timely response to outbreak investigations Plan for/address surge capacity needs during outbreaks (e.g., establishing investigation teams and/or student workforce or cross training staff) Develop, maintain and evaluate the use of communication protocols or guidelines for outbreak response and management Develop, implement, review and maintain a plan or strategy for the optimal use of lab supplies and equipment that addresses flexible, changing, and multi-disease purpose needs. Collaborate with clinical/private labs for surge, continuity of operations and CIDT issues. Tier 2: Enhanced or Expanded Activities Peer-to-Peer: Visit another ELC jurisdiction to facilitate knowledge sharing Implement advanced technologies (e.g., AMD, SaTScans, GIS) for more thorough and accurate detection of infectious diseases Improve use of surveillance data by implementing innovative methodologies (e.g., SaTScans , GIS, etc.) Improve coordination and exchange of surveillance data with other jurisdictions and partners Improve lab throughput, efficiency and proficiency by incorporating use of novel techniques for detection to expand capabilities and improve laboratory throughput, efficiency and proficiency Use analytical methods to enhance laboratory operational planning (e.g. Collecting and compiling data on resources needed for processing laboratory samples and estimating the cost/quantify the costs required for processing specimens in different scenarios, using throughput and network models to understand and plan for surge) AMD Training Participant Implement evidence-based prevention tools and/or interventions (e.g., policy, engineering, service delivery, education, and/or communication campaigns) to achieve improved prevention practices and reduction of disease Improve use and/or review of surveillance data for prevention and response (e.g. identifying risk populations to drive interventions, data quality checks, more robust analysis) Conduct process and/or outcome evaluations of tools and/or interventions to understand whether intended outcomes and/or effects were achieved and identify opportunities for improvement Foster collaboration among city, county, state and federal partners (e.g., workgroups) and other external partners for the purpose of improving outbreak response and management Develop communication tools such as public websites that disseminate information regarding emerging and re-emerging disease threats TX-DSHS-19-1309-A-000343 51 Tier 3: Advanced or Regional Activities • Develop and enhance regional laboratory networks for service sharing • AMD Training Lead • AMD Regional Bioinformatics I B: ELC Leadership, Management and Administration Tier 1: Core Required Activities • Manage ELC activities across all ELC programs and projects • Actively plan, coordinate and implement ELC activities across epidemiology, laboratory and health informatics interests at health department and within jurisdiction • Manage financial aspects of ELC Cooperative Agreements, including resource tracking and spending C: Health Information Systems Capacity Tier 1: Core Required Activities • Manage ELC activities across all ELC programs and projects. • Actively plan, coordinate and implement ELC activities across epidemiology, laboratory and health informatics interests at health department and within jurisdiction. • Manage financial aspects of ELC Cooperative Agreements, including resource tracking and spending. Tier 2: Enhanced or Expanded Activities • Advance electronic data exchange for Public Health Laboratories. • Advance electronic information exchange between electronic health records and public health. • Advance electronic information exchange between jurisdictions. • Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. • Implement (if appropriate) new/replacement information systems. • Enhance existing information system(s) by adding or improving functionality. • Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. • Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. I D: Impact and Evaluation Tier 1: Core Required Activities • Conduct cost-effectiveness and/or public health impact evaluations (in coordination with CDC) associated with ELC-funded activities. E: Cross-Cutting Emerging Issues: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Tier 2: Enhanced or Expanded Activities • Depending upon current baseline capacity, conduct specimen collection, shipping, case/contact/control interviews and medical record review, and transmit results to CDC to enhance the ability to rapidly respond to outbreaks. I TX-DSHS-19-1309-A-000344 52 • Depending upon current baseline capacity, enhance the ability of the laboratory to rapidly respond to outbreaks. • Depending upon current baseline capacity, enhance the ability of the health information system to rapidly respond to outbreaks. Section II: Emerging Infectious Disease Programs F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention Tier 1: Core Required Activities • • • • • • • • • • • • • • • • CaliciNet National Antimicrobial Resistance Monitoring System (NARMS) National Case Surveillance National Outbreak Reporting System (NORS) OutbreakNet PulseNet Tier 2: Enhanced or Expanded Activities CryptoNet and CryptoNet Regional Labs Activities Cyclospora Genotyping Activities FoodCORE Activities FoodNet Activities NoroSTAT Activities National Respiratory and Enteric Virus Surveillance System (NREVSS) Enhanced Activities Harmful Algal Bloom Surveillance, Response, and Mitigation OutbreakNet Enhanced Activities PulseNet Area Laboratories Activities Tier 3: Advanced or Regional Activities Integrated Food Safety Centers of Excellence Activities G: Healthcare-associated Infections and Antibiotic Resistance Program G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2: Antibiotic Resistance Laboratory Network (AR Lab Network) Tier 1: Core Required Activities Epidemiology: • In collaboration with public health laboratories, provide technical expertise and support to clinical laboratories, infection prevention networks, and healthcare facilities. • Conduct colonization screenings and continue until spread is controlled. Refer to CDC guidance to determine when colonization screening is recommended. Facilitate timely sharing of colonization screening results and incorporate findings in recommendations to affected healthcare facilities and providers. TX-DSHS-19-1309-A-000345 53 • Provide technical expertise to healthcare facilities. • Facilitate timely sharing of laboratory results and incorporate findings in recommendations to affected healthcare facilities and providers. • Conduct onsite infection control assessments at facilities where targeted organisms or resistance mechanisms have been identified (i.e., as part of the containment described in Strategy I). • Conduct onsite infection control assessments at facilities where outbreaks have occurred (i.e., as part of response efforts described in Strategy II). • Provide continued assistance until infection control gaps have been addressed. • Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. • Facilitate connections between facilities or clinical laboratories and public health labs to ensure appropriate isolates are forwarded to the regional AR laboratory for targeted surveillance activities • Identify and use data sources to inform prevention and response activities. • Identify and implement mechanisms to detect emerging MDROs within the jurisdiction (e.g., sentinel lab/facility surveillance) and to define local and regional epidemiology. • Use data to inform the HAI advisory committee structure, membership, and priorities. (See Area C for additional guidance for the HAI advisory committee. This activity in Area A refers to how data are used to determine structure, membership, and priorities of the committee. Area C, Strategy IV refers to minimum expectations of the committee.) • Conduct ongoing onsite assessments and gap mitigation in long length-of-stay, high-acuity facilities (e.g., skilled nursing facilities that provide ventilator care [vSNF], LTACHs) or others (e.g., dialysis facilities, outpatient facilities), based on identified needs (e.g., poor infection control practices), with the goal to improve infection control practices to reduce transmission of selected MDROs or reduce HAIs. Assessments will require direct observation. • Facilitate core element implementation in designated settings. Core elements should be applied in the setting for which they were designed • The HAI coordinator should assure HAI prevention through coordination throughout the jurisdiction (including for containment and response); epi-lab collaboration, including but not limited to coordination with the AR Lab Network regional lab, and use of the Targeted Assessment for Prevention; serve on the ELC governance team to monitor HAI program performance and spending; and serve as the primary point of contact for HAI communications with and reporting to CDC. • The AR/AS expert should provide senior-level expertise (e.g., doctoral level or equivalent experience) in epidemiology and infection prevention with proficiency in AR/AS and data for action, as described in the detailed guidance below. • Building upon work previously funded through the Ebola supplement, maintain and update as needed an inventory of all healthcare settings in the jurisdiction. Use this inventory to guide outreach for containment, response, and prevention activities. • Provide education/training on infection control for healthcare facilities on prevention of HAIs and control of targeted MDROs. • Providing training and support for local health departments in investigations in healthcare settings, control of targeted MDROs, and prevention of HAIs. TX-DSHS-19-1309-A-000346 54 • Improve onsite assessment capacity by developing expertise in facility assessment designed to improve infection prevention and control in outpatient or high-acuity, post-acute care settings. • Identify and engage with partners for prevention activities. Strong applications will define specific roles and responsibilities of the Recipient and those of the partners. • Jurisdictions with EIP catchment areas: Establish plans to share data and findings related to surveillance activities and projects and outbreaks. Funding requests should be of sufficient detail to demonstrate there is no overlap with EIP-funded activities and that ELC funds will not be used for research purposes. • Assign strategies, roles, and responsibilities of members. • Update the HAI plan regularly. Laboratory: • Increase or sustain laboratory capacity to perform CLIA-compliant organism identification and carbapenemase production testing on Carbapenem-resistant Enterobacteriaceae (CRE), including at least E. coli, Enterobacter, and Klebsiella, and a proportion of Carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates, as recommended by CDC. • Increase or sustain laboratory capacity to perform CLIA-compliant carbapenem-resistance mechanism testing on CRE (at least E. coli, Enterobacter, Klebsiella, and Citrobacter) and a proportion of CRPA isolates for the most common and important resistance mechanisms (e.g., PCR detection of KPC, NDM, VIM, OXA48-like OR Cepheid CARBA-R panel) as recommended and updated annually by CDC. • Report testing results to submitting clinical laboratory within two working days of testing completion. • Store bacterial isolates for a minimum of two years. Transport isolates of interest (as defined or specifically requested by CDC) to AR Lab Network regional lab and/or to CDC for further characterization or to CDC for deposit in a CDC repository. • Submit data, at least monthly, to CDC via APHL Informatics Messaging Services platform (AIMS) or CDCprovided templates. Participate in data reconciliation confirmation of counts and data quality. Communicate any test results defined as an “alert” by CDC (e.g., novel or high-concern resistance), within one business day to CDC and the state/local HAI/AR epidemiologist(s). • An AR lab expert should clearly demonstrate expertise in AR testing (particularly focused on AR Lab Network guidance) and data reporting for the jurisdiction • Train and educate laboratorians and maintain adequate workforce to perform CRE and CRPA testing. • Coordinate epidemiology and laboratory functions at state, city, county, and local levels, as well as with the AR Lab Network regional lab. • Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. The plan should include the list of prioritized antibiotic resistant organisms and mechanisms, based on the epidemiology of the jurisdiction. States that participate in the Emerging Infections Program Healthcare-Associated Infections-Community Interface Activity (EIP HAIC) should demonstrate efforts to enhance relationships and collaboration with EIP HAI/AR staff. • Coordinate connections with clinical laboratories serving the state or jurisdiction to solicit CRE and CRPA isolates from healthcare facilities (including short- and long-term acute care facilities) with specific focus on laboratories that serve high risk settings as defined by or in coordination with CDC. Provide outreach and technical assistance to clinical microbiology laboratories to improve the detection of targeted organisms, 55 TX-DSHS-19-1309-A-000347 including timely submission and reporting of results. Guidance for targeting laboratories serving high risk settings will be provided by the CDC HAI/AR program. • Facilitate coordinated connections with clinical laboratories in the state or jurisdiction to solicit isolates requested from the AR Lab Network regional lab for targeted surveillance activities (Tier 3, Strategy 1, Activity b) and for Candida activities (Tier 3, Strategy 1, Activity d). • Develop testing and communication protocols, reporting processes, and IT infrastructure to ensure timely testing and reporting of results to submitting laboratories, state prevention epidemiologists, jurisdictional public health laboratories, and CDC. • Work with APHL to implement or sustain reporting using APHL Informatics Messaging Services (AIMS) platform. Tier 2: Enhanced or Expanded Activities Epidemiology: • Conduct data validation to inform prevention. Preference for funding will be given to Recipients that will conduct their own validation rather than contracting for services. Recipients are required to identify 2 HAIs that will be validated during a funding year and are encouraged to consider Dialysis Event validation and Long Term Care Facility HAI validation in addition to inpatient HAIs. • Implement a targeted prevention project addressing MRSA BSIs or CDI, which involve transmission across facilities, based on data-identified need. The goal of this project is to reduce the burden of selected HAIs in facilities with high rates, through implementation of the TAP strategy or a Prevention Collaborative. • Continue work with partners across settings for prevention of device- and procedure-associated infections (CAUTI, CLABSI, dialysis BSI, surgical site infection) through implementation of the TAP Strategy or other data-driven prevention project. • Implement targeted project to improve antibiotic use. • Implement, continue, or enhance an MDRO patient registry. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. I Laboratory: • Increase or sustain laboratory capacity to perform CLIA-compliant routine confirmatory antibiotic susceptibility testing on CRE and a proportion of CRPA isolates, in accordance with CDC guidance. This testing would be in addition to the organism identification, carbapenemase production testing and carbapenem-resistance mechanism testing described under Tier 1. • Increase or sustain scope of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1. • Increase or sustain laboratory capacity to conduct reference identification of Candida spp. using MALDI-TOF or DNA-based methods. • Up to five non-regional public health laboratories may be funded to perform coordinated by CDC to support epidemiologic investigations in their state. These labs must be able to demonstrate sequencing capacity and follow guidance and training recommendations put forth by CDC. Sequencing priorities would be set by CDC, in accordance with emerging threats and current WGS capacities. CDC will provide resources and bioinformatics support for analysis of WGS data. Tier 3: Advanced or Regional Activities Laboratory: I TX-DSHS-19-1309-A-000348 56 AR Lab Network regional laboratories • In collaboration with CDC, provide CLIA-compliant organism identification, antibiotic susceptibility testing, carbapenemase production testing, and molecular detection of resistance mechanisms for new, unusual or emerging AR threats, including isolates suspected of carrying novel resistance mechanisms sent from state and local laboratories within the region. • Perform targeted surveillance for emerging or changing AR threats (e.g. mobile colistin resistance or carbapenemase genes), as directed by CDC, using lab testing to fill gaps in detection and containment. • Conduct reference identification and susceptibility testing of Candida spp. Regional laboratories will collect isolates from a diverse range of hospitals and other healthcare settings in their region to ensure wide surveillance coverage. • Sustain/implement specimen storage and isolate transport per CDC guidance or upon request (e.g., isolates which harbor new or unusual resistance, a subset of isolates including representative isolates from outbreaks) for additional characterization and potential inclusion in CDC specimen repositories. • Submit testing data at least monthly to CDC via APHL Informatics Messaging Services (AIMS) platform. • Provide regional laboratory support for state-led epidemiologic investigations and HAI/AR prevention efforts focused on carbapenemase-producing organisms (CPOs) by performing molecular tests, including CDC-recommended commercial assay(s), to detect colonization for CPOs. • At the direction of CDC, laboratories will perform C. auris colonization screening testing to support surveillance activities and outbreak investigations occurring within the region • Implement or sustain CDC-directed reference antibiotic susceptibility testing to new antibiotic agents by broth microdilution (BMD) of pan-resistant or nearly pan-resistant bacteria. • Perform whole genome sequencing for HAI/AR pathogens to support epidemiologic investigations in the region. Labs must be able to demonstrate sequencing capacity and follow CDC guidance and training recommendations. Sequencing priorities will be determined by CDC, in accordance with emerging threats and current WGS capacities. CDC will provide resources and bioinformatics support for analysis of WGS data. • Demonstrate surge capacity. Accept specimens for testing from outside of the region when CDC determines that a public health need exists and alternative testing capacity is limited or unavailable. • Report all colonization screening results to submitters within one day of testing completion. Report all targeted surveillance testing results at least monthly to submitting laboratories and the jurisdictional HAI programs. Submit colonization screening and targeted surveillance data at least monthly to CDC via APHL Informatics Messaging Services platform (AIMS). Participate in data reconciliation confirmation of counts and data quality. • Train laboratory personnel to demonstrate competency and proficiency for performing all AR tests (available in their test directory. • A regional epidemiologist should work closely with regional laboratory staff and state HAI/AR epidemiologists throughout the region to recruit and coordinate sample submissions and testing, and use of data for containment and prevention activities, using elements and guidance provided by CDC. • In collaboration with CDC programs, establish a project plan and protocol for collection of specimens and/or isolates from healthcare facility, other clinical microbiology laboratories, or other settings like sexually-transmitted disease clinics. • Implement AR-related consultations and results interpretation for facilities, designated outbreak and prevention program staff, and partners, and other network clinical or public health laboratories. 57 TX-DSHS-19-1309-A-000349 • Offer troubleshooting expertise or training for laboratory personnel conducting AR testing in regional state or local AR lab network funded public health laboratories, as needed/requested. • Host a regional partnership meeting for state HAI/AR prevention programs and public health laboratories within the region. • Participate in regularly scheduled conference calls with CDC to discuss AR concerns, emerging issues, protocol plans, etc. • Develop or sustain processes and IT infrastructure for timely reporting to submitting facilities, state or local public health laboratories, epidemiologists, regional AR prevention partners, and CDC. • Work with APHL to implement or sustain reporting using APHL Informatics Messaging Services (AIMS) platform and Lab Web Portal for applicable testing. Lab Web Portal should be implemented using sync services and not HL7. • Establish or sustain laboratory capacity for N. gonorrhoeae resistance surveillance by performing AST on up to 5,000 isolates and WGS for up to 1,250 isolates per funded laboratory annually. • Antibiotic susceptibility testing and serotyping of MDR-Streptococcus pneumoniae (up to 500 isolates per year). Funded laboratories will perform whole genome sequencing (WGS) for up to 500 isolates per funded laboratory annually. These WGS data will be used to detect and characterize S. pneumoniae isolates with unique antibiotic susceptibility patterns. • Perform CDC-directed and coordinated public health assessments of emerging or changing epidemiology of Clostridium difficile by implementing culture capacity for clinical specimens and environmental specimens. As directed by CDC, apply advanced molecular detection testing to type isolated bacteria and to assess C. difficile transmission. National TB Molecular Surveillance Center • Establish or sustain laboratory capacity for Mtb 24 locus MIRU-VNTR typing by testing approximately 9,000 isolates in total annually (from all 50 states and U.S. territories). Preference will be given to laboratories that have demonstrated proficiency in 24 locus MIRU-VNTR testing in accordance with methods recommended by CDC’s Division of TB Elimination. • Establish or sustain whole genome sequencing (WGS) of Mtb by sequencing approximately 9,000 isolates in total annually (from all 50 states and U.S. territories). The NextSeq sequencer is the preferred platform for this work. These sequence data will be used to conduct molecular surveillance of antibiotic susceptibility patterns and to strengthen epidemiologic investigations through transmission network analysis. Preference will be given to laboratories that have demonstrated proficiency In WGS testing of M. tuberculosis in accordance with methods recommended by CDC's Division of TB Elimination. • Implement Mtb sample inventory storage system; prepare subcultures of all submitted isolates and provide transport to CDC within three months of submission for long term storage. TX-DSHS-19-1309-A-000350 58 H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • • • • • • • • • • • • • I • • • • • Tier 1: Core Required Activities Identify and report nationally notifiable vector-borne disease cases to CDC using standard CSTE case definitions with complete reporting of key variables (using NNDSS, supplemental case report forms or enhanced surveillance platforms, e.g. ArboNET) Identify and report blood donations with evidence of vector-borne pathogens (including West Nile virus, Zika virus, Ehrlichia and Anaplasma spp. and Babesia spp.) to CDC Identify and report possible transfusion and transplant transmitted infections Analyze and interpret vector-borne disease surveillance data Report passively collected ecologic surveillance data already being collected (e.g. veterinary cases, sentinel animal infections, vector abundance and infection prevalence) for vector-borne disease to the appropriate CDC systems (e.g. ArboNET, MosquitoNET) and local vector control programs. Advise local agencies (e.g. mosquito abatement districts, health departments) on surveillance and control of vectors to reduce human disease where appropriate Maintain core capacity to perform testing for vector-borne diseases of public health importance to the jurisdiction. Participate in annual proficiency testing for vector-borne disease diagnostic testing Participate in CDC coordinated national and/or regional vector-borne disease meeting (e.g. ELC annual meeting and/or vector-borne disease focused meeting) Participate in relevant meetings and trainings to improve capacity for vector-borne diseases detection, reporting and response In coordination with CDC and other partners, investigate and respond to vector-borne disease outbreaks, implement timely control measures, and disseminate findings Conduct outreach and educational activities to increase awareness of healthcare providers, public health personnel and the public regarding the risks, clinical manifestations, diagnosis and prevention of vectorborne diseases Post jurisdiction specific vector-borne disease surveillance data to health department website Tier 2: Enhanced or Expanded Activities Identify and report non-nationally notifiable vector-borne disease cases to CDC Perform expanded analysis and interpretation of vector-borne disease surveillance data to inform public health action Investigate and report vector-borne disease cases with new or unusual modes of transmission or clinical manifestations Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET) Perform or obtain insecticide resistance testing results for mosquitos and submit, coordinate or verify submission of results to national systems (e.g. MosquitoNET). Use data to inform emergency mosquito control activities TX-DSHS-19-1309-A-000351 59 • Maintain enhanced capacity to perform testing or confirmation for an expanded number of vector-borne diseases of public health importance to the jurisdiction such as for a panel of arboviral infections and PCR testing for Ehrlichia and Anaplasma spp. • Develop and maintain surveillance and response plans for vector-borne diseases (e.g. emerging infections, outbreaks) as appropriate for the jurisdiction • Prepare up-to-date summaries of vector-borne disease data, and distribute to healthcare providers, public health partners, policy makers and the public Tier 3: Advanced or Regional Activities • In coordination with CDC and other ELC-funded jurisdictions, conduct enhanced case investigations and surveillance for vector-borne diseases to: 1) improve estimates of disease incidence and burden; 2) describe clinical features and outcomes; and 3) identify groups at increased risk for infection or disease to target prevention • Develop and maintain capacity to lead and coordinate complex investigations involving multiple jurisdictions or agencies (e.g., transfusion or transplant-associated transmission, and complex outbreaks) • Evaluate novel ways to conduct improved public health surveillance and collaborate with CDC to evaluate next generation public health surveillance (including informatics modernization initiatives). • Develop and maintain capacity to serve as a regional reference laboratory for other states and jurisdictions for advanced and confirmatory vector-borne disease diagnostic testing, including but not limited to plaque reduction neutralization testing • Develop and implement a comprehensive integrated vector surveillance and control plan • Collaborate with CDC and other CDC-supported extramural programs to evaluate the effectiveness and feasibility of integrated strategies to prevent, control or reduce the burden of vector-borne diseases (e.g. vaccines, therapeutics, clinical management, vector control or public education). • Establish and manage regional collaborations with other state and local health departments to improve resource sharing, staffing and capacity for vector-borne disease surveillance and control measures • Evaluate and modify prevention and control messages as appropriate • Develop comprehensive vector-borne disease communication plans • Develop and evaluate innovative communication approaches to improve information reach and retention • Perform workforce training, intensive public outreach and/or clinician education I Section III: Disease-Specific Projects I: Mycotics: Detecting and Preventing Fungal Infections • I • • • • Tier 1: Core Required Activities Acquire/maintain laboratory equipment or supplies for fungal diseases testing (note that testing should not be duplicative with Candida AR Lab Network testing) Tier 2: Enhanced or Expanded Activities Improve laboratory detection of fungal infections Respond to fungal disease outbreaks and report findings to CDC Contain or prevent the spread of antifungal-resistant fungal pathogens Use CSTE case definitions to conduct surveillance for coccidioidomycosis and histoplasmosis TX-DSHS-19-1309-A-000352 60 • Help improve standardized data collection for fungal disease surveillance, including revised case definitions and optional data elements harmonized across states • Conduct enhanced surveillance for one or more endemic mycoses to better characterize patient characteristics, diagnostics used, clinical illness, and possible exposures • Conduct active, population-based surveillance for invasive mold infections, including collection of clinical isolates and pathology specimens; states may consider using a case investigation form used by the Emerging Infections Program. • Implement or improve testing protocols for fungal infectious diseases • Develop health promotion materials for healthcare providers and the public to increase health literacy about fungal disease prevention (e.g., participate in national Fungal Disease Awareness Week activities) J: Binational Border Infectious Disease Surveillance (BIDS) Program • • • I • • • • • • • • Tier 1: Core Required Activities Assess the completeness, and data quality of Binational Variables (i.e., Binational Reporting Criteria, Country of Exposure, Country of Usual Residence and Country of Birth) in state and local systems by county Train state and local staff on the use of the Binational Reporting Criteria and related variables Binational Case Reporting Tier 2: Enhanced or Expanded Activities Integrate the Binational Variables into local and state electronic disease surveillance systems Incorporate the Binational Variables into routine case notifications to the National Notifiable Disease Surveillance System Implement or enhance human surveillance Develop, test, and refine binational information sharing and collaboration protocols Assess, enhance, or systematize data collection Share best practices through Peer to Peer training or consultation Assist local health jurisdictions with binational outbreak investigations Train border region epidemiologists/disease investigators, or physicians to improve surveillance and response K: Global Migration, Border Interventions and Migrant Health • • • • • • Tier 1: Core Required Activities Develop new investigation materials, processes, procedures, or technology that would more quickly and completely detect cases of immediate public health interest among globally mobile populations Analyze, report, and share surveillance, epidemiological, or clinical data for globally mobile populations. Implement interventions addressing the health needs of refugee and /or immigrant populations at conveyances or at border crossings Evaluate the effectiveness of interventions addressing the health needs of refugee and/or immigrant populations Enhance staff training and education on port of entry International Health Regulations core capacities (http://www.who.int/ihr/procedures/en) Facilitate coordination/exchange of surveillance, epidemiological, or clinical data for globally mobile populations TX-DSHS-19-1309-A-000353 61 L: Prion Surveillance Tier 1: Core Required Activities • Actively investigate all cases of suspected prion disease reported in state residents; refer out-of-state cases to the health department of patient's residence. • Within two weeks of a report, actively investigate all cases of suspected prion disease in higher priority cases of suspected prion disease (e.g., suspected cases in persons < 55 years of age, suspected cases of variant CJD or possible human CWD, suspected iatrogenic cases, and suspected case clusters. • Cross check various data sources to ensure that all cases are identified in the project area. Specific search terms are available from the CDC Prion Group and are listed in the detailed Prion guidance in Part III, section B of this NOFO. • Utilize human prion disease surveillance to better inform and lessen undue concerns among health professionals and the public. • Obtain scientific data to support development of evidence based and cost-effective policies • Work collaboratively with the state wildlife/natural resources department to ascertain the degree of CWD surveillance within the state, conduct chronic wasting disease related education and consider other activities aimed at persons who hunt within the state and those who consume venison provided by hunters. • Work collaboratively with CDC and other sites funded for enhanced surveillance of CJD and other prion diseases. • Work collaboratively with the National Prion Disease Pathology Surveillance Center at Case Western Reserve University by maintaining regular contact including at least twice yearly phone or email contact. • Identify facilities within the state that are able to perform brain autopsy on persons suspected of or clinically diagnosed with a prion disease. • Develop relationships with the CJD Foundation or comparable patient groups to enhance collaborative work and to educate and provide assistance to family members of persons affected by prion diseases. Conduct outreach with hospitals and facilities that care for persons with prion disease to educate caregivers, including family members and medical personnel, about prion disease-related infection control issues and about the importance of prion disease surveillance and confirming clinically suspected cases. • Work collaboratively with pathologists, neurologists, funeral and mortuary directors, and other appropriate professionals within the state to ensure these professionals are aware of the state's prion disease surveillance system as well as the prion disease-related resources available to support them, including at CDC, the National Prion Disease Pathology Surveillance Center, the state health department and the CJD Foundation. • Disseminate data and information on human prion disease within the state (e.g., reports, workshops, grand rounds, etc.) • Education of infection control practitioners and other relevant staff at hospitals and other facilities about the importance of appropriate infection control regarding human prion diseases M: Rabies Surveillance Tier 1: Core Required Activities • Develop or improve electronic systems that facilitate real-time flow of results between local and state agencies responsible for managing suspect rabies exposure cases TX-DSHS-19-1309-A-000354 62 • Develop or improve electronic systems that facilitate electronic laboratory reporting based on standard message mapping guides for national notification of animal rabies • Improve sharing of laboratory data to help facilitate confirmatory testing of samples between state and federal laboratories • Improve real-time laboratory data sharing to facilitate coordination of rabies response activities between local, state, and federal agencies N: Parasitic Diseases Surveillance Tier 1: Core Activities • Training in use of diagnostic parasitology tools. • Expand surveillance for soil transmitted helminth infections • Maintain or improve the use of appropriate diagnostic parasitology tools for case detection, surveillance and outbreak investigations. I O: Enhanced Vaccine-Preventable Disease (VPD) • • • • • • • • • • • • • • Tier 1: Core Required Activities VPD surveillance coordinator will serve as the point of contact for VPDs and related conditions for which surveillance is conducted through NNDSS or the ELC Project O CoAg Collect case data on key and enhanced variables, as described in CDC guidance Provide surveillance data to support evaluations of public health response to meningococcal disease, as appropriate (e.g., risk factors for meningococcal disease, serogroup B meningococcal vaccine effectiveness, retrospective record review to identify cases among the same household) Ensure reporting sources follow jurisdiction requirements to inform state/local health departments of varicella outbreaks; for jurisdictions where varicella is not a reportable condition but outbreaks of all etiologies are reportable, processes should be put into place to facilitate reporting of varicella outbreaks Develop, implement, and maintain surveillance systems Evaluate and enhance surveillance systems based on CDC guidelines Conduct regular assessment of surveillance data and implement processes to improve completeness, timeliness, and quality of case data Facilitate coordination/exchange of surveillance data with CDC For each disease/condition, support maintenance of the availability of appropriate surveillance testing capacity (e.g., culture, serotyping/serogrouping, molecular sequencing) within jurisdiction public health laboratories, VPD Reference Centers (RCs), and/or CDC laboratories Implement a flexible plan for use and acquisition of laboratory supplies and testing that addresses changing needs/purposes for each disease/condition Collect isolates from confirmed and probable cases of meningococcal disease and test for serogroup and additional molecular characterization Support linkage of laboratory specimens, isolates, and results with epidemiologic and clinical case-patient data Coordinate activities to increase access to specimens and isolates so that laboratory data are available to inform surveillance activities Support and integrate epidemiology, laboratory, immunization, and health information activities TX-DSHS-19-1309-A-000355 63 • Support VPD surveillance through coordination between epidemiology, laboratory, immunization, and health information systems (e.g., NNDSS, IIS, electronic lab reports (ELR), electronic case reports (eCR), Health Level 7 (HL7) messages) to enhance use and exchange of electronic data files • Foster collaboration among city, county, state, federal, and other internal and external partners to improve outbreak and case-based reporting for VPDs and related conditions (e.g., AFM) • Engage and collaborate with stakeholders by providing surveillance data to inform and support policies and public health evaluations for VPDs and related conditions (e.g., AFM) • Communicate and coordinate with public health partners to ensure appropriate investigation, testing, and case-based reporting for VPDs and related conditions (e.g., AFM) Tier 2: Enhanced or Expanded Activities • Enhance surveillance for severe cases of varicella • Enhance pertussis surveillance • Enhance H. influenzae surveillance • Enhance IPD surveillance • Enhance measles surveillance • Enhance mumps surveillance • Enhance surveillance for other vaccine preventable diseases I P: Legionnaires’ Disease Prevention • • • • I • • • • • • • • • • • I • Tier 1: Core Required Activities Develop and implement a comprehensive, multi-disciplinary LD outbreak response protocol. Attempt to interview all suspect and confirmed legionellosis cases to obtain exposure information (e.g., using a form similar to the SLDSS Case Report Form or the RIBD MMG) Report all cases including exposure information to CDC via SLDSS (using a data extract, if possible) or an HL7-based reporting mechanism using the RIBD MMG Develop and implement an LD Primary Prevention Strategy Tier 2: Enhanced or Expanded Activities Develop an LD investigative team consisting of epidemiology, environmental health, and laboratory staff Participate in RIBD MMG transition Perform enhanced surveillance to improve capture of possible sources of exposure. Utilize software packages such as SaTScan for geospatial detection of LD clusters and outbreaks Operationalize clinical Polymerase Chain reaction (PCR) capacity at the state laboratory Become CDC Environmental Legionella Isolation Techniques Evaluation (ELITE) member laboratory Build internal capacity for analysis of Legionella whole genome sequencing Collaborate with hospital and clinical laboratory systems to increase number of respiratory specimens cultured for Legionella Develop and implement an LD Primary Prevention Strategy Evaluate uptake of WMPs in buildings at increased risk Prepare and distribute communication materials regarding programmatic activities to relevant audiences Tier 3: Advanced or Regional Activities Evaluate interventions resulting from outbreak investigations. For each investigation, identify and report: TX-DSHS-19-1309-A-000356 64 • Evaluate effectiveness of policies and public health approaches to the implementation of industry standards for primary prevention of LD Q: Influenza Surveillance and Diagnostic Testing • • • • • • • • • • • • • • • • I • • • Tier 1: Core Required Activities Use standard investigative tools (i.e. influenza-associated pediatric death and novel influenza A case report forms), data sharing tools, and methods Participate in influenza outbreak investigations and assist local jurisdictions in large, complex outbreaks Identify and maintain an influenza surveillance coordinator Recruit, retain, and encourage timely reporting from ILINet providers Develop, implement and maintain the components of the U.S. Influenza Surveillance System Collect, analyze, and disseminate influenza surveillance data Advance meaningful public health use of electronic health records, including exploring the availability and utility of existing sources of electronic influenza morbidity (including influenza hospitalization data) and mortality data Facilitate the improvement of influenza surveillance as recommended by the Council of State and Territorial Epidemiologists (CSTE) Utilize modern techniques for diagnosis (i.e. real-time RT-PCR) for typing and subtyping of influenza viruses, including detection of novel influenza viruses, year-round Identify and maintain a laboratorian who is proficient in influenza diagnostic testing (i.e. PCR methods for influenza virus detection, typing, and subtyping Continue to assess your capacity for achieving the guidance and goals within the Right Size Road Map by evaluating and updating your implementation plans for achieving the Right Size objectives. Maintain weekly reporting of influenza test results from the U.S. World Health Organization (WHO) collaborating laboratories in your jurisdiction Coordinate connections between epidemiology and laboratory functions, at state and local levels Implement and maintain electronic mechanisms for exchange of public health information, including the Public Health Laboratory Interoperability Project (PHLIP) system to transmit specimen-level data to CDC each week Foster general collaboration and relationship building among city, county, state, and federal partners and other external partners (e.g. CSTE, APHL) Coordinate epidemiologic services throughout the state, including developing a collaborating relationship between ELC and FluSurv-NET staff (if applicable) Tier 2: Enhanced or Expanded Activities Systematic surveillance sampling of patients meeting the ILI case definition and presenting to ILINet providers. Report level of care (inpatient or outpatient) for patients with specimens tested at the PHL. Estimate population served by ILINet providers. R: Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance I Tier 1: Core Activities TX-DSHS-19-1309-A-000357 65 • Perform diagnostic testing for non-influenza respiratory viruses in eligible ELC public health state and local laboratories • Increase or maintain the number of clinical laboratories that report respiratory virus laboratory results to CDC via the National Respiratory and Enteric Virus Surveillance System (NREVSS), either directly or by passthrough from local and state public health departments. • Establish or improve non-influenza respiratory virus surveillance • Assist CDC in investigations of deaths associated with RSV among children less than five years of age • Work with CDC to determine rates of RSV-associated ICU admissions for some or all ages in specific catchment areas • Report appropriate type-specific respiratory virus results from public health laboratories to CDC via the National Enterovirus Surveillance System (NESS) and/or the National Adenovirus Type Reporting System (NATRS) • Participate in respiratory illness outbreak investigations and assist local jurisdictions in outbreaks as needed. • Transmit information regarding non-influenza respiratory virus testing from public health laboratories to CDC via the Public Health Laboratory Interoperability Project (PHLIP) system, including clinical variables when feasible. • Collaborate with CDC to implement electronic data transfers from clinical or health department laboratories to CDC of respiratory virus laboratory results, including epidemiologic and clinical data when feasible such as age, specimen collection date, illness onset date, location, severity/outcome measures (e.g., hospitalization, ICU admission, death). S: Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity • • • • • • • • • • Tier 1: Core Required Activities Identify and maintain appropriate staffing. Maintain and update (as needed) local SURRG project protocols and IT systems to address clinic, laboratory, surveillance, investigation, and data management GC rapid detection and response activities. Robust collection of specimens for gonococcal culture and performance of AST Conduct timely GC culture and AST via Etest, and maintain associated data Ship GC isolates and transmit manifests to the appropriate Antibiotic Resistance Laboratory (ARLN) for confirmatory agar dilution AST and whole genome sequencing. Rapidly initiate SURRG case investigations on all patients with elevated ASTs Initiate SURRG investigations/partner services/epi investigations on at least an additional 12 seed index cases (with susceptible GC) in the jurisdiction (and their social contacts, sex partners, and sex partners of sex partners as per the SURRG Epi Investigation protocol). Conduct routine process and outcome evaluations on core clinic and laboratory activities (e.g. monitor implementation and success of specimen collection criteria for gonococcal culture and AST, transport time, or culture yield by anatomic site). Analyze program data for programmatic quality improvement efforts. Develop and implement a plan to conduct analyses on GC rapid detection and response epi investigation and partner services activities. These analyses should attempt to 1) document of the impact and value of TX-DSHS-19-1309-A-000358 66 conducting local partner services and outbreak response activities, and 2) improve local understanding of GC and resistant GC epidemiology and transmission dynamics. These analyses may include partner services metrics, network information, epi, clinical, AST and/or genomic data. • To inform and improve GC and ARGC prevention and control efforts more broadly, awardees are required to disseminate (through documentation and/or presentation) lessons learned, best practices, local protocols, or results of programmatic analyses. Tier 2: Enhanced or Expanded Activities • Community messaging, workforce development, and training related to rapid response to resistant GC • Evaluate routinely collected programmatic data related to test-of-cure among persons tested and treated for GC who return for a test-of-cure visits. I T: Gonococcal Isolate Surveillance Project (GISP) • • • • • • • • I • • • • Tier 1: Core Required Activities Identify one or more categorical STD clinics and a local public health laboratory in a jurisdiction that will execute the program activities and meet the project period outcomes Collect urethral N. gonorrhoeae isolates from the first 25 men with symptomatic gonococcal urethritis seen in the STD clinic each month Inoculate specimens for culture onto selective media at the STD clinic(s). Subculture gonococcal isolates from the selective primary medium to a non-inhibitory medium in the local public health laboratory, as described in the GISP protocol Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination Assign isolates an identifying number, freeze the isolates and ship them monthly to the assigned GISP regional Antimicrobial-Resistance Laboratory Network (ARLN) reference laboratory for antibiotic susceptibility testing Maintain and store duplicates of submitted isolates in the local public health laboratory Review antibiotic susceptibility test results received from the ARLN laboratory, describe the epidemiology of resistant N. gonorrhoeae in submitting jurisdictions, and use results to help inform patient management and local public health response Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols Tier 2: Enhanced or Expanded Activities Identify one or more categorical STD clinics in the jurisdiction and a local public health laboratory that will execute the program strategies and meet the project period outcomes Collect urethral swabs for Gram stain, gonococcal culture and urethral/urine specimens for nucleic acid amplification testing (NAAT) from the first 25 men presenting to the participating STD clinic(s) each month with symptomatic urethritis Collect pharyngeal and/or rectal swabs for culture and NAAT from patients (men or women) seen in the participating STD clinic(s) reporting pharyngeal and/or rectal exposure (e.g., men reporting oral sex or receptive anal sex) until 25 cases of gonococcal infection at extragenital sites are identified each month Collect cervical swabs for gonococcal culture and NAAT from women undergoing pelvic examinations with concerns of cervicitis, women with known exposures to a GC case and women with a positive NAAT result in TX-DSHS-19-1309-A-000359 67 • • • • • • • • • • • the participating STD clinic(s) until 25 cases of gonococcal genital infections in women are identified each month. A urine specimen for NAAT (rather than a swab) is acceptable Inoculate specimens for culture onto selective media at the STD clinic(s). Subculture gonococcal isolates from the selective primary media to a non-inhibitory medium in the local public health laboratory, as described in the eGISP protocol Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination Assign isolates a unique identifying number, freeze the isolates and ship them monthly to the assigned eGISP regional Antimicrobial-Resistance Laboratory Network (ARLN) reference laboratory for antibiotic susceptibility testing Ship isolates associated with positive gonorrhea NAAT results monthly to the assigned ARLN laboratory for antimicrobial susceptibility testing by agar dilution and possible molecular characterization (including whole genome sequencing) Review antibiotic susceptibility test results received from the ARLN laboratory, describe the epidemiology of resistant N. gonorrhoeae in submitting jurisdictions, and use results to help inform local public health response Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols Identify and maintain records of all urethral, pharyngeal, rectal, and cervical isolates that are suggestive of N. meningitidis Ship the identified presumed N. meningitidis isolates monthly directly to the CDC Meningitis Branch Laboratory in Atlanta, Georgia for antibiotic susceptibility testing, confirmatory identification, and molecular characterization (including whole genome sequencing Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination Review antibiotic susceptibility test results received from the CDC Meningitis Branch Laboratory, describe the epidemiology of N. meningitidis in urethral, pharyngeal, rectal and cervical isolates in their jurisdiction to help inform patient management and local public health response Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols U: Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks • • • • • Tier 1: Core Required Activities Engage in formative assessment of MSM populations and transgender women with particular attention to local epidemiology and behaviors, social context, service availability, and disease. Use network methodological techniques to describe networks seeded from STD clinic patients who are MSM or transgender women who have a recent history of HIV infection or syphilis, or who have a history of repeated syphilis infection. Assure the provision of interventions to identify candidates for PrEP/ART and assure linkage to PrEP services, as well as interventions to assure treatment for syphilis. Measure all costs related to identification of networks and implementation of network-level interventions Participate in discussions about common protocols and common data elements across grantees TX-DSHS-19-1309-A-000360 68 • Contribute data to inform models of transmission dynamics V: Human Papillomavirus Surveillance Among Men Tier 1: Core Required Activities • • • • • • • I • Identify participating health center/s Obtain anal specimens from sexually active young adult MSM (N>300 annually). Store and ship specimens to CDC for HPV testing Obtain relevant surveillance information for each specimen, including at a minimum: age in years, sex (e.g., current gender identity and sex assigned at birth), race/ethnicity, HPV vaccination status (e.g., number of doses administered, with dates and/or intervals), sexual orientation and/or sex of sex partners, number of lifetime sex partners, and HIV status. Line-listed de-identified demographic and clinical data elements associated with each specimen will be collected by the awardee and electronically submitted to CDC following standardized protocols. Coordinate submission of specimens and surveillance data to CDC for HPV testing and analysis. Collaborate with CDC to evaluate changes in HPV prevalence. Tier 2: Enhanced or Expanded Activities Collaborate with CDC to evaluate changes in HPV prevalence W: Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats • • • • • • • • • • Tier 1: Core Required Activities Identify personnel or contractual staff to function as a jurisdictional-level Coordinator who will track and report all follow-up information for infants born to women enrolled in the US Zika Pregnancy and Infant Registry or other surveillance systems for emerging treats. Coordinate with birth defects surveillance efforts, the investigation and reporting of possible congenital Zika virus infection and other congenital infection cases with severe clinical manifestations. Work with CDC to guide analytic direction and identify prenatal care facilities for prioritized assessments/response Identify and report all eligible cases that meet required case definition within 30 days of case identification Participate in the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry by collecting follow-up clinical data at designated time points for Registry-eligible pregnant women and infants. Develop, maintain and/or enhance surveillance systems for emerging infections For emerging infections, describe case inclusion criteria and preliminary case definitions for public health awareness and collaboration Analyze, prepare summaries of data (e.g., reports, maps, manuscripts, and presentations), and distribute to medical providers, public health partners, policy makers, and the public Coordinate connections between epidemiology and laboratory functions, at state and local levels Collaborate with the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry to leverage the existing infrastructure TX-DSHS-19-1309-A-000361 69 • Identify and connect with national/local partners to raise awareness and increase provider support and collaboration. Examples include, but are not limited to: professional societies, health care systems, health plans, schools/universities, and community interest groups • Implement and maintain electronic mechanisms for exchange of public health information • • Ensure surveillance systems are modernized and integrated when possible, and linked to mother-child health information is used to assess the impact of congenital infection • Participate collaboratively to development of best practices for preparing and responding to emerging threats to pregnant women and their infants • Participate collaboratively to disseminate information on protection of pregnant women and their infants from other emerging infectious diseases, and known health threats to pregnant women/infants such as CMV • Actively participate in the Data Use Working Group to communicate the public health message to protect mothers and babies • Participate in the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry by collecting follow-up clinical data at designated time points for Registry-eligible pregnant women and infants TX-DSHS-19-1309-A-000362 70 B. Program and Project Detailed Guidance Attachments This section of the NOFO contains the detailed guidance for each program and project, which details sub-activities, funding strategies other key criteria. Applicants should apply for programs and projects that will support identified infectious disease detection, prevention, and control needs in their jurisdictions. Applicants may apply to any program or project, depending on jurisdiction-specific needs. TX-DSHS-19-1309-A-000363 71 Section I: Cross-cutting Emerging Infectious Disease Capacity, Systems, and Leadership A: Cross-Cutting Epidemiology and Laboratory Capacity Program Activity Contact Information Angelica O’Connor; Email: apw1@cdc.gov Funding Opportunity Description Background a. Overview The Epidemiology and Laboratory Capacity for Prevention and Control of Infectious Diseases (ELC) Crosscutting Epidemiology and Laboratory program is intended to improve core capabilities of jurisdiction’s health departments. Not only does this flexible funding help meet health departments’ core public health needs but also supports unanticipated events that could require the redirection of resources to confront rapidly emergent situations. ELC enhances epidemiology and laboratory capacity by supporting personnel to help address capacity deficits, programmatic gaps, and support unanticipated events. Flexible funding has proven to be an effective model for strengthening epidemiology and laboratory capacity among health departments.1 b. Healthy People 2020 Public Health Infrastructure Objective 11: Increase the proportion of Tribal and State public health agencies that provide or assure comprehensive laboratory services to support essential public health services Public Health Infrastructure Objective 13: Increase the proportion of Tribal, State, and local public health agencies that provide or assure comprehensive epidemiology services to support essential public health services c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Federal resources provided for infectious diseases are often prescriptive, both in terms of the activities they fund and pathogens they target. Yet in many health departments, the core infrastructure in epidemiology, laboratory, and information systems is not robust or flexible enough to meet the challenges of emerging infections optimally. Adding to the complexity of each jurisdiction’s infrastructure, unanticipated events may occur that require shifting resources to respond to an emerging or re-emerging disease. To better meet each jurisdiction’s specific needs and to be able to transition quickly during unanticipated events, resources need to be allocated in a multi-categorical and flexible way so agencies are better able to address planned-for and unanticipated infectious disease public health threats. b. Purpose: The purpose of this Cross-Cutting Epidemiology and Laboratory Capacity program is to provide support to maintain and strengthen infectious disease epidemiology and laboratory capacity so that state public health 1 Chung, Christina; Fischer, Leah; O’Connor, Angelica; Shultz, Alvin; 2017 “CDC's "Flexible" Epidemiologist: A Strategy for Enhancing Health Department Infectious Disease Epidemiology Capacity.” Journal of Public Health Management and Practice. May/Jun;23(3):295-30.1 TX-DSHS-19-1309-A-000364 72 agencies can effectively respond, prevent and control known and emerging (or re-emerging) infectious diseases. This is intended to address activities for needs that do not clearly fall under specific disease components and/or are cross-cutting, including the basic ‘core’ elements of an epidemiology and laboratory program for emerging and re-emerging infectious diseases. c. Outcomes: • Effective public health workforce prepared to address infectious disease threats, including: o Improved workforce knowledge and skills regarding next-generation sequencing (NGS), bioinformatics, and other AMD technologies. o Improved NGS capacity in state and local health departments. • Timelier disease reporting, investigation and initiation of control measures of clusters and outbreaks of infectious diseases • More effective and targeted interventions to protect public from infectious disease • Improved use of data to inform public health response and practice, including program and policy development • Public health laboratories are addressing testing needs more efficiently • Improved efficiencies between laboratories and their networks, including use of public health resources Funding Strategy: In FY 2019, the ELC cooperative agreement has collapsed four separate projects (Cross-Cutting Epidemiology, Cross-Cutting Laboratory, Advanced Molecular Detection, and Public Health Laboratory Sustainability) from previous years into this one program. While the cross-cutting activities have been consolidated under one section, the budgets for the laboratory and epidemiology sections will remain separate to distinguish the unique fiscal needs of each. Cross-Cutting Epidemiology and Laboratory Funds should be used for personnel (i.e., multi-disease purpose ‘ELC Flexible Epidemiologist’, and/or ‘Laboratorian’), supplies, travel, systems (e.g. courier / lab networks), statistical software and other requisite support to build and/or maintain epidemiological and laboratory capacity within the jurisdiction. Requests for cross-cutting leadership, program management, finance, and epi/lab integration staff should be submitted under the ELC’s newly established “Leadership” project. Total availability of funds for cross-cutting epidemiology and laboratory: $22,100,000 • Approximate number of awards given: 64 • Approximate average per award: $345,313; 64 awards In addition to the above, there is a total of $3,500,000 to support: (1) Advanced Molecular Detection (AMD)related workforce development through training at the state and local level, (2) Bioinformatics support, and (3) support state and local health department initiatives to extend the use of AMD technologies. See below for details on the funding strategy for AMD related projects to be funded within ELC’s Cross-Cutting component. TX-DSHS-19-1309-A-000365 73 (1) AMD Workforce Development: Applicants applying should apply either to be a training “lead” or “participant”: • Training lead: Funds should be requested to cover the costs of the training plus any in-state travel expenses for trainers and participants. o Approximate number of awards: 7 o Approximate average per award: $20,000 to $150,000 • Training participant: Funds should be requested for travel and training registration (if applicable). Other costs with accompanying justification will be considered. o Approximate number of awards: 20 to 40 o Approximate average per award: $5,000 to $15,000 (2) Bioinformatics Resource Support Component: Funds should be requested for staff time (if the bioinformatician is on staff) or, if the health department is contracting with a university for bioinformatics consultation services, the costs of acquiring those services (i.e., the costs of the contract or whatever mechanism is being used); travel costs for work within the region; other costs associated with performing this function. • Approximate number of awards: 7 • Approximate average per award: $50,000 to $150,000 (3) AMD Capacity Component (i.e., extending the application of AMD technologies): • Approximate number of awards: 5 to 20 • Approximate average per award: $20,000 to 100,000 Strategies and Activities: I I. AREA A: SURVEILLANCE, DETECTION, AND RESPONSE Strategy 1a: Enhance Workforce Capacity a) Conduct needs assessments to identify gaps and/or training needs in epidemiology and laboratory activities ☒Required ☐Optional b) Develop and implement a training plan based on the findings from the needs assessment. ☒Required c) Enhance skills and maintain pace with novel laboratory and epidemiology techniques by participating in trainings or creating training opportunities for professional development (e.g., forums, seminars, workshops) for staff ☒Required d) ☐Optional ☐Optional Peer-to-Peer: Visit another ELC jurisdiction to facilitate knowledge sharing i. Train a member(s) of your staff by visiting and participating in public health activities with another ELC jurisdiction. Specifics are to be negotiated between the participating ELC TX-DSHS-19-1309-A-000366 74 ii. iii. II. a) b) recipients and may involve reciprocal arrangements where host jurisdictions would later be hosted (however, such an arrangement is not a requirement). The ELC program will try to facilitate match-making between recipients. Travel that is approved and funded by CDC will be considered a required activity. After the Peer-to-Peer visit is completed a final report, using the ELC template, shall be submitted to the ELC Project Officer. ☐Required ☒Optional ☒Required ☐Optional Strategy 1b: Enhance investigation and outbreak response Lead/assist in timely response to outbreak investigations Plan for/address surge capacity needs during outbreaks (e.g., establishing investigation teams and/or student workforce or cross training staff) ☒Required c) Develop, maintain and evaluate the use of communication protocols or guidelines for outbreak response and management ☒Required d) a) ☒Optional Improve coordination and exchange of surveillance data with other jurisdictions and partners ☐Required IV. ☒Optional Strategy 1c: Improve Surveillance and Reporting Improve use of surveillance data by implementing innovative methodologies (e.g., SaTScans , GIS, etc.) ☐Required b) ☐Optional Implement advanced technologies (e.g., AMD, SaTScans, GIS) for more thorough and accurate detection of infectious diseases ☐Required III. ☐Optional ☒Optional Strategy 1d: Strengthen laboratory testing for response a} Improve lab throughput, efficiency and proficiency by incorporating use of novel techniques for detection to expand capabilities and improve laboratory throughput, efficiency and proficiency. ☐Required ☒Optional TX-DSHS-19-1309-A-000367 75 V. a) Strategy 1f: Improve laboratory coordination and outreach to improve efficiency Develop, implement, review and maintain a plan or strategy for the optimal use of lab supplies and equipment that addresses flexible, changing, and multi-disease purpose needs. ☒Required b) Collaborate with clinical/private labs for surge, continuity of operations and CIDT issues. ☒Required c) ☐Optional Use analytical methods to enhance laboratory operational planning (e.g. Collecting and compiling data on resources needed for processing laboratory samples and estimating the cost2/quantify the costs required for processing specimens in different scenarios, using throughput and network models to understand and plan for surge). ☐Required d) ☐Optional ☒Optional Develop and enhance regional laboratory networks for service sharing. Required elements for those receiving funding, unless otherwise specified: i. Improve laboratory coordination and outreach/information flow ii. Share information and data on the test services and informatics capabilities of each PHL participating in a regional network through use of the Public Health Laboratory System Database at https://www.apl.org/programs/research/IRP/Pages/resources/aspx and the Informatics Self-Assessment Tool for Public Health Laboratories (Available at https://www.aphl.org/programs/informatics/Pages/Informatics-Self-Assessment-Tool.aspx) iii. With network partners, formulate a shared plan and support for developing regional testing capability, including, for example: • Identification of shared tests and other services between PHLs in the network [Required of the network collectively] • Development of supportive MOUs or other agreements [Optional for the collective network or subsets of member laboratories] • Development of capability to support region-wide surge and COOP plans as demonstrated by active test sharing and plans for additional sharing in emergencies [Optional for the collective network or subsets of member laboratories] • Sharing of training and other resources (e.g., clinical lab survey instruments, biosafety technical materials) that support any of the many functions of PHLs, including quality management systems, testing capabilities and capacity [Optional for the collective network] ☐Required ☒Optional Adhikari, Bishwa; Carias, Cristina; Washington, Michael; Kahn, Emily; Meltzer, Martin. “A tool to estimate the costs of processing and testing samples in a laboratory.” Last updated: April 10, 2018, Version 2.1. If you would like to access this tool, please send an email to vnn9@cdc.gov. 2 TX-DSHS-19-1309-A-000368 76 VI. a) Strategy 1a: AMD Enhanced & Regional Activities AMD Training Participant: i. Sending staff to be trained at in-person courses and workshops on NGS, bioinformatics, and/or other AMD-related activities. ii. Enabling staff to participate in webinars and other structured online content. iii. Participating in needs assessment of AMD workforce as requested by training labs. iv. Providing evaluation and feedback on training materials and content delivery. States and localities planning to send staff to participate in regional AMD trainings should apply for this section. * Regional training networks are consistent with the seven PulseNet regions ☐Required b) ☒Optional AMD Training Lead: i. Hosting new and existing trainings, collaborating with local or regional partners where possible. ii. Conducting training needs assessment before scheduling regional or local training. iii. Conducting training evaluations to measure impact of course(s) and perform continuous improvement of training program. iv. Coordinating training activities with regional training participants. ☐Required ☒Optional States and localities are encouraged to work with training participants within their region (see note below [*]), and other regional training leads to develop discrete local or regional training plans. Existing training networks (*) are encouraged to apply and are also encouraged to incorporate local or regional resources where possible. Collaboration with universities or other public or private institutions with NGS and bioinformatics capacity to develop trainings is encouraged. c) AMD Regional Bioinformatics i. Assist the regional training lead in developing and carrying out training. This may involve, for example, assisting in the development of web-based modules that could be used within the region or nationally ii. Consult with states and localities in the region on bioinformatics problems. This may involve, for example, performing ad hoc bioinformatics analysis for those states or localities or assisting a staff member in one of their laboratories in doing his or her own analysis. iii. Coordinate and communicate with regional training leads and participants for bioinformatics technical support iv. Consult with local or state IT departments regarding IT policies necessary to support AMD implementation. v. Work with states or localities to resolve IT problems that are limiting the use of AMD technologies. TX-DSHS-19-1309-A-000369 77 vi. vii. viii. Assist states and large localities in the region in bioinformatics analysis, either by assisting staff in those organizations or by performing the analysis themselves. Work with state labs and CDC to find sustainable, affordable solutions to state and local health department AMD-related informatics needs such as storage and cloud computing. Work with state and local health departments to promote data sharing (where needed and appropriate) ☐Required ☒Optional * Regional training networks are consistent with the seven PulseNet regions. The lab supporting either the regional training lead or regional bioinformatician for workforce development and bioinformatics resource components may be the same as or may be different from the PulseNet Area Lab servicing the region AREA B: PREVENTION AND INTERVENTION I VII. a) Strategy 2a: Implement public health interventions and tools Improve use and/or review of surveillance data for prevention and response (e.g. identifying risk populations to drive interventions, data quality checks, more robust analysis) ☒Required b) Implement evidence-based prevention tools and/or interventions (e.g., policy, engineering, service delivery, education, and/or communication campaigns) to achieve improved prevention practices and reduction of disease. i. Use surveillance data to identify at-risk populations requiring focused intervention ii. Incorporate social and behavioral science approaches in the development, delivery and evaluation of interventions iii. Engage community stakeholders with surveillance data to mobilize collaborative action toward prevention. ☐Required c) ☐Optional ☒Optional Conduct process and/or outcome evaluations of tools and/or interventions to understand whether intended outcomes and/or effects were achieved and identify opportunities for improvement. ☐Required ☒Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I VIII. a) Strategy 3a: Coordinate and engage with partners Foster collaboration among city, county, state and federal partners (e.g., workgroups) and other external partners for the purpose of improving outbreak response and management ☒Required ☐Optional TX-DSHS-19-1309-A-000370 78 b) Develop communication tools such as public websites that disseminate information regarding emerging and re-emerging disease threats ☐Required ☒Optional Collaborations a. With CDC-funded programs: Collaborations with other CDC funded programs is strongly encouraged, especially where this cross-cutting epidemiology project supports emerging disease-specific needs. b. With organizations external to CDC: N/A Target Populations: N/A Evaluation and Performance Measurement: I Tier 1 (Measures #1-7) I Tier 2 (Measures #8-9) 1. Number of ELC-funded epidemiologists and laboratorians in your jurisdiction that are able to work across areas of infectious disease 2. Top training needs among jurisdictions and those that have been addressed 3. Percentage of reports of selected reportable diseases received by a public health agency within the awardee-required timeframe (PHEP 13.1) 4. Percentage of reports of selected reportable diseases for which initial public health control measure(s) were initiated within the appropriate timeframe (PHEP 13.2) 5. Number of outbreaks investigated by ELC-funded personnel by proportion and type 6. Epidemiology and laboratory coordination – TBD 7. AMD implementation - TBD 8. 9. I Peer-2-Peer Site Visit Report Programs, policies or interventions implemented that were informed by surveillance data Tier 3 (Measures #10-14) 10. Number of newly shared testing services, activities, or resources, by network member labs in existing shared testing services, activities, or resources (if participating in the laboratory network activity) 11. Workforce Development: Training Lead a. Number of individuals participating in AMD Regional Training events b. Number of trainings presented (in-person, web-based, or 1-on-1 consultations) c. Percentage training evaluations completed within the training region 12. Workforce Development: Training Participant a. Percentage of staff who completed AMD regional training or other AMD related trainings b. Percentage of staff trained to perform bioinformatics/ NGS data analysis techniques c. Percentage of staff able to perform bioinformatics/ NGS data analysis d. Number of AMD trainings attended (in-person, web-based, or 1-on-1 consultations with regional AMD Training Lead) TX-DSHS-19-1309-A-000371 79 13. 14. Bioinformatics Resource Support Lead a. Percentage of staff who completed AMD regional training or other AMD related trainings b. Percentage of staff trained to perform bioinformatics/ NGS data analysis techniques c. Percentage of staff able to perform bioinformatics/ NGS data analysis i. Number of AMD trainings attended (in-person, web-based, or 1-on-1 consultations with regional AMD Training Lead) AMD Capacity Building a. Number and proportion of applicants with at least one MiSeq sequencer b. Number and proportion of applicants who are actively applying next-generation sequencing to the following public health priorities: i. Bacterial foodborne illness (i.e., through PulseNet) ii. Antimicrobial-resistant hospital-acquired pathogens (such as CRE) iii. Influenza iv. Hepatitis C (i.e., by means of the GHOST system) v. Legionella vi. Streptococcal pathogens vii. Mycobacterium tuberculosis TX-DSHS-19-1309-A-000372 80 B: ELC Leadership, Management and Administration Program Activity Contact Information Angelica O’Connor; Email: apw1@cdc.gov Funding Opportunity Description Background a. Overview The Epidemiology and Laboratory Capacity for the Prevention and Control of Infectious Diseases (ELC) Cooperative Agreement has grown enormously since 1995 when it was first enacted with eight jurisdictions, $2 million and a single project. Today’s ELC annually awards between $200 and $300 million, has 64 jurisdictions and comprises many different categorical and cross-cutting programs, projects and activities. Through the years, the ELC has become a more integral and visible part of health departments’ infectious disease-related activities. However, with greater resources and opportunities, also comes challenges in the areas of leadership, management and administration of the health departments’ ELC and program-related activities. As we head into a new 5-year ELC NOFO cycle, this ELC Leadership initiative is intended to strategically provide health departments dedicated resources to optimize their ELC program through enhanced leadership and coordination. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Management of the ELC Cooperative Agreement is a challenging task that requires careful attention to detail and coordination across numerous branches within each health department; including epidemiology, environmental, laboratory and health information systems. This management also requires knowledge of technical, administrative and financial elements – some of which may be outside the expertise of senior program staff. In addition, this new 5-year NOFO includes opportunities to engage in robust public health programs to address several emerging infectious disease areas. To be effective in establishing these new initiatives, recipients will need clear and ongoing leadership engagement across their health departments. b. Purpose: The purpose of this section is to provide health departments with dedicated resources to assist in the leadership, management, coordination and administration of their ELC Cooperative Agreements. c. Outcomes: • Enhanced emerging infectious disease programs in the areas of food- and water-borne disease, healthcare acquired infections and antibiotic resistance, and vector-borne diseases. • Enhanced coordination across ELC, including integration of epidemiology laboratory and health informatics activities. • Improved health department leadership’s understanding and management of ELC portfolio. • Reduction in unspent funding through appropriate fiscal management by health departments to support public health activities as proposed. TX-DSHS-19-1309-A-000373 81 • Better visibility of impact and success of ELC funded activities at the state and local level. Funding Strategy: The resources available in this section should be used primarily for staff (this could include staff secured through contracts) and associated supplies and travel that are directly related to improving the integration, coordination, and fiscally-responsible management of the ELC program. As a new ELC initiative, it is hoped that the initiative will grow over time. In this first year, it is not anticipated that ELC will have the budget to provide a resource for every health department, but through demonstrated success and impact, increased support is a goal. Very large health departments might be able to make an effective case for multiple resources (e.g. an ELC Program Manager and a Financial administrator) while smaller health departments might want to focus on their most critical areas of need (e.g. internal coordination, project management, financial management, etc.) • Estimated total availability of funds: $8 to $11 million • Estimated number of awards given: 40 - 50 • Estimated average per award: $50,000 - $300,000 Strategies and Activities: I I. AREA A: SURVEILLANCE, DETECTION, AND RESPONSE Improve Health Department’s ELC Leadership, Management and Administration a) Manage ELC activities across all ELC programs and projects i. Further enhance work with health department staff to develop activities within the ELC scope (with special focus on ELC programs such as cross-cutting, foodborne, HAI/AR and vectorborne); monitor implementation and effectiveness of ELC activities and work with CDC to overcome barriers and challenges occurring during implementation of activities. ii. Participate in Annual Meetings: Attend ELC annual meeting(s) (for epidemiology, laboratory, health informatics and finance staff); and ensure that attendees disseminate pertinent information to others in their jurisdictions who were unable to attend. iii. Develop and maintain succession and sustainability planning (especially with respect to staff) for the continuation and improvement of ELC activities ☒Required b) ☐Optional Actively plan, coordinate and implement ELC activities across epidemiology, laboratory and health informatics interests at health department and within jurisdiction i. Actively seek (through perhaps an epi-lab liaison position) to coordinate ELC activities and data/information pertinent to health department’s mission with respect to infectious diseases. ii. Identify barriers impacting epi / lab integration and develop a plan and timeline for mitigating barriers iii. Enhanced coordination of ELC-related activities with local health departments within jurisdiction (including tribal governments), including identifying and requesting resources for local needs. TX-DSHS-19-1309-A-000374 82 ☒Required c) ☐Optional Manage financial aspects of ELC Cooperative Agreements, including resource tracking and spending ☒Required ☐Optional Collaborations: a. With CDC funded programs: Activities within this section should be coordinated with other CDC programs that support infectious diseaserelated activities at local health departments. Important programs include CDC’s Emerging Infections Program (EIP) and the Public Health Emergency Preparedness Cooperative Agreement (PHEP). b. With organizations external to CDC: Local health departments and other public health concerns (e.g. hospitals, vector control districts, etc.) within the jurisdiction’s boundaries; other local and state health departments outside of jurisdiction’s boundaries; tribes and/or tribal organizations. Target Populations: N/A Evaluation and Performance Measurement: Awardees are required to demonstrate that measurable progress is being made throughout the project period and share this progress in workgroup and partner conference calls. To indicate progress made toward program outcomes, data will be reported through: • Bimonthly (every two months) conference calls • Bimonthly (every two months) written updates to submitted via email prior to conference calls • Performance Measures for Tier 1 activities Measure #1 Outcome: Reduction in the percentage of unspent funds by health departments for ELC intended public health purposes I Measure: Unobligated funding identified on grantees Annual Federal Financial Report (FFR) Measure #2 Outcome: Improved ELC program management, coordination, and implementation of ELC activities I Measure: Quantitative or Qualitative scores on annual ELC technical reviews Measure: Number and proportion of Cross-cutting Epidemiology and Laboratory program activities on track as recorded on ELC’s monitoring portal (REDCap based) TX-DSHS-19-1309-A-000375 83 C: Health Information Systems Capacity Program Activity Contact Information Jason Hall, ELC Informatics Subject Matter Expert (404) 639-7884 Michele Hoover, Lead Public Health Advisor (404) 498-2705 Funding Opportunity Description Background a. Overview Data are foundational to every public health decision and enable the prevention, detection, and response to health threats. In our current world, data are also ubiquitous, with a growing volume and variety of data sources from both within and outside of traditional health partners. Public health has a unique opportunity to harness these data to make more timely and insight-driven decisions to inform their programs, policies, and investments, but requires robust health information systems infrastructure. b. Healthy People 2020 Healthy People 2020 Health Communication and Health Information Technology topic area c. Other National Public Health Priorities and Strategies These activities are aligned with CDC’s public health data strategy and IT transformation efforts. These efforts include components focused on expanding core data, informatics, and IT capacity; advancing interoperable systems and tools; and strengthening and expanding collaboration with and support for partners. These activities also complement the Centers for Medicare & Medicaid Services Promoting Interoperability (PI) Programs focused on increased accessibility and improved facilitation of data exchange between providers and patients (https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHrIncentivePrograms/). CDC Project Description a. Problem Statement: State and local public health agencies require standardized processes and interoperable systems to access the timely, high quality data that are critical to carrying out key public health functions. However, many are faced with challenges in building the health information systems capacity needed to produce, transmit, manage, and analyze these data in an efficient way. For instance, clinical and laboratory partners often exchange data that are not standardized or via labor-intensive, paper- based methods. In addition, in many jurisdictions, the systems for analyzing and sharing these data are stand-alone, outdated, or functionally deficient. b. Purpose: The purpose of the Cross-Cutting Health Information Systems (HIS) Capacity program is to provide jurisdictions the support to maintain, improve, and modernize health information systems infrastructure. Improvements should be forward-thinking and strategic, advancing standards-based electronic data exchange, increasing interoperability, and sustaining and enhancing integrated surveillance information systems. c. Outcomes: Mid-Term Outcomes: • Improved surveillance • Improved completeness of data • Improved timeliness of reporting TX-DSHS-19-1309-A-000376 84 • • • Increased distribution and use of data to public health partners Infectious disease data are automated and efficient Electronic mechanisms for data exchange are in place Long-Term Outcomes: • More efficient and accurate public health reporting • More rapid detection of cases and outbreaks • Improved use of data to • Inform public health response and control • Improve public health practice • Inform program and policy development • Develop and implement public health best practices and or guidelines Funding Strategy: Funds should be utilized for personnel, travel, supplies, equipment, or contractual support for proposed activities. • • • Estimated total availability of funds: $32,000,000 Estimated number of awards given: 64 Estimated average per award: $500,000 Distribution of funding for each activity will be dependent on jurisdictional needs, the quality and composition of the application, prior performance, as well as the availability of funds and agency priorities. Funding allocations will be discussed and clarified during the annual grantee meeting. Note that funding for systems development or acquisition costs may not be available through ELC. Funded jurisdictions are expected to adhere to the requirements of the cooperative agreement (see the CDC Project Description Section (Part II, #2, above). For HIS this includes: • Identifying a designated person with overall responsibility for HIS activities as well as personnel responsible for each activity; • Participating in a Technical Assistance (TA) consultation assessment to identify annual TA priorities (jurisdictions may also request EDX Technical assistance at EDX@cdc.gov if needed throughout the project period); • Participating in ELC HIS implementation, support, and monitoring efforts; • Working with CDC to measure key aspects of implementation (e.g., reporting the percent of lab report volume received through ELR at least once during the project period); and • Participating in efforts to define consistent ways to link surveillance data to laboratory findings from public health labs and CDC labs for all conditions. Strategies and Activities: I AREA A: SURVEILLANCE, DETECTION, AND RESPONSE TX-DSHS-19-1309-A-000377 85 I. a) Strategy 1h: Advance Electronic Data Exchange- Public health agencies receive data from and transmit data to many different stakeholders, including laboratories, healthcare, and CDC. This strategy is focused on standardizing and optimizing the exchange of data among these various entities Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. i. (Required) Maintain existing ELR transmissions ii. (Required for jurisdictions below 75%) Increase ELR - propose and execute a plan to increase the volume and percentage of lab reports received through ELR over the next year iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way (vs. re-keying or manually uploaded). iv. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc. and provide feedback to reporting facilities. ☒Required b) Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (a) Extract, translate and transmit the data for conditions contained in 5 additional finalized HL7 Nationally Notifiable Message Mapping Guides (see https://wwwn.cdc.gov/nndss/case- notification/message-mapping-guides.html for final MMGs) using the new HL7 case notification structure and retire the corresponding legacy formatted transmissions. (b) Use the CDC NNDSS onboarding process (see https://www.cdc.gov/nmi/tatrc/index.html) to receive approval for the new HL7-based case notifications before production transmissions are initiated or legacy transmissions are retired (for additional information please see NMI Technical Assistance and Training Resource Center at https://www.cdc.gov/nmi/ta-trc/index.html). ☒Required c) ☐Optional ☐Optional Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. i. Increase coverage and number of facilities submitting syndromic surveillance data to the BioSense Platform according to jurisdictional needs (a) (Required for any jurisdiction applying for Syndromic Surveillance funding) Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED) and urgent care facilities with messages that include the NSSP priority 1 and 2 data elements. TX-DSHS-19-1309-A-000378 86 ii. iii. iv. v. (Required for any jurisdiction applying for Syndromic Surveillance funding) Participate in the NSSP Community of Practice and other efforts to strengthen syndromic surveillance practice and use. This may include participation in meetings, workshops, and trainings; development of collaborative projects; increase use cases and practical applications by public health programs; share lessons learned and best practices, and providing feedback on the BioSense Platform. (a) Develop or enhance data quality control and assurance processes (b) Enhance timeliness of messages sent to jurisdiction systems and to NSSP BioSense Platform. Enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements. Develop or enhance syndrome monitoring and response protocols. Develop at least two collaborative projects (one with a CDC program) where syndromic surveillance can be used to address health department surveillance data needs. Projects done in collaboration with CDC should include sharing the syndromic data with the CDC program through the BioSense Platform. ☐Required d) Advance electronic data exchange for Public Health Laboratories. i. Create and send ELR based on Promoting Interoperability (formerly Meaningful Use (MU)) standards for all reportable conditions to or within the public health department. ii. Map local test, result, and specimen source codes to LOINC and SNOMED standards. iii. Establish electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. ☐Required e) ☒Optional ☒Optional Advance electronic information exchange between electronic health records and public health. i. Implement electronic case reporting (eCR) (a) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for conditions published in the Reportable Condition Trigger Tables (available at https://phinvads.cdc.gov/vads/SearchVocab.action) and use RCKMS for public health reporting decision support. (b) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for Chlamydia and Gonorrhea. Technical guidance on electronic case reporting for Gonorrhea and Chlamydia is available in a document named “Advancing ECR of STIs: Technical Guidance for Public Health Departments” (available at https://www.phii.org/ECR-STI-report). This document allows jurisdictions to choose different technical architecture of implementation while providing consistent guidance on the science of STI reporting. TX-DSHS-19-1309-A-000379 87 ii. iii. Participate in national efforts by engaging in the: 1) discussion and development of eCR standards by participating in the HL7 Public Health Working Group; and 2) development and updates to default reporting specifications and trigger codes by participating in the CSTE RCKMS vetting process Participate in the Reportable Conditions Knowledge Management System (RCKMS) to author jurisdictional reporting criteria and maintain reporting specifications ☐Required f) Advance electronic information exchange between jurisdictions. i. Create the capacity to transfer ELR messages and eCR messages between jurisdictions. These transfers refer to the electronic sending of ELR and case data between two jurisdictions for a lab report or a case that was reported to one jurisdiction but belongs to another jurisdiction ☐Required II. a) b) c) ☒Optional ☒Optional Strategy 1i: Sustain and enhance information systems- This strategy is focused on ensuring the information systems used to store and manage public health data are maintained and enhanced. Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. ☒Required ☐Optional ☐Required ☒Optional Implement (if appropriate) new/replacement information systems. Enhance existing information system(s) by adding or improving functionality. Prioritized enhancements are listed below, but other enhancements may be requested. i. Integrated surveillance information system: (a) Enhance systems to enable the automated processing and use of eCR (and if desired, Reportability Response) documents. (b) Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. (c) Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. If using a standalone CS database, migrate CS surveillance into an existing integrated information system. States using NBS version 5.3 or newer should use CS module available within the system. (d) Enhance systems to enable the automated processing and use of ELR, including complete susceptibility findings. ii. LIMS TX-DSHS-19-1309-A-000380 88 iii. (a) Enhance system to enable the automated processing and use of HL7 electronic test orders. (b) Consult with CDC to evaluate options for implementing and integrating a web portal to support electronic test ordering and reporting (ETOR). Syndromic surveillance information system (a) Explore, evaluate, and incorporate new data sources at your jurisdiction that can enhance syndromic surveillance. ☐Required d) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Illustrate projects: i. Enable lab-epi collaboration by identifying and implementing a universal case identifier (or similar linking variable) to include with laboratory and case data transmission (e.g., patient identifier that links data from health systems; identifier to link PulseNet data to case reports). ii. Develop systems or tools for public release of public health data. iii. Explore the efficiencies of moving an existing or new information system to a cloudbased/hosted environment. iv. Identify software or platforms that enable the integration and visualization of surveillance and laboratory data. v. Identify solutions to integrate AMD data with surveillance data for analysis or visualization. ☐Required e) ☒Optional ☒Optional Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. i. Implement management and analytic software ii. Increase network bandwidth and computing power and/or use cloud infrastructure to support AMD initiatives ☐Required ☒Optional Collaborations: a. With CDC funded programs: Recipients are expected to coordinate with others across their agency and local health departments in the planning, execution, and management of activities under this ELC program with related efforts funded through the Public Health Emergency Preparedness (PHEP) cooperative agreement and through categorical cooperative agreements (e.g., STD, HIV/AIDS, TB). b. With organizations external to CDC: Recipients are encouraged to participate with CDC and its partners in planning, development, implementation, and assessment efforts related to electronic data exchange and integrated surveillance systems. These partners include, among others, the Association of State and Territorial Health Officials (ASTHO), Council of TX-DSHS-19-1309-A-000381 89 State and Territorial Epidemiologists (CSTE), Association of Public Health Laboratories (APHL), the National Association of County and City Health Officials (NACCHO), the Public Health Informatics Institute (PHII), and the International Society for Disease Surveillance (ISDS). Target Populations: N/A Evaluation and Performance Measurement: Measures Data will be measured and reported quarterly on the ELC Health Information Systems Implementation Support and Monitoring calls, where progress made on recipient activities and toward program outcomes will be monitored and discussed. • • • • • Percent of lab report volume received through ELR Number of hospitals and public health labs with established electronic test ordering and reporting (ETOR) Percent of conditions for both state and nationally notifiable conditions that use HL7 format Percent of emergency departments (EDs) sending HL7 Promoting Interoperability (formerly MU) compliant syndromic surveillance messages to the health department and BioSense Platform Percentage of STD case investigations (e.g., Chlamydia, Gonorrhea) auto-created from ELR. TX-DSHS-19-1309-A-000382 90 D: Impact and Evaluation Program Activity Contact Information Christina Chung, cchung@cdc.gov and Martin Meltzer, qzm4@cdc.gov Funding Opportunity Description Background a. Overview The overall goal of this ELC funding is to support projects that use quantitative analytic methods to assess the cost-effectiveness and impact of ELC-funded activities on the transmission of infectious diseases. This project will also help to build capacity for these types of evaluations in state and local health departments. Ultimately, results from these assessments may be used to set priorities in the development and implementation of program strategies and activities; and make informed decisions about future program and policy development. b. Healthy People 2020 Public Health Infrastructure Goal: To ensure that Federal, State, Tribal, and local health agencies have the necessary infrastructure to effectively provide essential public health services. c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Impact evaluation is a critical component to understanding outcomes related to public health actions. Across jurisdictions, public health agencies often lack the capacity to perform impact evaluation activities (and evaluation activities in general), with resources notably absent in the area of infectious diseases. Data from CSTE’s Epidemiology Capacity Assessments suggests that among epidemiologists working at state health departments, the ability to ensure and assist in evaluation of programs, as well as develop program logic models and theories of action, are low. Limited impact evaluation capacity across jurisdictions in infectious disease programs limits CDC’s and awardees’ ability to articulate the importance of the public health sector, including the understanding of the effectiveness of ELC activities and strategies and opportunities to improve their implementation. b. Purpose: The main purpose of this funding will be to conduct impact and cost-effectiveness evaluations of ELC activities to illustrate quantitative impact (e.g. illnesses/hospitalizations averted, lives saved, etc.) to the public, policy makers and government leadership. Conducting these evaluations will also build capacity to assess impact and cost-effectiveness. Finally, these evaluations will help the public health sector collect information to improve the practice and demonstrate the effectiveness of ELC-funded strategies and activities. c. Outcomes: • Provide better demonstration of the public health impact of ELC-funded activities at the state and local level. • Provide evidence for making more informed decisions about public health infectious disease activities. • Develop independent state and local leadership capacity to conduct quantitative impact evaluations of infectious disease public health interventions. TX-DSHS-19-1309-A-000383 91 Funding Strategy: Funds should be used to hire a project manager to coordinate this activity. With technical assistance from CDC’s Health Economics and Modeling Unit and ELC evaluation specialists, the project manager’s job duties will include data collection and analysis, report writing, and presenting results to non-technical audiences as described in section I.a. below. In addition to staff, funding may be used to support trainings, supplies, travel, and other requisite support to implement cost-effectiveness evaluation projects and build impact evaluation capacity within the jurisdiction. The first year of the project will focus on precisely specifying the evaluation question(s) the recipient will analyze, and should include collecting baseline information (e.g. cost of outbreak response) that will be used later in the analysis. The first year will also focus on workforce development to build state and local capacity for quantitative analysis of impact. • Estimated total availability of funds: $600,000 • Estimated number of awards given: 5 • Estimated average per award: $120,000 Strategies and Activities: AREA B: Prevention and Intervention Strategies I I. a) Strategy 2a: Implement public health interventions and tools Conduct cost-effectiveness and/or public health impact evaluations (in coordination with CDC) associated with ELC-funded activities. i. Develop a specific analytic proposal (a) Identify the area to be evaluated with the outcomes (i.e. cases, hospitalizations, deaths averted) of interest, and frame in terms of a specific analytic question. (b) Identify the primary audience/purpose of the evaluation. (c) Identify the appropriate methods to answer the specific analytic question. (d) Identify the data needed to answer the evaluation question (e.g., epidemiologic data, cost data, data about implementation of the activities chosen for evaluation). ii. Develop impact and cost-effectiveness analytic skills through attending trainings in quantitative data analysis and cost-effectiveness methods. iii. Collect the data identified in the analytic proposal. iv. In collaboration, develop a tool and conduct the analysis outlined in the proposal. v. Develop a report/policy brief/document outlining the results and implications of the analysis ☒Required ☐Optional Collaborations: a. With CDC funded programs: CDC’s expectation is that the awardees will continually engage and work with CDC (specifically CDC’s Health Economics and Modelling Unit and ELC’s Evaluation Specialists) during the implementation of the project. The TX-DSHS-19-1309-A-000384 92 ELC program intends to provide both in-person and virtual technical assistance. The awardee will participate on quarterly, at the minimum, group check-in calls and discussions with other awardees. b. With organizations external to CDC: Optional. When appropriate, recipients are encouraged to collaborate with others to conduct evaluation activities. Possible partners could be located within health departments, academia, or agencies within the community. If chosen, applicant must provide evidence of prior collaborations with such groups and describe the organization’s role in achieving project outcomes, and how the applicant will interact with the program in specific terms. Prior achievements and evidence may be provided as an MOU, MOA, or letters of support. Target Populations: N/A Evaluation and Performance Measurement: Awardees are required to demonstrate that measurable progress is being made throughout the project period and share this progress in workgroup and partner conference calls. To indicate progress made toward program outcomes, data will be reported through: • Bimonthly (every two months) conference calls • Bimonthly (every two months) written updates to submitted via email prior to conference calls • Performance Measures for Tier 1 activities The recipient will be expected to develop a report/policy brief/document outlining the results and implications of the analysis. TX-DSHS-19-1309-A-000385 93 E: Cross-Cutting Emerging Issues: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Program Activity Contact Information Angelica O’Connor; Email: apw1@cdc.gov Funding Opportunity Description Background a. Overview The CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core capacity needed to respond to a variety of emerging infectious diseases. This includes the potential provision of additional funding to increase epidemiology, laboratory and health IT support to meet needs during a local, regional or national infectious disease emergency. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: If the factors giving rise to infectious disease emergencies could be predicted, then those associated emergencies might never occur. Nonetheless, the world of public health is in some state of preparedness or preparation for a variety of outbreaks such as threats related to novel influenza A, expanding arboviral disease vectors, foodborne pathogens, etc. Other types of outbreaks (e.g., SARS in 2002/2003 and fungal meningitis in 2012) may be far less anticipated. However, one commonality between most disease threats is resources available to mitigate them often only become available after the outbreak event occurs and becomes a public health emergency. Due to the unpredictable nature of these infectious disease emergencies and the lag in resources, jurisdictions need a ready mechanism to provide support for a range of infectious disease threats. b. Purpose: This potential funding is envisioned to provide additional laboratory, epidemiologic and/or health information systems surge capacity necessary for enhanced surveillance due to factors such as technology change and expanding disease boundaries or surge and response efforts associated with new or emerging infections including outbreak scenarios. c. Outcomes: State and local health departments better prepared to respond to new surveillance and response needs (including outbreaks) with more timely and efficient efforts for detection, investigation and implementation of control measures. Funding Strategy: Funding may be requested to support (depending on baseline capacity) temporary personnel, additional laboratory or office supplies, specimen shipping costs, and any other supplies needed for an effective response to an emergency or disease threat. Funds may be available on the condition of a local or national disease threat. Please request and have a plan for approximately $500,000 per jurisdiction (small jurisdictions TX-DSHS-19-1309-A-000386 94 may request less while very large jurisdictions may request more). Activities in this section will only be funded should conditions warrant, should funds become available. Applicants should limit their response to no more than one page. Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation response and reporting Depending upon current baseline capacity, conduct specimen collection, shipping, case/contact/control interviews and medical record review, and transmit results to CDC to enhance the ability to rapidly respond to outbreaks. ☐Required II. a) Strategy 1d: Strengthen laboratory testing for response Depending upon current baseline capacity, enhance the ability of the laboratory to rapidly respond to outbreaks. ☐Required III. a) ☒Optional ☒Optional Strategy 1j: Maintain and enhance integrated surveillance information Depending upon current baseline capacity, enhance the ability of the health information system to rapidly respond to outbreaks. ☐Required ☒Optional Collaborations: a. With CDC funded programs: Depending on the specifics of the disease threat, jurisdictions are encouraged to work with respective CDC programs if technical assistance is needed. With organizations external to CDC: b. With organizations external to CDC N/A Target Populations: N/A Evaluation and Performance Measurement: Report describing how resources awarded were used to mitigate the disease threat, including activities that were conducted that otherwise would not have been (or conducted faster/more completely). TX-DSHS-19-1309-A-000387 95 Section II: Emerging Infectious Disease Programs F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention Program Activity Contact Information N/A Funding Opportunity Description Background a. Overview This program of the Division of Foodborne, Waterborne, and Environmental Diseases, in collaboration with the Division of Viral Diseases and the Division of Parasitic Diseases and Malaria, aims to protect public health through the prevention and control of disease, disability, and death caused by foodborne, enteric, waterborne, and environmentally transmitted infections. This section describes the activities necessary for a comprehensive program in a jurisdiction for the detection, investigation and response, reporting, and prevention of illnesses and outbreaks. This template section is divided into three tiers. Tier 1 strategies and activities cover general surveillance, detection, and response; prevention and intervention; and communications and partnerships. Tier 1 activities apply to nationally notifiable diseases as well as conditions related to food, water, zoonotic, other enteric, and environmental transmission (See Project F Appendix 1). Tier 2 strategies and activities include expanded capacity for specific components of surveillance, investigation, and response. These activities are essential to understand and respond to changes in testing practices; identifying sources of sporadic enteric disease; developing or improving new methods for outbreak detection and response; and improving overall capacity for outbreak detection and response. Tier 3 includes activities for the Integrated Food Safety Centers of Excellence. All Tier 1 activities must be addressed before applying for additional funds under Tier 2. The program/project areas under each tier are briefly described below. Tier 1 includes (but activities are not limited to) the following programs. Programs listed may contain both epidemiologic and laboratory components: CaliciNet: A network of federal, state, and local public health laboratories established to capture norovirus genotyping data from outbreaks, which can link geographically different clusters of illness to a common source, e.g., foodborne outbreak National Antimicrobial Resistance Monitoring System (NARMS): A national public health surveillance system that tracks antimicrobial resistance in foodborne and other enteric bacteria. The goal of NARMS program is to help protect public health by providing information about emerging bacterial resistance, the ways in which resistance is spread, and how resistant infections differ from susceptible infections. National Case Surveillance: Collects data from all states on infections due to nationally notifiable diseases as well as conditions related to nationally notifiable foodborne, waterborne, and environmentally transmitted diseases. Information is gathered from both “laboratory-based” and “case-based” surveillance systems. TX-DSHS-19-1309-A-000388 96 National Outbreak Reporting System (NORS): National Outbreak Reporting System (NORS) captures all reports of enteric disease outbreaks caused by bacterial, viral, parasitic, chemical, toxin, and unknown agents, as well as foodborne and waterborne outbreaks of non-enteric disease. OutbreakNet: Provides basic epidemiologic support nationally PulseNet: National laboratory network that connects foodborne illness cases to detect outbreaks. PulseNet uses DNA fingerprinting, from pulsed-field gel electrophoresis and whole genome sequencing, of bacteria making people sick, to detect thousands of local and multistate outbreaks. Tier 2 includes the following enhanced programs: While any Tier 2 section is optional for applicants, if a jurisdiction is applying for a Tier 2 project then all the activities within that project are required. CryptoNet and CryptoNet Regional Labs: CryptoNet is an enhanced surveillance program that tracks cryptosporidiosis by regular analysis of merged traditional epidemiology data and subtyping data. Cryptosporidiosis subtyping surveillance is conducted using CryptoNet protocols and will use PulseNet infrastructure to support advancement. Regional labs provide support to participants in their region with troubleshooting, surge capacity for subtyping, and training of laboratory and analysis methods. Cyclospora genotyping: Amplicon-based multilocus sequence typing approach to provide genotyping information for Cyclospora cayetanensis. FoodCORE: FoodCORE is comprised of 10 centers that work together to develop new and better methods to detect, investigate, respond to, and control multistate outbreaks of foodborne diseases. FoodCORE provides support to improve laboratory, epidemiologic, and environmental health capacity. FoodNet: FoodNet conducts active surveillance in 10 sites aimed at reducing morbidity and mortality due to diseases commonly transmitted by food and understanding sources of these infections. FoodNet goals are to provide the knowledge base to inform national level surveillance and antimicrobial resistance as well as evaluate effectiveness of regulations and interventions aimed at reducing the burden of select foodborne illnesses. NoroSTAT: A network of sentinel states tasked with improving the timeliness and completeness of reported norovirus outbreaks due to all modes of transmission. National Respiratory and Enteric Virus Surveillance System (NREVSS) Enhanced: NREVSS Enhanced Conducts clinical laboratory-based norovirus surveillance to track endemic norovirus disease and circulating strains. One Health Harmful Algal Bloom System (OHHABS): A voluntary reporting system available to state and territorial public health departments and their designated environmental health or animal health partners. OHHABS collects data on HAB events and individual human and animal cases of HAB-associated illnesses. The goal of OHHABS is to collect information to support the understanding and prevention of HAB events and HAB-associated illnesses. OutbreakNet Enhanced: Provides epidemiologic support to state and local health departments to improve their capacity to detect, investigate, control, and respond to enteric disease outbreaks. PulseNet Area Labs: Provide support to network participants in their regions with trouble shooting, surge capacity for subtyping, training of laboratory and analysis methods, and coordination of regional calls and meetings. Environmental Microbiology: Conduct environmental sampling and testing of environmental samples for waterborne disease investigations. TX-DSHS-19-1309-A-000389 97 Tier 3 includes the following program: Integrated Food Safety Centers of Excellence (CoEs): CoEs are headquartered at state health departments that have demonstrated excellence in surveillance and investigation of foodborne illness and outbreaks, and each CoE must partner with at least one academic institution. The CoEs develop tools, deliver trainings, and provide consultations to public health professionals in other states who conduct surveillance and investigation of foodborne illness and outbreaks. CoEs are encouraged to propose additional activities not listed in this guidance that are compatible with program goals, build on current capacity and public health needs, and do not duplicate other efforts b. Healthy People 2020 Healthy People 2020 Goals for Food Safety include reducing the number of infections caused by key pathogens transmitted commonly through food (FS-1); reducing the number of outbreak-associated infections due to Shiga toxin-producing E. coli (STEC), Campylobacter, Listeria, or Salmonella associated with five food commodity groups (FS-2); preventing an increase in the proportion of nontyphoidal Salmonella and Campylobacter jejuni isolates from humans that are resistant to antimicrobial drugs (FS-3). c. Other National Public Health Priorities and Strategies National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) CDC Project Description a. Problem Statement Foodborne, waterborne, enteric, and environmentally transmitted disease surveillance and outbreak investigations are essential public health functions. Investigations require close collaboration between state, local, and federal agencies. Changes in society, technology, our environment, and microorganisms themselves are affecting the occurrence and complexity of foodborne, waterborne, enteric, and environmental diseases. Strong national surveillance is key to detecting outbreaks, and prompt and effective outbreak investigations and reporting are necessary to identify and remove contaminated products, prevent further illnesses, and focus prevention strategies on critical contamination points. Furthermore, antimicrobial resistance is one of our most serious health threats. Surveillance is critical to detect the emergence and spread of antibiotic resistance and to inform interventions that reduce resistance among bacteria. b. Purpose To support and enhance capacity for detection, investigation, control, and reporting of foodborne, waterborne, enteric, and environmentally transmitted disease cases and outbreaks. c. Outcomes • More efficient and accurate public health reporting • More effective public health workforce better prepared to respond to infectious disease threats • More rapid detection of cases and outbreaks • Improved surveillance o Improved completeness of data o Improved timeliness of reporting o Increased distribution and use of data to public health partners • More timely, complete and effective investigation efforts: o Response to outbreaks o Investigation of outbreaks TX-DSHS-19-1309-A-000390 98 • • o Implementation of control measures Improved use of data to: o Inform public health response and control o Improve public health practice o Inform program and policy development Coordination between laboratory and epidemiology is improved Funding Strategy In developing budgets for the activities described, separate budgets should be developed for laboratory and epidemiology activities. These budgets should include Tier 1 and Tier 2 activities, if a recipient is applying for Tier 2 funding. Tier 3 (CoE) activities should be addressed in a separate budget template. • • • • • Dedicated staff for investigation and reporting Resources to transmit surveillance data Training of state and local public health staff Supplies and equipment to maintain and enhance surveillance and outbreak reporting Tier 3 CoE Funding Note: A substantive portion of the CoE budget should be allocated to the academic partner. Detailed justifications must be included in the budget that make it clear how funds will be spent including a breakdown by salary, travel, supplies, etc. Estimated total availability of funds: Approximately $33 million Estimated number of awards given: 56-59 Estimated average per award: Approximately $575,000. The average award depends on the project areas and activities in which a jurisdiction participates. Strategies and Activities: • • • AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1a: Enhance Epidemiologic Workforce Capacity Support a sufficiently trained workforce for epidemiologic surveillance and outbreak response capabilities. Maintain supplies, computer equipment, and data entry personnel necessary for surveillance and outbreak reporting. i. Ensure staff have sufficient training to conduct the analysis of epidemiologic data related to clusters detected through PulseNet ii. Ensure personnel responding to outbreaks have the ability to use the Line List Editor in SEDRIC iii. Cross-train and educate staff about waterborne disease to build expertise for detection, investigation, and reporting of waterborne disease outbreaks ☒Required b) ☐Optional Support a sufficiently trained workforce and associated resources to electronically transmit case surveillance data TX-DSHS-19-1309-A-000391 99 i. ii. Integrate data elements into a disease surveillance system, build data entry screens, create data exports, and implement HL7 data transmission Develop, maintain, or enhance data management systems, working with IT/informatics staff, to enable transmission of data elements specified in Generic Version 2 and Foodborne Diarrheal Diseases MMGs in HL7 format; this includes supporting data migration from legacy systems ☒Required c) Identify a designated waterborne disease coordinator, a designated NORS point of contact, and at least one point of contact for foodborne, waterborne, zoonotic, and environmentally transmitted enteric disease case surveillance and outbreak response activities. ☒Required d) ☐Optional Travel at least one epi to the Regional PulseNet/OutbreakNet Meeting (or InFORM Conference) i. Also consider support for travel to other relevant conferences and trainings (e.g. CSTE, specialized trainings for enteric and/or waterborne diseases) ☒Required II. ☐Optional Participate in routinely scheduled teleconferences/calls: OutbreakNet/WASH quarterly webinars; NORS quarterly webinars; NARMS quarterly calls; monthly waterborne disease state partner calls; national case surveillance working group calls; and trainings, webinars, etc. for pathogen/program-specific activities including data transmission activities (mapping, page building, etc.) ☒Required e) ☐Optional ☐Optional Strategy 1a: Enhance Laboratory Workforce Capacity a} Support a well-trained staff on high quality laboratory processes to laboratory-based surveillance and outbreak response capabilities i. Ensure staff are trained and when necessary, attend trainings at their area lab or CDC ii. Ensure staff are certified in required lab procedures (e.g. PFGE/WGS, identification, serotyping, culturing of primary specimens) iii. Ensure staff are trained and certified to analyze and upload subtyping data to PulseNet or CryptoNet and typing data to CaliciNet national databases iv. Ensure staff/mechanisms (in-house or via partners) are available for collection of environmental samples (e.g., water [small and large volume], soil, surface, and other samples) for waterborne disease investigations ☒Required ☐Optional TX-DSHS-19-1309-A-000392 100 b) Identify at least one designated point(s) of contact for PulseNet, CryptoNet, NARMS laboratory activities, CaliciNet, waterborne laboratory testing, surveillance, and response activities, and Cyclospora genotyping i. Complete, sign and return PulseNet Memorandum of Understanding (MOU) and Terms of Reference (TOR) documents to CDC PulseNet staff, or provide contact information for the state or local public health official(s) responsible for signature of those documents ii. Complete sign, and return CryptoNet Memorandum of Understanding (MOU) to CDC CryptoNet staff, or provide contact information for the state or local public health official(s) responsible for signature of those documents iii. Complete, sign and return CaliciNet Memorandum of Understanding (MOU) to CDC CaliciNet staff, or provide contact information for the state or local public health official(s) responsible for signature of those documents ☒Required c) ☐Optional Participate in regularly scheduled calls, webinars, in-person trainings, etc. i. Participate in monthly calls (AMD/CARB, etc.) facilitated by PulseNet ii. Participate in area lab calls administered by PulseNet area labs and/or APHL iii. Participate in routine (e.g., weekly, monthly, quarterly) CaliciNet meetings between epidemiology and laboratory staff on norovirus outbreaks iv. Participate in quarterly NARMS conference calls ☒Required ☐Optional d) Travel at least one PulseNet laboratorian to the Regional PulseNet/OutbreakNet meetings or the InFORM Conference; Travel at least one laboratorian per CaliciNet-certified laboratory to the annual CaliciNet User meeting ☒Required III. a) ☐Optional Strategy 1b: Enhance Epidemiologic Investigation and Outbreak Response Implement model practices to improve timeliness and efficiency for cluster and outbreak response i. Monitor for and detect foodborne, waterborne, and zoonotic enteric disease clusters (a) Develop improved methods for the public to report suspected food- or water-related health concerns or outbreaks and for staff to follow-up these reports (e.g. illness hotlines or public complaint systems) ii. Develop and/or implement standard investigation protocols and tools to facilitate expanded outbreak investigations that include epidemiologic, laboratory, environmental health, and health communication staff collaboration (a) Develop and implement water related emergency response plans iii. Increase the number of foodborne, waterborne, and zoonotic enteric disease outbreak investigations that include an environmental health component to identify contributing factors or root causes and preventive measures 101 TX-DSHS-19-1309-A-000393 ☒Required b) Conduct investigations prompted by detection of a cluster, or local, or multistate foodborne or waterborne disease outbreaks i. Interview all foodborne, waterborne, enteric and environmentally transmitted disease cases (including zoonotic) identified as part of a cluster of infections and/or a multistate investigation. This includes conducting hypothesis-generating interviews and followup/focused interviews with outbreak-specific questionnaires when they are developed by CDC ii. Participate fully in CDC-led multistate outbreak investigations, including participation in analytic epidemiologic investigations and obtaining product information from persons infected with a pathogen that matches by subtyping isolates from foods, water, animals, or the environment iii. Work with other states on foodborne and waterborne disease outbreak investigations and reporting of other water-related issues iv. Assist local jurisdictions in large, complex foodborne and waterborne disease outbreaks (a) Provide technical assistance and training to local public health agencies and health departments on detection, investigation, control, and prevention ☒Required c) a} ☐Optional Strategy 1c: Improve Epidemiologic Surveillance and Reporting Report cases of nationally notifiable (foodborne, waterborne, enteric, and environmentally transmitted) diseases to NNDSS, as appropriate. This includes real-time reporting or consultation for cases of botulism and free-living ameba infections i. Manage electronic reporting of case data within state and to CDC (NNDSS) ii. Respond 24/7 to cases of botulism and free-living ameba. Work with CDC clinical consultation service or Emergency Operations Center to ensure management and resolution of cases ☒Required b) ☐Optional Implement control measures as appropriate based on cluster and outbreak investigations ☒Required IV. ☐Optional ☐Optional Collect and transmit national case surveillance data to CDC for all cases of nationally notifiable (foodborne, waterborne, enteric, and environmentally transmitted) diseases with a standard questionnaire or data elements that are specified in CSTE position statements (See Project F Appendix 1). This includes listeriosis, STEC and post-diarrheal HUS, vibriosis, cholera, typhoid fever, paratyphoid fever, salmonellosis, shigellosis, and campylobacteriosis, cryptosporidiosis, giardiasis, and cyclosporiasis TX-DSHS-19-1309-A-000394 102 i. ii. iii. Work with the CDC programs to validate and to clean surveillance data for pathogens with standard questionnaires or data elements during annual data cleaning Improve reporting to CDC of data elements requested in standard questionnaires or specified by CSTE position statements Work with CDC national case surveillance programs to provide state laboratory identification numbers that allow linking routine national surveillance data with isolate or specimen data (PulseNet, CryptoNet, NARMS, reference laboratories) ☒Required c) Conduct environmental health assessments or inspections as part of surveillance (e.g., food establishments, aquatic facilities, childcare centers) and report to CDC as appropriate ☒Required d) ☐Optional Review paper and electronic data systems for waterborne disease outbreaks (1971 through present) and enter unreported outbreaks in the NORS-Water module ☒Required h) ☐Optional Work with the CDC NARMS team to submit isolates from every outbreak caused by diarrheagenic Escherichia coli, Salmonella, and Shigella and report the state laboratory identification number for each submitted isolate in the corresponding NORS reports ☒Required g) ☐Optional Report to NORS all foodborne outbreaks, waterborne outbreaks, and enteric disease outbreaks due to person-to-person, animal contact, environmental contamination, and indeterminate/unknown modes of transmission i. Work with the CDC NORS team to validate and to clean outbreak data contained in NORS reports during annual data cleaning. ii. Improve data completeness for NORS outbreak reports iii. Report data for environmental health, contributing factors, and preventative measures in NORS reports ☒Required f) ☐Optional Explore feasibility of making fungal and parasitic diseases reportable in your jurisdiction ☒Required e) ☐Optional ☐Optional Explore feasibility of reporting HAB associated event and illness data (human and animal) to OHHABS ☒Required ☐Optional TX-DSHS-19-1309-A-000395 103 V. a) Strategy 1d: Strengthen laboratory testing for response Provide laboratory testing support and subject matter expertise in local and multi-jurisdictional outbreak investigations for foodborne, waterborne, enteric, and environmentally transmitted disease ☒Required b) Participate in local and multi-jurisdictional outbreak investigations i. Read bi-weekly PulseNet Quick Tips and engage in the use of the PulseNet/OutbreakNet SharePoint site to follow outbreak investigations ☒Required c) a) ☐Optional Strategy 1e: Enhance laboratory testing for surveillance and reporting Support the necessary infrastructure to conduct laboratory-based surveillance, diagnostics and subtyping i. Procure or maintain appropriate laboratory and data analysis equipment (including software upgrades), supplies, service agreements, and personnel necessary to support PulseNet, CryptoNet, NARMS, CaliciNet, and general surveillance and outbreak investigation functions, including waterborne diseases] ii. If necessary, maintain supplies, equipment and personnel necessary for obtaining and storing isolates from primary specimens positive for enteric pathogens by culture independent diagnostic tests ☒Required b) ☐Optional Submit representative isolates from outbreaks for antimicrobial resistance characterization by NARMS, along with form 50.34 documents according to current Enteric Diseases Isolate Submission Table guidance (located here: https://www.cdc.gov/ncezid/dfwed/edlb/index.html) or according to additional requests from CDC i. Outbreak isolates should be submitted as soon as possible and should not be batched, for example, with quarterly shipments of NARMS routine surveillance isolates.] ii. If available, the CDC-assigned report identification number from NORS should be included in the “Previous Laboratory Results/Comments” section of the CDC 50.34 Form for each isolate submitted to CDC for AST] iii. The state lab identification number for each outbreak isolate submitted to CDC for AST should be included in the “Isolates/Strains” section of the NORS Form (CDC 52.13 Form) for the reported outbreak ☒Required VI. ☐Optional ☐Optional Improve or maintain specimen delivery capacity TX-DSHS-19-1309-A-000396 104 i. ii. Work with local jurisdictions and clinical laboratories for submissions to the state public health laboratory for foodborne, waterborne, enteric, and environmentally transmitted diseases Work with CDC to submit specimens from the state public health lab, as appropriate, for foodborne, waterborne, enteric, and environmentally transmitted diseases ☒Required c) Conduct real-time subtyping as part of PulseNet, the national molecular platform for food pathogens (enteric bacteria) i. Upload subtyping results and associated metadata to the PulseNet national databases in real-time (within 4 working days from receipt in PulseNet lab for PFGE and within 7 working days from receipt for DNA extraction for WGS) ii. Communicate data analysis findings (clusters/outbreaks) via the PulseNet/OutbreakNet SharePoint site in real-time iii. Obtain cultures for subtyping in PulseNet by isolating organisms from patient specimens/broths tested positive by culture independent diagnostic testing methods (CIDT) ☒Required d) ☐Optional Send clinical, animal, and environmental (bacterial, viral, parasitic) specimens to CDC or state labs for testing ☒Required g) ☐Optional Conduct testing for detection and/or typing for CaliciNet activities i. Conduct norovirus testing and sequence-based typing using standardized laboratory protocols ii. Document and store norovirus positive stool samples for 3 years iii. Document and store stool samples of norovirus negative outbreaks for further testing at one of the Unexplained Viral Diarrhea Outbreak Support Centers (UVD-OSC). Contact calicinet1@cdc.gov for information on UVD OSC, if needed. iv. Provide a minimum set of data elements in the CaliciNet outbreak reports v. Include a unique outbreak identifier in CaliciNet reports enabling linkage of those records with the appropriate NORS outbreak report ☒Required f) ☐Optional Complete electronic logsheets and submit NARMS routine surveillance isolates within one month after the end of each quarter according to current NARMS sampling scheme ☒Required e) ☐Optional ☐Optional Conduct testing and/or subtyping as part of CryptoNet, the national database for cryptosporidiosis TX-DSHS-19-1309-A-000397 105 i. ii. iii. Collect, screen, and ship Cryptosporidium positive clinical (outbreak and/or sporadic) and zoonosis-associated animal specimens in compatible fixative to the CryptoNet Reference Laboratory at CDC for subtyping If certified, conduct near real-time subtyping of Cryptosporidium positive stools using CryptoNet protocols If certified upload subtyping results and associated metadata to CryptoNet using PulseNet infrastructure ☒Required VII. a) Strategy 1f: Enhance coordination between lab-epi-HIS Develop or maintain the ability to link laboratory data with epidemiologic data, environmental health data, and other sources as needed (e.g. geospatial and geographic data) i. Enhance or maintain information and data sharing tools to communicate relevant findings between laboratory, epidemiology, and environmental health ii. Share data interpretation reports and other relevant information between laboratory, epidemiology, and environmental health and with other appropriate public health staff in real-time iii. Maintain continuity of epidemiology and laboratory points of contact to jointly achieve NARMS routine surveillance and outbreak representative testing goals iv. Build and maintain relationships and with informatics and IT partners ☒Required b) a) ☐Optional Strategy 1g: Improve laboratory coordination and outreach to improve efficiency Improve coordination/consolidation activities, workflows, and flow of information within laboratories ☒Required b) ☐Optional Facilitate coordination/exchange of data with other jurisdictions during multijurisdictional events and investigations ☒Required VIII. ☐Optional Regularly engage in coordination through routine meetings and information sharing between lab/epi/environmental health ☒Required c) ☐Optional ☐Optional Actively communicate with Area/Regional/Reference laboratories, within area/region laboratories, and CDC laboratories, as appropriate i. Work with PulseNet Area Laboratories in your area/region and PulseNet Central at CDC to communicate information about subtyping data, troubleshooting issues, and any issues affecting network function TX-DSHS-19-1309-A-000398 106 ii. iii. Work with CryptoNet Regional Laboratories in your region and the CryptoNet Reference Laboratory at CDC to communicate information about specimen sampling and processing, subtyping data, and troubleshooting issues Work with area/regional laboratories and the CaliciNet reference laboratory at CDC about specimen sampling and processing, typing data, and troubleshooting issues ☒Required IX. a) Strategy 1h: Advance electronic information exchange implementation Incorporate all condition-specific data elements in the Foodborne and Diarrheal Diseases Message Mapping Guide (https://wwwn.cdc.gov/nndss/case-notification/message-mapping-guides.html) and listeriosis MMG, when available, into data management systems and test electronic data transmission processes for case surveillance with CDC partners to ensure accuracy and completeness of data transmitted ☒Required b) ☐Optional ☐Optional Implement or continue HL7 transmission of national case surveillance data to CDC for all of nationally notifiable (foodborne, waterborne, and environmentally transmitted) diseases with a standard questionnaire or data elements that are specified in CSTE position statements. This includes listeriosis, STEC and post-diarrheal HUS, vibriosis, cholera, typhoid fever, paratyphoid fever, salmonellosis, shigellosis, and campylobacteriosis, cryptosporidiosis, and giardiasis i. Transmit all core data elements in the Generic Version 2 Message Mapping Guide (https://wwwn.cdc.gov/nndss/case-notification/message-mapping-guides.html) via the HL7 electronic reporting standard) ii. Transmit all condition-specific data elements in the Foodborne and Diarrheal Diseases Message Mapping Guide using the HL7 electronic reporting standard (https://wwwn.cdc.gov/nndss/case-notification/message-mapping-guides.html) and listeriosis MMG, when available. iii. If HL7 transmission is not feasible, transmit or describe plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *.xls or *.csv) by email; if transmission of electronic tabular data is not feasible, describe plans to transmit data via traditional mechanisms (e.g., email/fax of individual case report forms). iv. For cryptosporidiosis, if HL7 transmission is not feasible, assess feasibility of electronic transmission of data first for each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet and for each outbreak-associated case and then sporadic cases for which a Cryptosporidium specimen has not been submitted for subtyping to CryptoNet. ☒Required ☐Optional AREA B: PREVENTION AND INTERVENTION I X. a) Strategy 2c: Implement health promotion strategies Develop and maintain public-facing foodborne and waterborne disease prevention websites TX-DSHS-19-1309-A-000399 107 i. Recommended milestones: (a) Having launched a prevention website (b) Having updated an existing prevention website ☒Required b) Develop and disseminate evidence-based health education and promotion materials/messages by a variety of modes to increase health literacy about disease prevention i. Review and update food-, water-, and hygiene-related health promotion materials annually, including web materials, social media, and fact sheets ii. Develop or maintain the capacity to carry out “Awareness Weeks” (e.g., Healthy Swimming, Healthy Contact Lens Week, Fungal Disease Awareness) iii. Websites/communications to explain to public how surveillance is done and what the benefit is to the public ☒Required c) ☐Optional Work with CDC Waterborne Disease Prevention Branch staff in the first grant year to develop metrics for evaluating health promotion activities ☒Required d) ☐Optional ☐Optional Use CDC’s Model Aquatic Health Code (MAHC; http://www.cdc.gov/mahc), outbreak, and other surveillance data to inform efforts to reduce recreational water-associated illness, drowning, and injuries at public treated aquatic venues. Strategies could include: i. Inform the public (a) Expand recreational water health and illness, drowning, injury prevention information on state websites (b) Add links to all state/local pool codes to state recreational water health website (c) Add links, if feasible, to make pool inspection data publicly accessible ii. Work with partners (a) Build and maintain relationships between epidemiology, laboratory, health promotion, and environmental health staff and/or other staff involved in public pool regulation (e.g., building code, environment) related to healthy swimming and reducing the risk of illness, drowning, and injury in aquatic venues. (b) Conduct discussions between health department staff (e.g., epidemiology and environmental health) and aquatics sector representatives to discuss feasibility of adopting key MAHC elements iii. Understand, review, and improve the MAHC (a) Review the MAHC against existing pool code(s) to identify public health gaps in existing state/local pool code(s). See “Using the MAHC” for key comparison elements (www.cdc.gov/mahc/usingthemahc.html#comparing) TX-DSHS-19-1309-A-000400 108 iv. (b) Review the MAHC Annex to be aware of data supporting aquatic facility design and operational changes (c) Participate in MAHC-related webinars and educational opportunities (d) Participate in the Council for the Model Aquatic Health Code (CMAHC; www.cmahc.org) to inform or submit recommended improvements to the MAHC 1. Assign a state environmental health designee for CMAHC contact purposes (e) Explore feasibility of adopting all or key portions of the MAHC identified in gap analysis. Core MAHC element(s) to consider are found at “Using the MAHC” (www.cdc.gov/mahc/usingthemahc.html#comparing) and include areas such as: 1. Cryptosporidium reduction and mitigation (Mini MAHCs at www.cdc.gov/mahc/editions/current.html) 2. Pool chemical-associated injury reduction 3. Lifeguarding improvements focused on zones of surveillance 4. Indoor aquatic venue air quality improvement 5. Bather hygiene and pool water contamination reduction 6. Required training and supervision Enhance pool inspections (a) Adapt existing pool inspection forms to enhance risk based inspections and decision making (b) Collaborate with IT/informatics partners to ensure data are entered electronically in a database designed for data analysis (see www.cdc.gov/healthywater/swimming/publichealth-professionals/data-collection-database-construction.html) (c) Use and analyze pool inspection data to inform and target resource use ☒Required I XI. ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS Strategy 3a: Coordinate and engage with partners a) Provide technical assistance and training to local public health agencies and health departments on foodborne, waterborne, enteric, and environmentally transmitted disease prevention issues ☒Required b) Build and maintain relationships and integration with food and water related partners (e.g., hospital infections, pathogen groups, antimicrobial resistance, environmental health, water utilities, aquatic facilities, beaches, animal health, regulatory partners) ☒Required c) ☐Optional ☐Optional Work with other local, state, and federal partners to develop and use outbreak investigation materials and guidance for improving foodborne, waterborne, enteric, and environmentally transmitted diseases outbreak detection, investigation, response, reporting, and prevention TX-DSHS-19-1309-A-000401 109 i. ii. iii. iv. Collaborate with other jurisdictions and external partners to share lessons learned and improve coordination] Work with partners such as the Integrated Food Safety Centers of Excellence to identify and use tools and resources in your jurisdiction Work with partners such as the PulseNet Area Labs, CryptoNet Regional Laboratories, and CaliciNet Outbreak Support Centers (CN-OSCs) and Unexplained Viral Disease Outbreak Support Centers (UVD-OSCs) to identify and use tools and resources in your jurisdiction Collaborate with organizations such as APHL, FDA, USDA, EPA, USGS, CSTE, WHO INFOSAN, PulseNet International, and others required during investigations of national and international outbreaks and other public health activities ☒Required XII. a) ☐Optional Strategy 3b: Information dissemination Regularly analyze, prepare, and disseminate summaries of waterborne disease outbreak data (e.g., reports, manuscripts, and presentations) ☒Required ☐Optional ☒Required ☐Optional Tier 2: CryptoNet and CryptoNet Regional Labs I XIII. a) XIV. a) Strategy 1a: Enhance workforce capacity Participate in monthly CryptoNet calls Strategy 1b: Enhance investigation and outbreak response Enhanced epidemiologic interviews and investigations i. Improve interviewing timeliness and completeness: this includes attempting to interview all cases of cryptosporidiosis ii. Review exposure data for subtyping clusters in real-time ☒Required XV. a) ☐Optional Strategy 1c: Improve surveillance and reporting Assess feasibility of implementing electronic transmission of CryptoNet case report form i. Collect all data elements in CryptoNet case report form for each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet ii. Routinely transmit/send data to CDC CryptoNet program iii. Implement FDD MMG cryptosporidiosis tab ☒Required ☐Optional TX-DSHS-19-1309-A-000402 110 XVI. a) Strategy 1d: Enhance laboratory testing for response Enhanced case investigation response and reporting i. Provide recommendations and guidance to laboratories within the appropriate region on issues related to laboratory testing or programmatic changes (i.e. WGS) ii. Serve as a resource for surge capacity testing and reference capabilities in response to large outbreaks ☒Required b) Sustain and enhance laboratory diagnostic/subtyping capacity i. Actively participate in evaluation and/or validation of new methods, testing of new software modules and scripts, adopt improvements to laboratory, analysis, communications processes in a timely fashion] ii. Conduct subtyping and/or WGS using CryptoNet protocols for Cryptosporidium clinical cases and zoonosis-related animal specimens, when available ☒Required XVII. a) ☐Optional ☐Optional Strategy 1e: Enhance laboratory testing for surveillance and reporting Enhanced public health laboratory surveillance i. If possible, conduct subtyping of specimens according to CryptoNet protocols ii. If conducting subtyping in state public health is not feasible, ship specimens regularly to CDC or regional CryptoNet lab iii. Provide subtyping and/or WGS capacity to CryptoNet participating laboratories within their designated area ☒Required ☐Optional ☒Required ☐Optional Tier 2: Cyclospora Genotyping I XVIII. Strategy 1d: Strengthen laboratory testing for response a) Conduct genotyping of Cyclospora as part of case or outbreak investigations I Tier 2: Environmental Microbiology XIX. Strategy 1a: Enhance workforce capacity a) Support a well-trained staff to conduct testing of environmental samples for waterborne disease investigations i. Ensure staff are trained in required lab procedures to process and test environmental samples (e.g., water [small and/or large volume], soil, surface, and other samples) for fecal contamination, etiologic agents, and physicochemical water quality parameters TX-DSHS-19-1309-A-000403 111 ☒Required XX. a) Strategy 1d: Enhance laboratory testing for response Develop or maintain capacity to conduct testing of environmental samples for waterborne disease investigations i. Process and test environmental samples (e.g., water [small and/or large volume], soil, surface, and other samples) for fecal contamination, etiologic agents, and physicochemical water quality parameters ☒Required b) ☐Optional ☐Optional Collaborate with CDC to develop metrics for environmental assessments as part of waterborne disease investigations ☒Required ☐Optional Tier 2: FoodCORE I XXI. a) Strategy 1a: Enhance workforce capacity Participate in monthly program calls, annual vision meetings, and program site visits ☒Required XXII. a) Strategy 1b: Enhance investigation and outbreak response Enhanced epidemiologic interviews and investigations i. Improve interviewing timeliness and completeness: this includes attempting to interview all cases of Salmonella, Listeria and STEC infection, all cases with WGS/NARMS testing results ii. Review exposure data for subtyping clusters in real-time iii. Obtain product information from patients infected with a strain of bacteria that matches a subtyped strain in a food product iv. Participate in team trainings with state and local staff in outbreak investigation methods ☒Required b) ☐Optional Enhanced environmental health-related investigation and response activities i. Conduct assessments as part of cluster, outbreak, and complaint investigations] ii. [Obtain samples (and associated product information) of implicated and suspect products for testing, as appropriate ☒Required c) ☐Optional ☐Optional Report program-specific metrics to CDC TX-DSHS-19-1309-A-000404 112 i. Working with CDC, develop/modify metrics and report via collaboratively determined mechanisms and timelines. Current metrics available at: https://www.cdc.gov/foodcore/metrics/index.html ☒Required ☐Optional ☒Required ☐Optional XXIII. Strategy 1c: Improve surveillance and reporting a) Assess feasibility of implementing NORSDirect & NEARS XXIV. Strategy 1e: Enhance laboratory testing for surveillance and reporting a) Enhanced public health laboratory surveillance i. Ensure routine transport of clinical specimens and specimens from outbreak-associated cases to the public health laboratory ii. Conduct real-time subtyping of all Salmonella, STEC, and Listeria iii. Conduct real-time testing/diagnostics of parasitic identification and calicivirus characterization iv. Collect serologic samples from persons with Hepatitis A virus infection linked to foodborne disease outbreaks for molecular characterization ☒Required ☐Optional Tier 2: FoodNet I XXV. a) Strategy 1a: Enhance workforce capacity Support staff to collect and submit epidemiological data to CDC i. Ensures coordination with laboratory for prioritizing isolate sequencing of cases with exposure and antimicrobial use information ii. Works with laboratory point of contact to link laboratory and epidemiologic data iii. Ensures epidemiologic interviews and data is complete and submitted to CDC FoodNet ☒Required ☐Optional XXVI. Strategy 1c: Improve surveillance and reporting a) Enhance epidemiologic interviews and data collection i. Complete interviews of patients for standardized demographic, clinical, and travel data elements ii. Collect diagnostic method and test brand used for enteric testing iii. Collect standardized data elements associated with antimicrobial resistance infections and case exposure ascertainment iv. Complete transmission of data to CDC FoodNet on or before timeline requested by program TX-DSHS-19-1309-A-000405 113 ☒Required b) Conduct surveillance for emerging enteric pathogens i. Collect standardized data associated with FoodNet designated pathogens (e.g. ETEC, EAEC) ii. Complete submission of data to CDC FoodNet on or before timeline requested by program] iii. Participate in project to evaluate polymicrobial detections ☒Required c) ☐Optional Conduct surveillance for laboratory testing practices and volume data for laboratories reporting to FoodNet sites i. Collect standardized data elements associated with laboratory testing volume ii. Complete yearly submission of data to CDC FoodNet on or before timeline request by program ☒Required d) ☐Optional ☐Optional Report FoodNet-specific measures to CDC i. Performance metrics for new activities will be developed in collaboration with sites in the first six months of the award ii. Sites will report data for laboratory practices and testing volume as determined with CDC iii. CDC will calculate other site-specific measures and provide an annual summary to sites ☒Required ☐Optional XXVII. Strategy 1e: Enhance laboratory testing for surveillance and reporting a) Conduct laboratory testing and subtyping for FoodNet activities i. Develop laboratory capability for parallel testing by CIDT and culture ii. Develop laboratory capability for testing of emerging enteric pathogens iii. Enhance capacity to reflex culture ☒Required b) ☐Optional Store/preserve isolates for future characterization i. Ensure all isolates with exposure and antimicrobial epidemiologic information are stored ii. Store a sample of isolates for all FoodNet pathogens ☒Required ☐Optional XXVIII. Strategy 1f: Enhance coordination between lab-epia) Develop and implement a plan for prioritizing isolate sequencing and epidemiologic interviews i. Laboratory and epidemiology staff must be involved in plan development and implementation TX-DSHS-19-1309-A-000406 114 ☒Required ☐Optional XXIX. Strategy 1h: Advance electronic information exchange implementation a) Update site surveillance systems to collect and transmit FoodNet active surveillance data through HL7 Recommended milestones: • Have performed gap analysis using FDD MMG • Have incorporated FoodNet data elements into state electronic surveillance system OR ensured elements are mapped into the HL7 message to be sent to CDC • Have transmitted test messages with FoodNet-specific data elements to CDC • Have validated HL7 FoodNet data with CDC staff • Have completed full migration to HL7 data transmission ☒Required XXX. a) ☐Optional Strategy 1i: Sustain and/or enhance information systems Develop/maintain the ability to link laboratory data with FoodNet epidemiologic data i. Maintain a current laboratory point of contact for FoodNet related activities ii. Ensure laboratory specimen identifiers for PulseNet sequence information (e.g. PulseNet key, WGS ID) is transmitted to CDC ☒Required ☐Optional Tier 2: NoroSTAT I XXXI. Strategy 1c: Improve surveillance and reporting a) Report all suspected and confirmed norovirus outbreaks due to any mode of transmission through NORS within 7 business days of notification of the outbreak to the state health department i. Provide a minimum set of data elements in the NORS outbreak reports (includes: state, date of outbreak, number ill, suspected or confirmed etiology, and setting) ☒Required b) Report all laboratory-confirmed norovirus outbreaks due to any mode of transmission through CaliciNet within 7 business days of receipt of outbreak specimens i. Include a unique outbreak identifier in CaliciNet reports enabling linkage of those records with the appropriate NORS outbreak report ☒Required I ☐Optional ☐Optional Tier 2: National Respiratory and Enteric Virus Surveillance System (NREVSS) Enhanced XXXII. Strategy 1c: Improve surveillance and reporting a) Establish and/or increase participation in clinical laboratory reporting of aggregate norovirus diagnostic results via the National Respiratory and Enteric Virus Surveillance System (NREVSS), either directly or through local/state health departments TX-DSHS-19-1309-A-000407 115 ☒Required b) Collect corresponding demographic and clinical data on patients tested for norovirus at clinical laboratories ☒Required c) ☐Optional ☐Optional Request aliquots/residual stool specimens from patients that test positive for norovirus at clinical laboratories to be sent to public health laboratories for further confirmation and genotyping. ☒Required ☐Optional Tier 2: HAB Surveillance, Response and Mitigation Special funding is available for Tier 2: Harmful algal bloom (HAB) Activities. Priority will be given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months of the drafting of this funding opportunity. • Estimated total availability of funds: $450,000 - $500,000 • Estimated number of awards given: 2-4 I XXXIII. Strategy 1c: Improve surveillance and reporting a) Address public health issues related to harmful algal blooms in one or more of the following areas: surveillance, mitigation, or event response. i. Report HAB associated event and illness data (human and animal) to OHHABS ii. Develop protocol and resources for public health response and mitigation to HAB events iii. Weekly/Ongoing surveillance, detection, investigation, and reporting of HAB-associated illnesses and events, as well as HAB-associated outbreaks, to CDC iv. Utilization of a One Health approach at state and local levels to build relationships supportive of HAB surveillance, mitigation, or event response in the state v. Participation in monthly state/ELC and HAB surveillance group calls coordinated by CDC ☒Required b) Lead a peer-to-peer network of HAB planning and response i. Lead coordination across and between states (regardless of funding status) in sharing scientific evidence and programmatic best practices for HAB-associated outbreaks for both drinking and recreational waters ☐Required I ☐Optional ☒Optional Tier 2: OutbreakNet Enhanced XXXIV. Strategy 1a: Enhance workforce capacity a) Work with a CoE TX-DSHS-19-1309-A-000408 116 i. b) Identify and implement projects or trainings that engage an Integrated Food Safety Center of Excellence (CoE); this could be a hands-on project or application of existing CoEdeveloped tools. A new/distinct project does not need to be developed for each grant year ☒Required ☐Optional ☒Required ☐Optional Participate in monthly program calls and site visits XXXV. Strategy 1b: Enhance investigation and outbreak response a) Improve interviewing timeliness and completeness: this includes attempting to interview all cases of Listeria and STEC infection, all cases with WGS/NARMS testing results, and as many Salmonella cases as possible, in addition to those associated with multistate cluster investigations ☒Required b) ☐Optional Report program-specific metrics to CDC i. Working with CDC, develop/modify metrics and report via collaboratively determined mechanisms and timelines. Current metrics available at: https://www.cdc.gov/foodsafety/outbreaknetenhanced/metrics.html ☒Required ☐Optional XXXVI. Strategy 1c: Improve surveillance and reporting a) Assess feasibility of implementing NORSDirect and NEARS i. In the first year, explore completion of the NEARS free e-Learning on Environmental Assessment of Foodborne Illness Outbreaks course (http://www.cdc.gov/nceh/ehs/elearn/ea_fio/index.htm). ii. If feasible, develop a plan for participation in NEARS; if not feasible please describe primary barriers. ☒Required I ☐Optional Tier 2: PulseNet Area Laboratories XXXVII. Strategy 1d: Enhance laboratory testing for response a) Enhanced outbreak investigation response and reporting i. Provide recommendations and guidance to laboratories within the appropriate region on issues related to laboratory testing or programmatic changes (i.e. WGS and non-culture based methods) ii. Serve as a resource for surge capacity testing and reference capabilities in response to large foodborne outbreaks or potential threats of bioterrorism that might occur locally or nationally TX-DSHS-19-1309-A-000409 117 ☒Required b) ☐Optional Sustain and enhance laboratory diagnostic/subtyping capacity i. Actively participate in evaluation and/or validation of new methods, testing of new software modules and scripts, adopt improvements to laboratory, analysis, communications processes in a timely fashion ☒Required ☐Optional XXXVIII. Strategy 1e: Enhance laboratory testing for surveillance and reporting a) Improve surveillance to drive public health action i. Provide laboratory bench training, technical guidance and scientific expertise to PulseNet participating laboratories within their designated area ☒Required ☐Optional XXXIX. Strategy 1f: Enhance coordination between lab-epi-HIS a) Improve laboratory coordination and information flow between state public health laboratories i. Coordinate and host PulseNet regional and training meetings ii. Serve as representative of laboratories within their areas/region on the PulseNet Steering Committee and the PulseNet/OutbreakNet Regional Meeting and InFORM planning committees ☒Required ☐Optional Tier 3: Integrated Food Safety Centers of Excellence I XL. a) Strategy 1a: Enhance workforce capacity Develop and disseminate resources to improve surveillance and investigation of foodborne illness and outbreaks and to improve information systems (FSMA Legislative Activities 1 and 6) i. Improve the ability of other health departments to conduct surveillance and investigation of foodborne illness and outbreaks; strengthen the knowledge base of the network of public health professionals that respond to foodborne illness, and provide a forum for peer-topeer exchange of ideas ii. Conduct in-person and/or remote site visits, trainings, consultations, etc. to other jurisdictions iii. Host reverse site visits with public health staff visiting the CoE iv. Develop materials and posted them to the CoEFoodSafetyTools.org ☐Required b) ☒Optional Assist public health agencies perform analyses to evaluate the timeliness and effectiveness of surveillance and investigation of foodborne illness and outbreaks (FSMA Legislative Activity 2) i. Provide assistance on the use of performance metrics and/or evaluation tools TX-DSHS-19-1309-A-000410 118 ii. iii. Create reports, manuscripts, and presentations completed using data from foodborne illnesses and outbreak surveillance systems Describe research and analysis projects funded by non-ELC sources ☐Required c) Improve access to trainings and education for students and public health personnel in laboratory, epidemiological, and environmental investigation of foodborne illness (FSMA Legislative Activities 3, 4, & 5) i. Deliver in-person and online courses (including live learning courses) ii. Develop and deliver a food safety or foodborne illness certificate program iii. Establish stipends/scholarships for food safety or foodborne illness programs iv. Support students and projects through internships/field placements ☐Required d) ☒Optional Participate in monthly program calls, workgroup calls, annual vision meetings, and program site visits ☐Required f) ☒Optional Enhance awareness and communication of available tools and resources surveillance and investigation of foodborne illness and outbreaks (FSMA Legislative Activity 7) i. Maintain a CoE website ii. Develop and distribute social posts about the CoEs and foodborne disease iii. Attended meetings to present/promote the CoEs ☐Required e) ☒Optional ☒Optional Work with CDC CoE program staff to develop and report program-specific performance metrics i. Working with CDC, develop/modify metrics and report via collaboratively determined mechanisms and timelines. Current metrics include tracking activities such as the number of other jurisdictions assisted, reports/manuscripts/presentations developed, training courses delivered, website usage data, and CoE promotion activities. Full details for these metrics are available via program staff: FoodSafetyCoE@cdc.gov ☐Required ☒Optional Collaborations a. With CDC funded programs Integrated Food Safety Centers of Excellence (CoEs), CaliciNet, CryptoNet, EHS-Net, FoodCORE, FoodNet, NARMS, NCEH SAFE WATCH/Private Well Initiative, OHHABS, PulseNet. b. With organizations external to CDC TX-DSHS-19-1309-A-000411 119 Association of Public Health Laboratories, Council of State and Territorial Epidemiologists, U.S. Environmental Protection Agency (EPA), U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS), and the U.S. Food and Drug Administration (FDA) Target Populations N/A Evaluation and Performance Measurement Measures #1-2 (Tier 1) 1. Report completeness and timeliness data for interviews for cases of Salmonella, STEC, and Listeria infection associated with multistate outbreaks in which an outbreak-specific questionnaire was disseminated by CDC (Activity 1b.2) 2. Please report separately for Salmonella, STEC, and Listeria: • Proportion of outbreak-specific questionnaires returned to CDC • Median time (in days) from date of notification to completion using an outbreak-specific questionnaire disseminated by CDC Measures #3-4 (Tier 1) Report data for MMG use/implementation (Activity 1h.1) 3. Percent of generic version 2 data elements that have been incorporated into state electronic disease surveillance systems for transmission by HL7 message, by pathogen. 4. Percent of condition-specific data elements in the FDD MMG that have been incorporated into state electronic disease surveillance systems for transmission by HL7 message, by pathogen. Measures #5-7 (Tier 1) Report data for PulseNet activities (Activity 1e.1) Total # of Isolates Received in the Public Health Lab • E. coli O157, Non-O157 STEC, Listeria, Salmonella, Nontyphoidal Salmonella (including ser. Paratyphi B), Salmonella ser. Typhi, Salmonella ser. Paratyphi A, Salmonella ser. Paratyphi C, Shigella, Campylobacter, Vibrio cholerae, Non-cholerae Vibrio 6. WGS Measures for E. coli O157:H7, Non-O157 STEC, Listeria, Salmonella, Campylobacter, Vibrio cholerae, Non-cholerae Vibrio • # of Human Isolates sent to another Lab for WGS • Total # of Isolates Sequenced in-house • # of Human Isolates Sequenced in-house • % in-house WGS of Human Sequences Submitted within 7 Working Days • Median Turn-Around-Time for in-house WGS of Human Isolates (in working days) 7. CIDT Measures for E. coli, STEC, Salmonella, and Campylobacter • Specimens/Broths Received in PHL for E. coli, Salmonella, Campylobacter • Specimens/ Broths sent to CDC for Isolation and/or Serotyping for E. coli, Salmonella, Campylobacter • Number Identified for STEC O157, STEC Non-O157, STEC Negative/Repeat Tests, Salmonella, Campylobacter 5. TX-DSHS-19-1309-A-000412 120 Measure #8-11 (Tier 1) Report data for CryptoNet activities (Activity 1e.3) 8. Number (percent) of outbreak-associated and sporadic Cryptosporidium specimens submitted to CDC for typing (required only if funded for CryptoNet) 9. Number (percent) of CDC or regional lab submitted specimens with completed CryptoNet forms submitted to CDC CryptoNet 10. Number (percent) of outbreak-associated and sporadic Cryptosporidium specimens subtyped (required only if funded for CryptoNet) 11. Number (percent) of in house typed specimens with completed CryptoNet case form submitted to CDC CryptoNet Measures #12-14 (Tier 1) Report data for CaliciNet activities (Activity 1e.4). Please note, there are additional CaliciNet measures that will be calculated by CDC staff; these are described later in the measures section. 12. Outbreaks (≥ 2 specimens) tested for norovirus: • total number • number with likely foodborne transmission • percentage with likely foodborne transmission 13. Outbreaks (≥ 2 specimens) sequenced for norovirus • total number • number with likely foodborne transmission • percentage with likely foodborne transmission 14. Frequency (e.g., weekly, monthly, quarterly) of meetings between epidemiology and laboratory staff on norovirus outbreaks Tier 2 NREVSS Measures (#1-3) 1. Number of clinical laboratories reporting weekly aggregate counts of norovirus tests performed and the number of those testing positive into NREVSS. 2. Number (%) of patients testing positive for norovirus at clinical laboratories for whom demographic/clinical data are provided. 3. Number (%) of patients testing positive for norovirus at clinical laboratories for whom stool specimens were sent to the public health laboratory for confirmation and genotyping Tier 2 HAB Measures (#4-5) Report data for HAB activities. Please note, there are additional HAB measures that will be calculated by CDC staff; these are described later in the measures section. 4. Report of engagement with CDC or other federal agencies on waterborne or HAB disease and outbreak detection, investigation, and reporting, including with whom engagement occurred. 5. Report of coordination and technical assistance provided to participating jurisdictions by topic area Jurisdiction-reported metrics may be developed/modified via a collaborative process between CDC and participating jurisdictions. They will evaluate a list of measurable activities addressing HAB concerns and issues relevant to the jusisdictions awarded. These indicators will help state and local public health officials in the develop courses of action for surveillance, response and mitigation of HAB outbreaks. TX-DSHS-19-1309-A-000413 121 6. 7. 8. Tier 2 PulseNet Area Laboratories Measures (#6-8) Number of individuals your lab trained from other laboratories in your area (PFGE and/or WGS) Number of isolates for which PFGE testing was done from other laboratories in your area Number of isolates for which WGS testing was done from other laboratories in your area Tier 2 FoodCORE Measures The FoodCORE metrics data are reported biannually to the CDC FoodCORE Team; Applicants who are currently funded FoodCORE centers do not need to resubmit metrics data that were previously submitted in biannual reports. Otherwise, applicants should describe in general terms a plan for collecting FoodCORE metrics (e.g. if there are existing data sources or if systems or sources would need to be modified or developed). The metrics are developed/modified via a collaborative process between CDC and participating jurisdictions. They evaluate a list of measurable activities covering diverse aspects of outbreak response. These indicators will help state and local public health officials in the FoodCORE catchment areas evaluate and implement effective standardized surveillance and response for enteric disease outbreaks, document successful models, and hone response methodology. Additional information for the current metrics and relevant definitions can be accessed at: http://www.cdc.gov/foodcore/metrics.html. Tier 2 OutbreakNet Enhanced Measures The OutbreakNet Enhanced metrics data are reported annually to the CDC OutbreakNet Enhanced Team; Applicants who are currently funded OutbreakNet Enhanced sites do not need to resubmit metrics data that were previously submitted in annual reports. Otherwise, applicants should describe in general terms a plan for collecting OutbreakNet Enhanced metrics (e.g. if there are existing data sources or if systems or sources would need to be modified or developed). The metrics are developed/modified via a collaborative process between CDC and participating jurisdictions. They evaluate a list of measurable activities covering diverse aspects of outbreak response. These indicators will help state and local public health officials in the OutbreakNet Enhanced catchment areas evaluate and implement effective standardized surveillance and response for enteric disease outbreaks, document successful models, and hone response methodology. Additional information for the current metrics and relevant definitions can be accessed at: https://www.cdc.gov/foodsafety/outbreaknetenhanced/metrics.html. Tier 2 FoodNet Measures The FoodNet performance metrics will be developed via a collaborative process between CDC and FoodNet sites. Metrics and the reporting details will continue to be developed collaboratively during the project period. Additionally, CDC will calculate site-specific measures and provide an annual summary to sites. Tier 3 Integrated Food Safety Centers of Excellence Measures The Integrated Food Safety Centers of Excellence (CoEs) performance metrics are developed/modified via a collaborative process between CDC and CoE participating jurisdictions. Metrics and the reporting details will continue to be developed collaboratively during the project period. Full details for the current metrics are available via program staff: FoodSafetyCoE@cdc.gov The following performance measures will all be reported to recipients by CDC program staff; recipients do not need to calculate or submit these data via ELC. TX-DSHS-19-1309-A-000414 122 National Surveillance Team staff will calculate the following metrics using data from surveillance systems (See Project F Appendix 1). (Tier 1 Activities 1c.1 and 1.c2) • The number of detected cases of Salmonella, Shigella, Campylobacter, and STEC infection reported to LEDS. • Number of cases of listeriosis, cholera and vibriosis, typhoid and paratyphoid fever, and STEC reported through HL7 message transmission to CDC. • Number of cases of listeriosis, cholera and vibriosis, and typhoid and paratyphoid fever reported through a standard questionnaire or data elements that are specified in CSTE position statements or electronic tabular format to CDC. • The following metrics will be calculated separately for listeriosis, cholera and vibriosis, typhoid and paratyphoid fever, and STEC based on reporting of current standard questionnaires (or the corresponding data elements) to CDC: o The proportion of reports with minimally sufficient demographic data (age, sex, race, ethnicity and for listeriosis cases pregnancy status) o The proportion of reports with minimally sufficient epidemiologic data (travel history; for listeriosis nursing home history; for cholera and vibriosis outbreak status and water exposure history) o The proportion of reports with minimally sufficient clinical data (illness onset, hospitalization, clinical outcomes, signs and symptoms and medical history) o The proportion of reports with minimally sufficient laboratory data (specimen source, date of collection, state public health laboratory isolate identification number; for vibriosis species isolated or detected) o The proportion of reports with minimally sufficient food history data (not applicable to typhoid and paratyphoid fever cases) o The proportion of reports with submitted to CDC within 7 days of interview date for listeriosis, within 30 days of isolation or detection for cholera and vibriosis, typhoid and paratyphoid fever, and STEC • The proportion of listeriosis cases with clinical isolates uploaded to PulseNet within 14 days of specimen collection date • The proportion of culture-confirmed cases with an identifier that links epi data to PulseNet isolate data for STEC and listeriosis NORS staff will calculate the following measures and will provide a summary to each reporting site that describes and assesses site-specific performance. The summary also will include performance data aggregated from all of the reporting sites in order to give sites a sense of their relative performance. For the data completion measures, entering unknown or undetermined when applicable will count as completion. The NORS reporting forms and guidance are available at www.cdc.gov/nors • Number of finalized outbreaks reported to NORS per 1,000,000 persons per year. Target: o Animal contact: 0.5 outbreaks per million population per year o Foodborne: 2 outbreaks per million population per year o Person-to-person: 5 outbreaks per million population per year o Waterborne: 0.25 outbreaks per million population per year TX-DSHS-19-1309-A-000415 123 Percentage of outbreak reports with complete information on primary cases, based on the following fields. Target: 100%. o Age groups of cases, sex of cases, number of hospitalizations, number of cases with information on hospitalization status, number of deaths, and number of cases with information on death status. • Percentage of outbreak reports with complete information on outbreak etiology, based on the following fields. Target: 100%. o For animal contact, environmental, foodborne, person-to-person, and unknown mode outbreaks, answer for “Is there at least one confirmed or suspected etiology?” Completion of etiology table when at least one etiology is confirmed or suspected, i.e., genus, species, serotype, confirmed/suspected status, and number of lab-confirmed cases. o For waterborne outbreaks, completion will be reviewed for genus/chemical/toxin, species, serotype/serogroup/serovar, genotype/subtype, total number of tested primary cases, and total number of primary cases tested positive. o Additionally, for confirmed etiologies of PulseNet/NARMS pathogens Campylobacter, E. coli, Listeria, Salmonella, Shigella, and Vibrio, completion of isolates table including CDC System, State Lab ID, and PulseNet cluster code. • Percentage of animal contact, foodborne, and waterborne outbreak reports with complete vehicle or type of water exposure and venue/system information, based on the following fields. Target: 100%. o For animal contact outbreaks, animal vehicle, animal type, confirmed/suspected status, and reasons confirmed/suspected, or “animal vehicle undetermined” is selected with reason(s) animal contact with undetermined vehicle entered. o For foodborne outbreaks, food name, confirmed/suspected status, reason(s) confirmed/suspected, method(s) of processing and preparation, and import status, or “food vehicle undetermined” is selected with reason(s) foodborne with undetermined vehicle entered. o For waterborne outbreaks, completion will be reviewed for type of water exposure (including other type and unknown type), water venue (treated and untreated), drinking water system, and other type description (“water type” field). • Percentage of outbreak reports with complete information on setting, based on the following fields. Target: 100%. o For animal contact outbreaks, settings of exposure are entered. o For environmental, person-to-person, and unknown mode outbreaks, major setting of exposure is entered. o For foodborne outbreaks, location where food was prepared and location of exposure fields are entered. o For waterborne outbreaks, recreational water setting of exposure (treated and untreated), drinking water setting of exposure, or other setting of exposure is entered (other/unknown type of water exposure). NARMS staff will calculate the following measures using data on isolates and outbreaks from the previous calendar year. Guidelines for isolate shipping can be found at https://www.cdc.gov/ncezid/dfwed/edlb/index.html under “Laboratory protocols and resources” (in table, • TX-DSHS-19-1309-A-000416 124 under Service, see “NARMS” for routine surveillance and “Outbreak investigation” for outbreak isolate shipping) • Number and percentage of isolates (collected from humans in previous calendar year) received by state laboratory that were shipped to NARMS as part of routine surveillance. These include isolates with specimen collection dates in 2018 that were shipped to NARMS during CY 2018 and early CY 2019. All isolates should be received at CDC before the routine surveillance isolate submission deadline. Target: a) Nontyphoidal Salmonella (including serotype Paratyphi B): 5% - the first 2018 isolate received and every 20th thereafter b) Shigella: 5% - the first 2018 isolate received and every 20th thereafter c) E. coli O157: 5% - the first 2018 isolate received and every 20th thereafter d) Salmonella typhi: 100% - all isolates, including duplicates e) Paratyphi A and C: 100% - all isolates, including duplicates f) Vibrio species other than V. cholerae: 100% - all isolates, including duplicates g) Campylobacter (FoodNet sites only): varies by site • Total number of routine surveillance shipments of 2018 isolates (those collected from humans in calendar year 2018) made to NARMS; target: at least 4 quarterly shipments within a month after each quarter • Number of suspected single-state outbreaks of Salmonella, Shigella, and diarrheagenic E. coli having three representative isolates submitted to the appropriate contact person/laboratory unit within the Enteric Diseases Laboratory Branch at CDC for antimicrobial susceptibly testing (AST). These include outbreaks where the first primary case became ill in CY 2018. Target: Three representative isolates from 100% of suspected single-state outbreaks for Salmonella, Shigella, and diarrheagenic E. coli (If <3 isolates are available, sites should send as many isolates as are available) CDC CaliciNet staff will calculate the following measures from data submitted to CaliciNet: • Norovirus sequences submitted/uploaded to CaliciNet within 2 weeks after receiving samples in the laboratory o total number o percentage • Mandatory attendance of at least one laboratorian per CaliciNet-certified laboratory to the annual CaliciNet User meeting Tier 2 NoroSTAT Measures I • • • CDC NoroSTAT staff will calculate the following measures surveillance and outbreak data Of all suspected and confirmed norovirus outbreaks due to any mode of transmission reported to NORS, number (percent) reported within 7 business days of initial report to state health department. Of all confirmed norovirus outbreaks (typically 2 specimens required by the state for confirmation) due to any mode of transmission reported to CaliciNet, number (percent) reported within 7 business days of receipt at the state laboratory. Of all suspected and confirmed norovirus outbreaks reported to NORS, number (percent) reported with the minimum data elements completed (state, date of outbreak, number ill, suspected or confirmed etiology, and setting). TX-DSHS-19-1309-A-000417 125 • Of all confirmed norovirus outbreaks reported to CaliciNet, number (percent) containing an outbreak identifier that can be linked with a corresponding NORS Report Tier 2 HAB Measures • • • CDC NoroSTAT staff will calculate the following measures surveillance and outbreak data Number of reports and human and animal case forms entered in OHHABS Percent of OHHABS reports that have been finalized Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports. Project F Appendix 1: National Case Surveillance Appendix Disease Message Surveillance case definition and Standard questionnaire or Mapping Data elements defined in CSTE position statement Guides (MMG)1 Listeriosis GenV2 & https://www.cdc.gov/listeria/surveillance.html Listeriosi s MMG STEC GenV2 & https://wwwn.cdc.gov/nndss/conditions/shiga-toxinFDD producing-escherichia-coli/case-definition/2018/ MMG https://www.cdc.gov/nationalsurveillance/ecolisurveillance.html N/A Post-diarrheal GenV2 HUS GenV2 & https://www.cdc.gov/vibrio/surveillance.html Cholera and FDD Vibriosis MMG Typhoid and Paratyphoid Fever GenV2 & FDD MMG https://www.cdc.gov/typhoid-fever/surveillance.html Botulism GenV2 https://www.cdc.gov/botulism/surveillance.html Surveillance system Listeria Initiative, NNDSS STEC Initiative,2 LEDS4, NNDSS NNDSS Cholera and Other Vibrio Illness Surveillanc e (COVIS) System, NNDSS National Typhoid and Paratyphoi d Fever Surveillanc e (NTPFS), NNDSS National Botulism Consultatio TX-DSHS-19-1309-A-000418 126 Salmonellosis GenV2& FDD MMG Shigellosis GenV2 & FDD MMG Campylobacterios GenV2 & is FDD MMG Cryptosporidiosis GenV2 & FDD MMG Giardiasis GenV2 https://www.cdc.gov/nationalsurveillance/salmonellasurveillance.html n Service, NNDSS LEDS4, NNDSS https://www.cdc.gov/nationalsurveillance/shigellasurveillance.html LEDS4, NNDSS https://wwwn.cdc.gov/nndss/conditions/campylobacteriosis/ case-definition/2015/ NNDSS https://wwwn.cdc.gov/nndss/conditions/cryptosporidiosis/ CryptoNet case report form: https://www.cdc.gov/parasites/crypto/cryptonet.html NNDSS CryptoNet for enhanced molecular surveillanc e NNDSS No nationally defined disease specific elements https://wwwn.cdc.gov/nndss/conditions/giardiasis/ Not nationally notifiable but under standardized surveillance: NNDSS Free living Gen V2 Naegleria fowleri causing primary amebic amebae meningoencephalitis (PAM): infections https://wwwn.cdc.gov/nndss/conditions/naegleria-fowlericausing-primary-amebic-meningoencephalitis-pam/ Balamuthia mandrillaris disease https://wwwn.cdc.gov/nndss/conditions/balamuthiamandrillaris-disease/ Acanthamoeba Disease (Excluding Keratitis) https://wwwn.cdc.gov/nndss/conditions/acanthamoebadisease-excluding-keratitis/ Abbreviations: Generic Version 2 (GenV2), Message Mapping Guide (MMG), Foodborne and Diarrheal Diseases (FDD), Shiga toxin-producing E. coli (STEC), Message Mapping Guide (MMG), Laboratory-based Enteric Disease Surveillance (LEDS), Cholera and Other Vibrio Illness Surveillance (COVIS), National Typhoid and Paratyphoid Fever Surveillance (NTPFS) 1 Finalized MMGs can be accessed here: https://wwwn.cdc.gov/nndss/case-notification/message-mappingguides.html 2 STEC Initiative collects data only through electronic data transmission (HL7 or tabular electronic data). 3 States will be asked to provide a PulseNet identifier for cases of post-diarrheal HUS cases reported to NNDSS, where applicable. 4 LEDS data is collected directly from FoodNet for participating sites. Abbreviations: Generic Version 2 (GenV2), Message Mapping Guide (MMG), Foodborne and Diarrheal Diseases (FDD), Shiga toxin-producing E. coli (STEC), Message Mapping Guide (MMG), Laboratory-based Enteric Disease TX-DSHS-19-1309-A-000419 127 Surveillance (LEDS), Cholera and Other Vibrio Illness Surveillance (COVIS), National Typhoid and Paratyphoid Fever Surveillance (NTPFS) 1 Finalized MMGs can be accessed here: https://wwwn.cdc.gov/nndss/case-notification/message-mappingguides.html 2 STEC Initiative collects data only through electronic data transmission (HL7 or tabular electronic data). 3 States will be asked to provide a PulseNet identifier for cases of post-diarrheal HUS cases reported to NNDSS, where applicable. 4 LEDS data is collected directly from FoodNet for participating sites. TX-DSHS-19-1309-A-000420 128 G: Healthcare-associated Infections and Antibiotic Resistance Program The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes a program that addresses healthcare-associated infections (HAIs) and antibiotic resistance (AR). The HAI/AR Program includes two interrelated components —G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2: Antibiotic Resistance Laboratory Network (AR Lab Network). During the last two years of the 2015–2019 cycle, the minimum required epidemiology activities for the health department HAI/AR program and related state-based laboratory activities were consolidated into a single project (K1A), while the regional laboratory activities were included in a separate project (K3). Notable changes in the 2019–2023 cycle are (a) the inclusion of all epidemiology activities in a single component (G1) rather than several discrete projects, and (b) the deconsolidation of epidemiology and laboratory activities into separate guidance such that state-based laboratory activities are included with regional laboratory activities in a single laboratory component (G2), reflecting that both the state and regional labs comprise the AR Lab Network. Applicants should note activities in their G1 and G2 applications aimed at improving epidemiology-laboratory (epi-lab) collaboration across the HAI/AR Program. Key points about each component: • • • • • G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship Epidemiology activities have been organized in two Tiers. o Tier 1 activities are required of all Recipients. o All Tier 2 activities are optional. Recipients may apply for funding of none, any, or all activities. We anticipate awarding funding to up to 10 Applicants per optional project. The activities described in this portion of the guidance are focused on epidemiology; there are no laboratory activities. However, the guidance includes several activities aimed at improving coordination between epidemiologists in the health department HAI/AR program and laboratories in the AR Lab Network. In general, epidemiologists should use data provided by the AR Lab Network (and other appropriate sources) to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response efforts, including sharing of laboratory results for timely action and providing recommendations for testing. o For containment, see Core Area A, Strategy I o For responses other than containment, see Core Area A, Strategy II o For other epi-lab collaboration, see Core Area A, Strategy IV The HAI coordinator should assure epi-lab coordination. This could be accomplished by the HAI coordinator directly or through assignment of this task. The health department HAI/AR program should work with public health laboratory partners to develop coordinated work plans (see Core Area A, Strategy IV). G2: Antibiotic Resistance Laboratory Network (AR Lab Network) Laboratory activities have been organized in three Tiers, all in ELC Core Area A. o Tier 1 activities are required of all local or state laboratory Applicants. We anticipate funding up to 56 Applicants. TX-DSHS-19-1309-A-000421 129 • • • o Tier 2 activities are optional for local or state laboratory Applicants. We anticipate funding up to 56 Applicants. Applicants who apply for Tier 2 are required to apply for Activity I.a, but remaining activities are optional. o Tier 3 activities are directed toward regional laboratories and the National TB Molecular Surveillance Center. We anticipate funding up to seven Applicants for regional laboratory activities and one Applicant as the National TB Molecular Surveillance Center. The activities described in this guidance are directed toward the laboratory. In general, laboratories should perform testing of isolates and other specimens, provide results back to submitting laboratories, and coordinate with and provide technical support to clinical and other public health laboratories. However, as in the epidemiology guidance, the laboratory guidance includes several activities aimed at improving coordination between laboratories in the AR Lab Network and epidemiologists in the HAI/AR program. o See Tier 1, Strategy III o See Tier 3, Strategy II (Activity a) and Strategy IV The AR lab expert should assure lab-epi coordination with regard to HAI/AR activities, including AR Lab Network activities. This could be accomplished by the AR expert directly or through the assignment of this task. The public health laboratory should work with the HAI/AR program to develop coordinated work plans (see Tier 1, Strategy III). TX-DSHS-19-1309-A-000422 130 G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship Program Activity Contact Information HAIAR@cdc.gov Funding Opportunity Description Background a. Overview The goals of the Healthcare-associated Infection (HAI)/Antibiotic Resistance (AR) Program are to prevent HAIs to protect patients and healthcare personnel; to advance the detection, response, and containment of AR; and promote antibiotic stewardship (AS), to ensure safety, quality, and value in healthcare delivery systems. Related activities in epidemiology are described here in G1: Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship), while laboratory activities are described in G2: Antibiotic Resistance Laboratory Network (AR Lab Network). b. Healthy People 2020 The HAI objectives for Healthy People 2020 reflect the commitment of the U.S. Department of Health and Human Services to reduce HAIs and prevent spread of AR. The 2020 targets include reduction in central lineassociated bloodstream infections (CLABSIs) by 50%, catheter-associated urinary tract infections (CAUTIs) by 25%, invasive methicillin-resistant Staphylococcus aureus (MRSA) infections by 50%, and Clostridioides difficile infection (CDI) by 30%. c. Other National Public Health Priorities and Strategies Detecting and preventing HAIs and AR is a cross-cutting federal priority. The National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination (HAI Action Plan) sets goals and priorities for reduction of HAIs across healthcare settings, while the National Strategy for Combating Antibiotic-Resistant Bacteria and companion National Action Plan articulate national goals, priorities, objectives, milestones, and reduction targets to provide an overarching framework for federal investments aimed at combating antibioticresistant bacteria. Key strategies include containing emerging threats from antibiotic-resistant organisms, detecting and responding to outbreaks within healthcare facilities, promoting surveillance through the National Healthcare Safety Network (NHSN), and expanding prevention efforts through collaborations and innovative approaches. Recipient activities should reflect these strategies as well as recommendations (as available) from the CDC/CSTE Antibiotic Resistance Surveillance Task Force (CSTE Position Statement 13-SI-01) and the Council for Outbreak Response for HAIs and Antimicrobial Resistance (CORHA). CD Project Description a. Problem Statement: HAIs and AR have been a recognized public health threat for many years. HAIs are associated with morbidity, mortality, and increased healthcare costs, yet many are preventable. The threats posed by HAIs caused by antibiotic-resistant pathogens vary nationwide, but AR has been identified in every state. Inappropriate prescribing and consumption of antibiotics contributes to this growing problem of AR. Local, territorial, and state health departments have an important role in coordinating, implementing, and leveraging regional HAI/AR prevention and response efforts, including the promotion of antibiotic stewardship. b. Purpose: TX-DSHS-19-1309-A-000423 131 The purpose of this funding announcement is to support and enhance the capacity of local and state health departments to improve patient safety by preventing HAIs, containing emerging AR, and improving use of antibiotics. c. Outcomes: By the end of the project period, Recipients are expected to show measurable progress toward the following outcomes: • Novel or high-concern resistance rapidly identified and contained • Timely and effective response to HAI/AR outbreaks • Reduction in HAIs in all healthcare settings • Improved infection control capacity and practices in all healthcare settings • AS core elements implemented in healthcare settings • Improved information sharing • Improved data-driven prevention • Enhanced coordination of prevention efforts in all healthcare settings Funding Strategy As a condition of funding under this project, Recipients must attach a letter of commitment from state leadership (e.g., state epidemiologist, state health official) to support the HAI/AR prevention program goals. Recipients should utilize funds for personnel, travel, supplies, equipment, or contractual support for proposed activities. Mechanisms to acquire personnel could include direct hires by Recipient, CDC staff working in the state (e.g., CDC-sponsored fellows, trainees, or other field assignees), or contracts to local experts. In general, in-state travel for containment, other response activities, onsite assessment of infection control and prevention practices, and other onsite technical assistance will be prioritized over other travel. With the exception of required travel to the annual HAI/AR Recipients’ meeting in Atlanta, Georgia, in-state travel will be prioritized over out-of-state travel. All Recipients are all eligible to apply for optional activities (i.e., Tier 2), after first addressing all of the required activities in Tier 1. Priority for funding optional activities in this year will be given to Recipients who showed progress during the prior ELC funding cycle as presented in the application (background and current capacity); propose feasible plans that reflect the Recipient’s capacity, include the rationale for why the Recipient considers a problem high priority, and explain how performance measures will be captured and reported; and present credible justification of an unaddressed AR public health threat. Optional activities in Tier 2 might be included in only the first two or three years of the ELC cycle, so work plans should reflect the potential for time-limited funding. We anticipate awarding up to 10 Recipients for each optional activity. Regardless of Tier, Recipients should make clear in their budget requests which strategies and activities (whether required or optional) will be supported by the requested funding, as well as the justification for why activities are needed; failure to do so may result in failure to receive funding. Recipients should be aware that future funding decisions will be based on measurable progress, as indicated by progress toward desired outcomes and financial spending and reporting, as reported in performance measures and as reported at least quarterly in updates to CDC. 132 TX-DSHS-19-1309-A-000424 Funding will be prioritized first to support an HAI coordinator and an AR/AS expert, and next for infrastructure (including other personnel) to carry out infection control and prevention work for required activities (i.e., Tier 1). Desired personnel should have knowledge and expertise in infection control (e.g., investigating outbreaks in healthcare facilities, use of the tiered containment strategy, decolonization strategies to interrupt transmission), AS, and analysis of surveillance data. • Estimated total availability of funds: $28,000,000 • Estimated number of awards given: 57 • Estimated average per award: $400,000 Strategies and Activities: I AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I. Strategy 1b: I. Support containment of novel or high-concern antibiotic-resistant organisms. This includes prompt detection of and response to certain targeted resistant organisms (e.g., pan-resistant organisms) or mechanisms (e.g., mcr-1-producing Enterobacteriaceae) and implementation of regional control strategies for certain resistance mechanisms in geographic areas where these mechanisms are more commonly encountered (e.g., New Delhi metallo-β-lactamase (NDM)-producing Enterobacteriaceae in areas where this mechanism is endemic). Organisms included in each containment tier or targeted for regional intervention may vary by region depending on the local epidemiology. a) In collaboration with public health laboratories, provide technical expertise and support to clinical laboratories, infection prevention networks, and healthcare facilities. i. Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that ensure timely detection and response to targeted resistant threats. The plan should include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. ii. The plan should be available for review by CDC by the end of the funding year. iii. Implement timely detection and response to targeted organisms or mechanisms and track response actions and times. Initiate action within 1 business day of receiving an alert value from the AR Lab Network. iv. Provide technical and epidemiologic consultation to public health laboratories in the AR Lab Network to guide recruitment of clinical (i.e., not in the AR Lab Network) laboratories in their jurisdiction that serve facilities identified as high risk for multidrug-resistant organisms (MDROs), as defined by local epidemiology, infection control assessments, and/or CDC guidance for AR Lab Network isolate testing. v. Provide outreach and technical assistance to clinical microbiology laboratories and infection prevention networks to improve the detection of targeted organisms, case reporting, and response. vi. Advise health care facilities on which specimens to send for testing, promote local, state, and regional laboratory support, and facilitate isolate submission for testing. vii. Facilitate coordinated response among interconnected facilities. This includes but is not limited to sharing data, such as laboratory testing results, for situational awareness and action. TX-DSHS-19-1309-A-000425 133 ☒Required b) ☐Optional Conduct colonization screenings and continue until spread is controlled. Refer to CDC guidance to determine when colonization screening is recommended. Facilitate timely sharing of colonization screening results and incorporate findings in recommendations to affected healthcare facilities and providers. ☒Required ☐Optional II. Strategy 1b: Support rapid response. Response refers to efforts to control newly identified HAIs and AR risks not described in section I and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. a) Provide technical expertise to healthcare facilities. i. Implement timely detection and response and track response actions and times. ii. Use tracking of response requests and actions to inform future response and prevention efforts. iii. Facilitate coordinated response among interconnected facilities. This includes but is not limited to sharing data, such as laboratory testing results, for situational awareness and action. iv. Implement response-driven prevention through implementation of jurisdiction-wide interventions based on lessons learned during responses. Examples of activities include disseminating jurisdiction-wide health advisory or other communication to providers regarding outbreak investigations and recommendations, creating new tools or resources tailored to the setting or provider-type experiencing an outbreak, engaging with specialty organizations at a local or national level to share outbreak lessons and promote prevention (e.g., at an annual conference or webinar), or engaging with relevant licensing or specialty boards (e.g., to discuss including infection control in continuing education requirements for providers or licensing/accreditation requirements for facilities). ☒Required b) ☐Optional Facilitate timely sharing of laboratory results and incorporate findings in recommendations to affected healthcare facilities and providers. ☒Required ☐Optional III. Strategy 1b: Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses. a) Conduct onsite infection control assessments at facilities where targeted organisms or resistance mechanisms have been identified (i.e., as part of the containment described in Strategy I). Assessments may require direct observation and ongoing monitoring of infection prevention practices in affected areas/units. ☒Required ☐Optional TX-DSHS-19-1309-A-000426 134 b) Conduct onsite infection control assessments at facilities where outbreaks have occurred (i.e., as part of response efforts described in Strategy II). Assessments may require direct observation and ongoing monitoring of infection prevention practices in affected areas/units. ☒Required c) ☐Optional Provide continued assistance until infection control gaps have been addressed. ☒Required ☐Optional IV. Strategy 1b, 1d, 1g: Enhance other aspects of epi-lab coordination not already covered in Strategies I and II. (For complementary strategies and activities directed toward public health laboratories, see the separate guidance for the AR Lab Network.) a) Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. ☒Required b) ☐Optional Facilitate connections between facilities or clinical laboratories and public health labs to ensure appropriate isolates are forwarded to the regional AR laboratory for targeted surveillance activities ☒Required ☐Optional V. Strategy 1a, 1b, 1c, 1d, 1g: Use data for action (e.g., NHSN, Emerging Infections Program [EIP], AR Lab Network, Targeted Assessment for Prevention [TAP], triangulation of multiple data sources). a) Identify and use data sources to inform prevention and response activities. i. Demonstrate access to NHSN (or equivalent data) and state/local data. Strong applications will reflect access to HAI data sufficient to define regional epidemiology. ii. Use NHSN data in conjunction with state/local data to identify healthcare facilities and networks (e.g., acute care facilities, long- term acute care hospitals [LTACHs], nursing homes) with high incidence of selected HAIs (e.g., CDI) to facilitate prevention. ☒Required b) Identify and implement mechanisms to detect emerging MDROs within the jurisdiction (e.g., sentinel lab/facility surveillance) and to define local and regional epidemiology. ☒Required c) ☐Optional ☐Optional Use data to inform the HAI advisory committee structure, membership, and priorities. (See Area C for additional guidance for the HAI advisory committee. This activity in Area A refers to how data are used to determine structure, membership, and priorities of the committee. Area C, Strategy IV refers to minimum expectations of the committee.) i. Ensure that membership includes stakeholders with expertise in areas identified by data as high priority. Strong applications will explain the rationale for how committee members TX-DSHS-19-1309-A-000427 135 ii. were selected based on an identified priority need. For example, if data indicate that dialysis bloodstream infections (BSIs) are high priority, then the committee should include someone with dialysis expertise. HAI advisory committee should use data to help define jurisdiction priorities for HAI prevention and response to AR. Strong applications will specify these priorities. ☒Required d) [Tier 2] Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries will only be considered for funding if the work plan addresses these requirements and articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. ☐Required e) ☐Optional ☒Optional [Tier 2] Conduct data validation to inform prevention. Preference for funding will be given to Recipients that will conduct their own validation rather than contracting for services. Recipients are expected to conduct some prior analysis of their state NHSN data to identify HAIs at priority need for external validation. Recipients are required to identify 2 HAIs that will be validated during a funding year. In addition to the inpatient facility-based HAI validation, recipients are strongly encouraged to conduct Dialysis Event validation and Long Term Care Facility HAI validation at least once during the current cooperative agreement cycle. i. Conduct health department validator training to enhance workforce capacity for HAI. ii. Assure competency in data validation and NHSN methods and definitions via certificates of completion of in-person or online training iii. Prior to data validation, conduct an analysis of jurisdiction's data to target the HAIs, facilities, and records to be validated. iv. During validation, assess local surveillance data quality, HAI surveillance data completeness, timeliness, sensitivity and specificity and identify reporter training needs. v. After validating, produce a HAI validation report and an assessment of each guidance component, and provide feedback to facilities to have them correct their data in NHSN and provide user trainings to prevent future case misclassification. vi. After validating, produce a HAI validation report, an assessment of each guidance component, quantitative information, and recommended modifications. vii. Identify ongoing barriers among healthcare facilities to produce required line-listing information linking laboratory and admissions data. Provide recommendations for reducing barriers. viii. Identify ways to ensure secure transmission of spreadsheet data from healthcare systems to health department. TX-DSHS-19-1309-A-000428 136 ix. Build and foster data validation collaborations for improving upon tools and guidance. Strengthen partnerships with healthcare facilities by demonstrating transparency of validation processes. ☐Required I VI. ☒Optional AREA B: PREVENTION AND INTERVENTION Strategy 2a: Implement data-driven prevention strategies. a) Conduct ongoing onsite assessments and gap mitigation in long length-of-stay, high-acuity facilities (e.g., skilled nursing facilities that provide ventilator care [vSNF], LTACHs) or others (e.g., dialysis facilities, outpatient facilities), based on identified needs (e.g., poor infection control practices), with the goal to improve infection control practices to reduce transmission of selected MDROs or reduce HAIs. Assessments will require direct observation. Note that this activity is complementary to but distinct from Area A, Strategy III. (Area A, Strategy III focuses on facilities where targeted AR threats or outbreaks have been identified. Area B, Strategy I focuses on facilities at high risk for AR threats or outbreaks). Strong applications will include clear rationale (including data when available) for selection of settings. ☒Required b) ☐Optional [Tier 2] Implement a targeted prevention project addressing MRSA BSIs or CDI, which involve transmission across facilities, based on data-identified need. The goal of this project is to reduce the burden of selected HAIs in facilities with high rates. Selected HAIs may include MRSA BSIs, CDI, or both. Recipients may select one or both of the following sub-activities. i. Implement TAP Strategy (https://www.cdc.gov/hai/prevent/tap.html), including but not limited to 1) running TAP reports to target facilities, 2) assessing gaps in infection control, and 3) implementing prevention measures. Recipients should target facilities based on need (e.g., higher standardized infection ratio [SIR] or cumulative attributable difference [CAD]) with goal of reducing overall regional incidence of selected HAI. Outcome measure must be completed pre- and post-intervention. For most jurisdictions the minimum expectation is 10 facilities, but the target number should reflect jurisdiction size and funding (e.g., larger jurisdictions with higher funding should include more facilities). CDC is available for consultation to determine an appropriate number of minimum facilities. Strong applications will include all three TAP components; specify the selected HAI(s) and number of facilities needed to reach a jurisdiction-wide standardized infection ratio (SIR) goal for a given HAI; and describe data or other rationale to select an HAI for TAP implementation. ii. Lead or actively support implementation of prevention Collaborative(s). Strong applications will include clear explanation of participants and roles/responsibilities, reduction goals, interventions to be implemented, and methods for baseline, process, progress, and outcome measurements. Facility participants should be targeted based on need (e.g., higher SIR or CAD) with the goal of reducing overall regional incidence of selected HAI. Outcome measure must be completed pre- and post-intervention. For most jurisdictions the minimum expectation is 10 facilities, but target number should reflect jurisdiction size and TX-DSHS-19-1309-A-000429 137 funding (e.g., larger jurisdictions with higher funding should include more facilities). CDC is available for consultation to determine an appropriate number of minimum facilities. ☐Required c) [Tier 2] Continue work with partners across settings for prevention of device- and procedureassociated infections (CAUTI, CLABSI, dialysis BSI, surgical site infection). Recipients may select one or both of the following sub-activities. i. Implement the TAP Strategy (https://www.cdc.gov/hai/prevent/tap.html), including but not limited to 1) running TAP reports to target facilities, 2) assessing gaps in infection control, and 3) implementing prevention measures. Recipients should target facilities based on need (e.g., higher standardized infection ratio [SIR] or cumulative attributable difference [CAD]) with goal of reducing overall regional incidence of selected HAI. Outcome measure must be completed pre- and post-intervention. For most jurisdictions the minimum expectation is 10 facilities, but target number should reflect jurisdiction size and funding (e.g., larger jurisdictions with higher funding should include more facilities). CDC is available for consultation to determine an appropriate number of minimum facilities. This strategy may involve deployment of TAP for multiple HAIs based on data-identified need. Strong applications will include all three TAP components; specify the selected HAI(s) and number of facilities needed to reach a jurisdiction-wide standardized infection ratio (SIR) goal for a given HAI; and describe data or other rationale to select the HAI(s) for TAP implementation. Note: for dialysis facilities, use the NHSN Excess Infections report (i.e., CAD) to help target facilities for prevention and utilize CDC recommended interventions and tools to facilitate BSI prevention. ii. Recipients may propose other prevention projects not addressed elsewhere. Proposed activities should be compatible with program goals and public health needs but may not include research. Strong applications will specify the selected HAI(s) and setting(s), reduction goals, interventions to be implemented, and methods for baseline, process, progress, and outcome measurements. ☐Required VII. a) ☒Optional ☒Optional Strategy 2a: Implement antibiotic stewardship efforts Facilitate core element implementation in designated settings. Core elements should be applied in the setting for which they were designed i. Participate each year in CDC's U.S. Antibiotic Awareness Week observance. ii. Distribute CDC's Core Elements and materials from Be Antibiotics Aware: Smart Use, Best Care to local partners, providers, healthcare systems, and the general public (year round). iii. Provide access to education and expertise on antibiotic stewardship across the spectrum of health care. iv. Coordinate activities with quality improvement programs (e.g., Quality Innovation Networks-Quality Improvement Organizations [QIN-QIOs], Hospital Improvement TX-DSHS-19-1309-A-000430 138 v. Innovation Networks [HIINs]), hospital associations, state professional societies, and other key partners. Monitor state-level outpatient antibiotic use and use of selected antibiotic classes (e.g., fluoroquinolones) in order to inform dissemination strategies and collaborative activities. Data can be obtained from CDC's Antibiotic Resistance Patient Safety Atlas at https://gis.cdc.gov/grasp/PSA/indexAU.html ☒Required b) ☐Optional [Tier 2] Implement targeted project to improve antibiotic use. Recipients may select any of the following sub-activities. i. Analyze state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, such as providing feedback to providers on antibiotic prescribing practices or identifying facilities with significant opportunities to improve antibiotic use. ii. Implement and evaluate evidence-based, local-level interventions, such as those from CDC's Core Elements, to improve antibiotic prescribing in human healthcare settings. For settings for which there are no core elements, Recipients should work with CDC SMEs on appropriate strategies for that setting. Strong applications should be scaled in regards to the number of facilities reached based on the type of facility included in interventions, size of the jurisdiction, and intensity of the interventions. Additionally, strong applications should target facilities or providers with the most opportunities and need to improve antibiotic use. iii. Engage policymakers and support development of new state or local policies that encourage antibiotic stewardship implementation and/or tracking of human antibiotic use data. Examples of such policies could include (1) requirements for antibiotic stewardship programs in hospitals and/or nursing homes, (2) requirements for hospital antibiotic use reporting into the NHSN AU module, and (3) requirements for making antibiotic prescriptions reportable to health departments through prescription drug monitoring programs (PDMPs) or through other reporting mechanisms. ☐Required ☒Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I VIII. a) Strategy 3a: Sustain HAI/AR capacity to implement program (HAI coordinator, AR/AS expert). The HAI coordinator should assure HAI prevention through coordination throughout the jurisdiction (including for containment and response); epi-lab collaboration, including but not limited to coordination with the AR Lab Network regional lab, and use of the Targeted Assessment for Prevention; serve on the ELC governance team to monitor HAI program performance and spending; and serve as the primary point of contact for HAI communications with and reporting to CDC. ☒Required ☐Optional TX-DSHS-19-1309-A-000431 139 b) The AR/AS expert should provide senior-level expertise (e.g., doctoral level or equivalent experience) in epidemiology and infection prevention with proficiency in AR/AS and data for action. The expert should lead program and policy development to reduce AR infections and implement AS; provide expertise in infectious diseases, HAIs, and AR; lead and oversee in the development and implementation of locally relevant public health interventions and prevention guidelines that include AS and control of CDI, CRE, or MDROs; and lead the development and implementation of containment strategies for the jurisdiction. ☒Required IX. a) Strategy 3a: Engage public health and healthcare providers Building upon work previously funded through the Ebola supplement, maintain and update as needed an inventory of all healthcare settings in the jurisdiction. Use this inventory to guide outreach for containment, response, and prevention activities. ☒Required b) ☐Optional Providing training and support for local health departments in investigations in healthcare settings, control of targeted MDROs, and prevention of HAIs. ☒Required d) ☐Optional Provide education/training on infection control for healthcare facilities on prevention of HAIs and control of targeted MDROs. ☒Required c) ☐Optional ☐Optional Improve onsite assessment capacity by developing expertise in facility assessment designed to improve infection prevention and control in outpatient or high-acuity, post-acute care settings. Examples of activities include training staff in conducting assessments or hiring, contracting with, or collaborating with infection prevention experts. ☒Required ☐Optional X. Strategy 3a: Coordinate prevention activities with partners (e.g., health systems, hospital associations, quality improvement programs such as QIN-QIOs and HIINs, Epicenters, EIP, local health departments, regulatory/licensing entities, ESRD networks) a) Identify and engage with partners for prevention activities. Strong applications will define specific roles and responsibilities of the Recipient and those of the partners. ☒Required b) ☐Optional Jurisdictions with EIP catchment areas: Establish plans to share data and findings related to surveillance activities and projects and outbreaks. Funding requests should be of sufficient detail to demonstrate TX-DSHS-19-1309-A-000432 140 there is no overlap with EIP-funded activities and that ELC funds will not be used for research purposes. ☒Required ☐Optional XI. Strategy 3a: Convene HAI advisory committee. The committee should include local stakeholders, and representatives from the state and/or regional public health laboratories, state survey agency, hospital/emergency preparedness, and patient representatives. As stipulated in Core Area A, Strategy IV.c, data should inform advisory committee structure, membership, and priorities. a) Assign strategies, roles, and responsibilities of members. b) ☒Required ☐Optional ☒Required ☐Optional Update the HAI plan regularly. Collaborations a. With CDC-funded Programs: Recipients are expected to coordinate planning, execution, and management of activities with laboratories funded under the ELC program (i.e., both state and regional laboratories in the AR Lab Network (as stipulated in core area A, strategies I, II, and IV) and relevant other ELC-funded programs (e.g., with Project I. Mycotics, for containment of Candida auris). Recipients are also expected to collaborate and ensure alignment with the CDC-funded Emerging Infections Program sites, Prevention Epicenters, and partnering collaborations. b. With organizations external to CDC: Recipients should collaborate with other health agencies, clinical or other partnering laboratories, hospitals and other facilities, public health (state, city, county, local) health partners, Centers for Medicare & Medicaid Services-funded networks (e.g., QIN-QIOs, HIINs), Hospital Preparedness Program, hospital associations, academic partners, and others to maximize detection and prevention efforts, make progress toward national targets, and reduce duplication of efforts. Target Populations: N/A Evaluation and Performance Measurement: Recipients are expected to report the performance measures in January 2020 and September 2020, and at the time of continuation applications when the emphasis will be on the narrative reporting. Recipients will also be expected to share progress of implementation of work plans (including but not limited to hiring of personnel or execution of contracts) as well as status of spending during regularly scheduled (i.e., at least quarterly) updates to CDC program personnel. Performance measure details including rationale, data elements, and additional guidance will be communicated to recipients in a separate document. Performance measure details will be communicated to recipients in a separate document. An abbreviated list is included below. TX-DSHS-19-1309-A-000433 141 1. Number of clinical laboratories engaged to improve testing 2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy 3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type 4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type a. Of the facilities where proactive onsite infection control assessments were conducted: Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type 5. Number of facilities the Recipient or a designee engaged to facilitate core element implementation, by facility type a. Of the facilities engaged by the Recipient or a designee to facilitate core element implementation: Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type 6. Status of state’s HAI plan 7. Confirmation of update to inventory of all healthcare settings in the jurisdiction Tier 2 (Measures #8-10) I 8. 9. 10. Number of facilities implementing TAP Strategy, by facility type Implementation of HAI prevention Collaboratives Implementation of targeted project to improve antibiotic use TX-DSHS-19-1309-A-000434 142 G2: Antibiotic Resistance Laboratory Network (AR Lab Network) Program Activity Contact Information ARLN@cdc.gov Funding Opportunity Description Background a. Overview The goals of the Healthcare-associated Infection (HAI)/Antibiotic Resistance (AR) Program are to prevent HAIs to protect patients and healthcare personnel; to advance the detection, response, and containment of AR; and to promote antibiotic stewardship (AS), to ensure safety, quality, and value in healthcare delivery systems. Related epidemiology activities are described in G1, Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship, while laboratory activities are described here in G2, Antibiotic Resistance Laboratory Network (AR Lab Network). The AR Lab Network builds laboratory capacity for early detection of drug-resistant pathogens and public health infrastructure for rapid response to stop transmission, which are critical components of effective strategies for preventing the spread of AR. b. Healthy People 2020 Healthcare-associated Infections (HAIs)/AR objectives have been established for Healthy People 2020 that reflect the commitment of the U.S. Department of Health and Human Services (HHS) to prevent and reduce HAIs/AR. c. Other National Public Health Priorities and Strategies Detecting and preventing HAIs and AR is a cross-cutting federal priority. The National Strategy for Combating Antibiotic-Resistant Bacteria and companion National Action Plan articulate national goals, priorities, objectives, milestones, and reduction targets that provide an overarching framework for federal investments aimed at combating antibiotic-resistant bacteria and Clostridioides difficile infections. Key strategies include detecting and responding to emerging threats from antibiotic-resistant organisms, and containing outbreaks within healthcare facilities. CDC Project Description a. Problem Statement: AR causes more than 2 million illnesses and 23,000 deaths in the United States annually. Combating AR requires early detection of new resistance and robust prevention efforts, including early outbreak detection and response. Creating state and regional laboratory capacity to detect antibiotic-resistant bacteria and fungi will improve the ability to implement timely local prevention efforts and to develop national strategies that limit transmission of resistant pathogens and prevent infections. Some AR threats like carbapenem-resistant Enterobacteriaceae (CRE) are resistant to nearly all available therapeutic agents and require enhanced detection and infection control measures to prevent the spread of infections. For other pathogens, like resistant Neisseria gonorrhoeae, and Candida species, detection of resistance is challenging because antibiotic susceptibility testing is not routinely performed in hospital or other laboratories. In these cases, resistance data are needed to identify outbreaks, prevention measures, and to develop treatment guidelines. Streptococcus pneumoniae infections are decreasing because of an effective TX-DSHS-19-1309-A-000435 143 vaccine, but new resistant strains may emerge that are not protected by the vaccine. Early detection of these serotypes will help to keep the vaccine up-to-date. Detecting resistance in slow-growing bacteria, like Mycobacterium tuberculosis (Mtb), requires implementing new rapid methods, like whole genome sequencing (WGS), to identify critical resistance and to provide molecular typing data for tracking transmissions during outbreaks and for ongoing surveillance. b. Purpose: The AR Lab Network builds lab capacity to rapidly detect AR in healthcare and the community, and inform local responses to prevent spread and protect people. The AR Lab Network includes public health labs in all 50 states and Puerto Rico, including seven regional labs and the National Tuberculosis Molecular Surveillance Center (National TB Center). State and local laboratories will build or sustain capacity to detect and support response to concerning resistance. As a whole, the network tracks changes in resistance and helps identify and respond to outbreaks faster. c. Outcomes: Implementation of AR Lab Network activities will result in: • Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods • Rapid identification and containment of AR threats including novel resistance • Timely and effective response to HAI/AR outbreaks • Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts • Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response • Enhanced molecular surveillance of antibiotic resistance of Mtb • Enhanced capacity for detection of outbreaks and transmission of Mtb Funding Strategy: Recipients should utilize funds for personnel, supplies, equipment, contractual support, or travel for proposed activities. Shipping costs for AR Lab Network activities are funded by CDC separately. If funding is requested for shipping supplies or the use of a courier service, please provide details and/or justification. Applicants should make clear in their budget requests which strategies and activities will be supported by the requested funding as well as provide justification for why these activities are needed; failure to do so may result in failure to receive funding. Recipients should be aware that future funding decisions will be based on measurable progress, as reported by progress made toward desired outcomes, performance measures, and semi-annual updates to CDC. All applicants are eligible to apply for Tier 2 activities. Priority for funding Tier 2 required and optional activities will be given to applicants who demonstrated progress during the prior ELC funding cycle; propose feasible plans that reflect the program’s capacity, and explain how performance measures will be addressed and reported. Tier 1: Basic funding for minimum required activities as described in guidance. All activities under Tier 1 are required for all applicants. (Activities I. – IV.) TX-DSHS-19-1309-A-000436 144 • Estimated total availability of funds: $2,500,000 • Estimated number of awards given: 56 • Estimated average per award: $44,000 Tier 2: Enhanced laboratory capacity. CDC will fund up to 56 recipients to perform enhanced lab activities in addition to core activities under Tier 1, as described in the guidance. Applying for Tier 2 is optional, but encouraged. Tier 2 applicants must apply for Activity V.a., all other activities are optional. Note that average award may vary depending on number of awards given. Activities V.a.-V.c.: • Estimated total availability of funds: $2,250,000 • Estimated number of awards given: up to 56 • Estimated average per award: $40,000 Activity V.d.: Whole genome sequencing of CRE, CRPA, or other healthcare associated organisms • Estimated total availability of funds: $250,000 • Estimated number of awards given: up to 5 • Estimated average per award: $50,000 Tier 3: (Activities VI. – XII.) AR Lab Network regional labs-CDC will fund up to 7 regional labs to support AR Lab Network regions (https://www.cdc.gov/drugresistance/solutions-initiative/ar-lab-networks.html#about) and activities. Candidates for regional lab funding are not limited to laboratories that previously received funding for regional lab activities. • Estimated total availability of funds: $14,000,000 • Estimated number of awards given: 7 • Estimated average per award: $2,000,000 National TB Molecular Surveillance Center. CDC will fund one public health laboratory to provide WGS and 24locus MIRU-VNTR for all Mtb isolates from culture-confirmed cases of TB in the United States for surveillance of resistance determinants and transmission. Applying to be the National TB Molecular Surveillance Center is optional, but all related activities are required. • Estimated total availability of funds: $1,800,000 • Estimated number of awards given: 1 • Estimated average per award: $1,800,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I Tier 1: Core AR lab activities for all jurisdictions applying for AR Lab Network funding I. a) Strategy 1e: Enhance and sustain laboratory testing for surveillance and reporting Increase or sustain laboratory capacity to perform CLIA-compliant organism identification and carbapenemase production testing on Carbapenem-resistant Enterobacteriaceae (CRE), including at TX-DSHS-19-1309-A-000437 145 least E. coli, Enterobacter, and Klebsiella, and a proportion of Carbapenem-resistant Pseudomonas aeruginosa (CRPA) isolates, as recommended by CDC. ☒Required b) Increase or sustain laboratory capacity to perform CLIA-compliant carbapenem-resistance mechanism testing on CRE (at least E. coli, Enterobacter, Klebsiella, and Citrobacter) and a proportion of CRPA isolates for the most common and important resistance mechanisms (e.g., PCR detection of KPC, NDM, VIM, OXA-48-like OR Cepheid CARBA-R panel) as recommended and updated annually by CDC. ☒Required c) ☐Optional Submit data, at least monthly, to CDC via APHL Informatics Messaging Services platform (AIMS) or CDCprovided templates. Participate in data reconciliation confirmation of counts and data quality. Communicate any test results defined as an “alert” by CDC (e.g., novel or high-concern resistance), within one business day to CDC and the state/local HAI/AR epidemiologist(s). ☒Required II. ☐Optional Store bacterial isolates for a minimum of two years. Transport isolates of interest (as defined or specifically requested by CDC) to AR Lab Network regional lab and/or to CDC for further characterization or to CDC for deposit in a CDC repository. ☒Required e) ☐Optional Report testing results to submitting clinical laboratory within two working days of testing completion. ☒Required d) ☐Optional ☐Optional Strategy 1a: Sustain AR capacity to implement program AR Lab Network Activities a} An AR lab expert should clearly demonstrate expertise in AR testing (particularly focused on AR Lab Network guidance) and data reporting for the jurisdiction. Additionally, the AR lab expert should: i. have knowledge of resources available at the AR Lab Network regional lab and how and when to access that testing, ii. assure coordination between state and local HAI/AR programs and the AR Lab Network regional lab, iii. facilitate submission of isolates and other specimens to the local, state, and/or regional lab, iv. facilitate submission of testing data to CDC, and v. serve as primary point of contact for AR Lab Network communications with CDC. ☒Required b) ☐Optional Train and educate laboratorians and maintain adequate workforce to perform CRE and CRPA testing. ☒Required ☐Optional TX-DSHS-19-1309-A-000438 146 III. a) Strategy 1g: Improve laboratory and epidemiology coordination and outreach Coordinate epidemiology and laboratory functions at state, city, county, and local levels, as well as with the AR Lab Network regional lab. ☒Required b) Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. The plan should include the list of prioritized antibiotic resistant organisms and mechanisms, based on the epidemiology of the jurisdiction. States that participate in the Emerging Infections Program Healthcare-Associated Infections-Community Interface Activity (EIP HAIC) should demonstrate efforts to enhance relationships and collaboration with EIP HAI/AR staff. ☒Required c) a) ☐Optional Strategy 1h: Advance electronic information exchange implementation Develop testing and communication protocols, reporting processes, and IT infrastructure to ensure timely testing and reporting of results to submitting laboratories, state prevention epidemiologists, jurisdictional public health laboratories, and CDC. ☒Required b) ☐Optional Facilitate coordinated connections with clinical laboratories in the state or jurisdiction to solicit isolates requested from the AR Lab Network regional lab for targeted surveillance activities (Tier 3, Strategy 1, Activity b) and for Candida activities (Tier 3, Strategy 1, Activity d). ☒Required IV. ☐Optional Coordinate connections with clinical laboratories serving the state or jurisdiction to solicit CRE and CRPA isolates from healthcare facilities (including short- and long-term acute care facilities) with specific focus on laboratories that serve high risk settings as defined by or in coordination with CDC. Provide outreach and technical assistance to clinical microbiology laboratories to improve the detection of targeted organisms, including timely submission and reporting of results. ☒Required d) ☐Optional ☐Optional Work with APHL to implement or sustain reporting using APHL Informatics Messaging Services (AIMS) platform. ☒Required ☐Optional Tier II: Enhanced activities. Applicants may apply for funding to address the enhanced laboratory activities described below in addition to required Tier 1 core activities. TX-DSHS-19-1309-A-000439 147 V. a) Strategy 1e: Expand and sustain AR Lab testing and reporting Increase or sustain laboratory capacity to perform CLIA-compliant routine confirmatory antibiotic susceptibility testing on CRE and a proportion of CRPA isolates, in accordance with CDC guidance. This testing would be in addition to the organism identification, carbapenemase production testing and carbapenem-resistance mechanism testing described under Tier 1. ☒Required b) Increase or sustain scope of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1. ☐Required c) ☒Optional Increase or sustain laboratory capacity to conduct reference identification of Candida spp. using MALDI-TOF or DNA-based methods. ☐Required d) ☐Optional ☒Optional Up to five non-regional public health laboratories may be funded to perform coordinated by CDC to support epidemiologic investigations in their state. These labs must be able to demonstrate sequencing capacity and follow guidance and training recommendations put forth by CDC. Sequencing priorities would be set by CDC, in accordance with emerging threats and current WGS capacities. CDC will provide resources and bioinformatics support for analysis of WGS data. ☐Required ☒Optional Tier III: Antibiotic Resistance Lab Network Regional Laboratories: Applying to be an AR Lab Network regional lab is optional, but for those that apply, note that all activities except those under Strategy VI below are required. VI. a) Strategy 1e: Expand and sustain AR lab testing and reporting for surveillance In collaboration with CDC, provide CLIA-compliant organism identification, antibiotic susceptibility testing, carbapenemase production testing, and molecular detection of resistance mechanisms for new, unusual or emerging AR threats, including isolates suspected of carrying novel resistance mechanisms sent from state and local laboratories within the region. Guidance for required mechanism testing directory will be set by CDC. ☒Required b) ☐Optional Perform targeted surveillance for emerging or changing AR threats (e.g. mobile colistin resistance or carbapenemase genes), as directed by CDC, using lab testing to fill gaps in detection and containment. i. Lab will perform coordinated public health surveillance for CDC-targeted AR pathogens. This surveillance will involve CDC-directed collection of isolates, swabs or waste clinical specimens from a network of collaborating clinical laboratories throughout the jurisdiction, with results shared with submitting laboratories and CDC. Some specified isolates will be TX-DSHS-19-1309-A-000440 148 shared with CDC for additional characterization. Techniques may include isolation of bacterial isolates from swabs or other clinical specimens, bacterial identification, antibiotic susceptibility testing, and molecular characterization (e.g., PCR or whole genome sequencing). ☒Required c) Conduct reference identification and susceptibility testing of Candida spp. Funded labs will use MALDITOF or DNA-based methods for identification and CDC-recommended antifungal susceptibility testing methods to characterize 1,000 to 2,000 Candida spp. isolates annually. Regional laboratories will collect isolates from a diverse range of hospitals and other healthcare settings in their region to ensure wide surveillance coverage. ☒Required d) a) ☐Optional Submit testing data at least monthly to CDC via APHL Informatics Messaging Services (AIMS) platform. Participate in data reconciliation confirmation of counts and data quality. For any results defined as an “alert” by CDC (e.g., novel or high-concern resistance), communicate results within one business day to CDC and the state/local HAI/AR program. ☒Required VII. ☐Optional Sustain/implement specimen storage and isolate transport per CDC guidance or upon request (e.g., isolates which harbor new or unusual resistance, a subset of isolates including representative isolates from outbreaks) for additional characterization and potential inclusion in CDC specimen repositories. ☒Required e) ☐Optional ☐Optional Strategy 1d: Expand and sustain AR lab testing for response Provide regional laboratory support for state-led epidemiologic investigations and HAI/AR prevention efforts focused on carbapenemase-producing organisms (CPOs) by performing molecular tests, including CDC-recommended commercial assay(s), to detect colonization for CPOs. Regional labs will work with state/local epidemiologists or HAI/AR prevention programs to facilitate collection and transportation of specimens for colonization testing to ensure timely testing of specimens (e.g., ≤ two working days’ time to reporting molecular results). AR Lab Network regional labs will: i. work with state HAI/AR programs to transport collection kits to healthcare facilities where swabbing for colonization testing will take place, ii. provide advice to healthcare facilities and personnel on the collection and transportation of specimens, iii. have specimens collected at healthcare facilities sent directly from healthcare facilities to the regional lab, iv. test and report results to the jurisdictional public health department and laboratory and submitting healthcare facility within two working days of specimen receipt, and v. submit colonization testing data to CDC, via AIMS, at least monthly TX-DSHS-19-1309-A-000441 149 ☒Required b) At the direction of CDC, laboratories will perform C. auris colonization screening testing to support surveillance activities and outbreak investigations occurring within the region. AR regional labs will: i. Work with state HAI/AR program to transport collection swabs to healthcare facilities where swabbing for colonization testing will take place, ii. provide advice to healthcare facility laboratories on the collection and transportation of specimens, iii. have specimens collected at healthcare facilities sent directly from healthcare facilities to the regional lab, iv. test and report results to the jurisdictional public health department and laboratory and submitting healthcare facility in timeframe consistent with CDC guidance, and v. submit colonization testing data to CDC at least monthly. ☒Required c) ☐Optional Demonstrate surge capacity. Accept specimens for testing from outside of the region when CDC determines that a public health need exists and alternative testing capacity is limited or unavailable. The testing volume and turn-around time will be determined in collaboration with CDC. ☒Required f) ☐Optional Perform whole genome sequencing for HAI/AR pathogens to support epidemiologic investigations in the region. Labs must be able to demonstrate sequencing capacity and follow CDC guidance and training recommendations. Sequencing priorities will be determined by CDC, in accordance with emerging threats and current WGS capacities. CDC will provide resources and bioinformatics support for analysis of WGS data. ☒Required e) ☐Optional Implement or sustain CDC-directed reference antibiotic susceptibility testing to new antibiotic agents by broth microdilution (BMD) of pan-resistant or nearly pan-resistant bacteria. CDC will purchase and provide equipment to the labs for creating on-demand BMD panels and work with CDC to obtain drug powders for antibiotic susceptibility testing. Labs will validate testing and establish capacity to test up to 150 isolates per year. Testing and reporting results to submitters and CDC will be timely. ☒Required d) ☐Optional ☐Optional Report all colonization screening results to submitters within one day of testing completion. Report all targeted surveillance testing results at least monthly to submitting laboratories and the jurisdictional HAI programs. Submit colonization screening and targeted surveillance data at least monthly to CDC via APHL Informatics Messaging Services platform (AIMS). Participate in data reconciliation confirmation of counts and data quality. For any results defined as an “alert” by CDC (e.g., novel or TX-DSHS-19-1309-A-000442 150 high-concern resistance), communicate results within one business day of the result to CDC and to local/state HAI/AR epidemiologist(s) of the originating jurisdiction. ☒Required VIII. a) Strategy 1a: Sustain workforce capacity to implement AR Lab Network regional lab activities Train laboratory personnel to demonstrate competency and proficiency for performing all AR tests (e.g., antibiotic susceptibility testing, detection of resistance mechanisms, and advanced molecular diagnostics, such as whole genome sequencing, to detect resistance and addressing the genetic relatedness of bacterial isolates) available in their test directory. ☒Required IX. a) ☐Optional Offer troubleshooting expertise or training for laboratory personnel conducting AR testing in regional state or local AR lab network funded public health laboratories, as needed/requested. ☒Required e) ☐Optional Implement AR-related consultations and results interpretation for facilities, designated outbreak and prevention program staff, and partners, and other network clinical or public health laboratories. ☒Required d) ☐Optional In collaboration with CDC programs, establish a project plan and protocol for collection of specimens and/or isolates from healthcare facility, other clinical microbiology laboratories, or other settings like sexually-transmitted disease clinics, for: i. Clinical isolates requiring specialized testing [e.g., CRE, and CRPA, Candida spp., and MDRStreptococcus pneumoniae (for AR regional labs conducting this testing), and ii. Outbreak detection requested through state or local health authorities (CPO, C. auris, and other pathogens as needed and resources permit) ☒Required c) ☐Optional Strategy 1g: Improve laboratory and epidemiology coordination and outreach A regional epidemiologist should work closely with regional laboratory staff and state HAI/AR epidemiologists throughout the region to recruit and coordinate sample submissions and testing, and use of data for containment and prevention activities, using elements and guidance provided by CDC. ☒Required b) ☐Optional ☐Optional Host a regional partnership meeting for state HAI/AR prevention programs and public health laboratories within the region. ☒Required ☐Optional TX-DSHS-19-1309-A-000443 151 f) Participate in regularly scheduled conference calls with CDC to discuss AR concerns, emerging issues, protocol plans, etc. ☒Required X. a) Strategy 1h: Advance electronic information exchange implementation Develop or sustain processes and IT infrastructure for timely reporting to submitting facilities, state or local public health laboratories, epidemiologists, regional AR prevention partners, and CDC for the following: i. Clinical isolates requiring specialized testing (e.g., pan-resistant organisms, CPOs, and Candida spp.) ii. Outbreak detection requested through state or local health authorities (CPOs, C. auris, and other pathogens as needed and resources permit) iii. Representative sets of isolates to describe estimates of scope and magnitude of specific AR threats and mechanisms for resistance (Neisseria gonorrhoeae, Candida spp., and MDRStreptococcus pneumoniae for regional labs conducting this testing) ☒Required b) a) ☐Optional Work with APHL to implement or sustain reporting using APHL Informatics Messaging Services (AIMS) platform and Lab Web Portal for applicable testing. Lab Web Portal should be implemented using sync services and not HL7. ☒Required XI. ☐Optional ☐Optional Strategy 1e: Implement or maintain additional laboratory capacity (some regional labs) Establish or sustain laboratory capacity for N. gonorrhoeae resistance surveillance by performing AST on up to 5,000 isolates and WGS for up to 1,250 isolates per funded laboratory annually. i. Preference will be given to laboratories that have demonstrated proficiency in antibiotic susceptibility testing of N. gonorrhoeae using agar dilution and β-lactamase testing in accordance with methods recommended by CDC’s Division of STD Prevention (http://www.cdc.gov/std/gisp/gisp-protocol-feb-2015_v3.pdf), and those with capacity to manage data and report results as required by project protocols. ii. Funded labs must comply with CDC’s GC AR surveillance data reporting, data quality management, and specimen submission protocols (See hyperlink above). iii. Work plan must address/describe processes for ensuring timely AST and maintaining data integrity (data QC-check) at all stages. CDC recommends importing manifests from submitters into LIMS Labs that hand-enter data from submitter manifests must implement processes to ensure data entry accuracy. iv. Testing will be done on isolates sent from STD surveillance clinic sites (GISP and eGISP) and from state public health laboratories funded for the rapid detection and response program (SURRG). TX-DSHS-19-1309-A-000444 152 v. vi. vii. viii. ix. x. Funded regional laboratories must complete AST and communicate non-alert antibiotic susceptibility testing results to submitters or designates within 3 weeks of submission or as otherwise directed by CDC. For any results identified as a defined “alert” by CDC (i.e. resistant or emerging resistance) funded laboratories must communicate results within one business day to both CDC and submitters. Funded laboratories will also submit data routinely (at least monthly) to CDC via APHL Informatics Messaging Services platform (AIMS). AR Lab Network laboratory staff will participate in semi-annual agar dilution proficiency assessments administered by CDC. Sequencing priorities would be set by CDC. WGS data will be transmitted to CDC within one month of AST testing; CDC will provide resources and bioinformatics support for analysis of WGS data. These sequence data will be used to detect and characterize isolates with unique antibiotic susceptibility patterns and to strengthen epidemiologic investigations through sexual network analysis. Funded laboratories must store gonorrhea isolates for at least 2 years, and transport all isolates at least two times per year to CDC for further characterization or to deposit in a CDC Biorepository. ☐Required b) Antibiotic susceptibility testing and serotyping of MDR-Streptococcus pneumoniae (up to 500 isolates per year). Funded laboratories will perform whole genome sequencing (WGS) for up to 500 isolates per funded laboratory annually. These WGS data will be used to detect and characterize S. pneumoniae isolates with unique antibiotic susceptibility patterns. ☐Required c) ☒Optional ☒Optional Perform CDC-directed and coordinated public health assessments of emerging or changing epidemiology of Clostridium difficile by implementing culture capacity for clinical specimens and environmental specimens. As directed by CDC, apply advanced molecular detection testing to type isolated bacteria and to assess C. difficile transmission. ☐Required ☒Optional XII. Strategy 1e: Serve as the National TB Molecular Surveillance Center to enhance or sustain molecular testing of M. tuberculosis (Mtb) isolates for surveillance and reporting. a) Establish or sustain laboratory capacity for Mtb 24 locus MIRU-VNTR typing by testing approximately 9,000 isolates in total annually (from all 50 states and U.S. territories). Preference will be given to laboratories that have demonstrated proficiency in 24 locus MIRU-VNTR testing in accordance with methods recommended by CDC’s Division of TB Elimination. Testing will be done on isolates submitted from public health laboratories. The funded laboratory is expected upload the 24 locus MIRU-VNTR TX-DSHS-19-1309-A-000445 153 result into the web based TB Genotyping Information Management System within two weeks of submission. ☒Required b) Establish or sustain whole genome sequencing (WGS) of Mtb by sequencing approximately 9,000 isolates in total annually (from all 50 states and U.S. territories). The NextSeq sequencer is the preferred platform for this work. These sequence data will be used to conduct molecular surveillance of antibiotic susceptibility patterns and to strengthen epidemiologic investigations through transmission network analysis. Preference will be given to laboratories that have demonstrated proficiency In WGS testing of M. tuberculosis in accordance with methods recommended by CDC's Division of TB Elimination. WGS testing will be done in parallel with 24 locus MIRU-VNTR testing on isolates submitted from public health laboratories. The laboratory should transmit the WGS FASTQ file and run report to CDC within three weeks of submission. ☒Required c) ☐Optional ☐Optional Implement Mtb sample inventory storage system; prepare subcultures of all submitted isolates and provide transport to CDC within three months of submission for long term storage. ☒Required ☐Optional Collaborations a. With CDC-funded programs: Collaboration with CDC programs is expected to ensure implementation of approved or recommended methods and protocols that support national data needs. To ensure that efforts and activities are complimentary and minimize the burden on clinical laboratories, sites should coordinate their activities with: • Other ELC-funded Antibiotic Resistance Lab Network programs and initiatives, • ELC-funded HAI/AR Programs, • Emerging Infections Program (EIP) sites and initiatives, if present in their state or jurisdiction • APHL AIMS program implementation team collaborations • Prevention Epicenters and partnering collaborations b. With organizations external to CDC: Recipients should collaborate with other state or public health laboratories, clinical laboratories, and medical and/or public health academic centers to assure that efforts are being maximized while avoiding duplication of efforts. Target Populations: N/A Evaluation and Performance Measurement: Recipients are expected to report the performance measures in January 2020 and September 2020, and at the time of continuation applications when the emphasis will be on the narrative reporting. Recipients will also be expected to share progress of implementation of work plans (including but not limited to hiring of personnel or execution of contracts) as well as status of spending during regularly scheduled (i.e., at least quarterly) TX-DSHS-19-1309-A-000446 154 updates to CDC program personnel. Performance measure details including rationale, data elements, and additional guidance will be communicated to recipients in a separate document. I Tier 1 (Measures #1-7) Performance measure details will be communicated to recipients in a separate document. An abbreviated list is included below. 1. Characterization of the clinical laboratory network in jurisdiction 2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory 3. For results identified as a defined “alert” by CDC (e.g., novel or high-concern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction 4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory 5. Proportion of isolates tested, and number of isolates tested by genera 6. Number of isolates transported upon request to CDC 7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program I Tier 2 (Measures #8) I Tier 3 (Measures #10-15) 8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols 9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance 10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance 11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced 12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites 13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. 14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. 15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe TX-DSHS-19-1309-A-000447 155 H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Program Activity Contact Information General program inquiries and questions on this guidance: VBDELC@cdc.gov; Jeff Borchert, gqx1@cdc.gov; (970) 221-6494 Arbovirus diseases: Stacey Martin, zmt0@cdc.gov; (970) 494-6703 Lyme disease, plague, tularemia: Kiersten Kugeler, bio1@cdc.gov; (970) 225-4245 Rickettsial diseases: Kristen Nichols-Heitman, wwd7@cdc.gov; (404) 718-4670 Parasitic vector-borne diseases (non-malaria): Elizabeth Gray, djn8@cdc.gov; (404) 718-4725 Funding Opportunity Description Background a. Overview Vector-borne diseases, including those transmitted to humans by mosquitoes, ticks, fleas, and lice, are a large and growing public health problem in the United States. Mosquito-borne viruses such as West Nile virus (WNV) are often characterized by unpredictable and episodic epidemics that vary in place and time. Tickborne diseases, including but not limited to Lyme disease, have more than doubled in number and increased in geographic range over the last few decades. Timely surveillance and reporting, accurate diagnostics, and vector control are needed. This program supports sustainable, locally relevant vector-borne disease prevention programs to respond to the increasing threat of vector-borne diseases. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Vector-borne diseases, caused by a diverse array of pathogens, are transmitted to humans by various types of vectors. These recognized threats, as well as novel and emerging conditions, have increasingly challenged the public health programs tasked with preventing, detecting, reporting, and controlling them. b. Purpose: The purpose of this program is to support state and local health departments to implement and maintain accurate and relevant surveillance for human disease and their vectors, improve diagnostics, and to implement and evaluate prevention strategies. This program comprises all vector-borne surveillance and control activities related to pathogens transmitted by mosquitoes, ticks, fleas, and lice, thus replacing arboviral (M1), Lyme (N1), and non-Lyme tick-borne (N2) projects in past iterations of this cooperative agreement. Applicants should focus their proposed activities on the most important vectors and vector-borne diseases in their jurisdiction. c. Outcomes: 1. Improved laboratory capacity to support vector-borne disease surveillance. 2. Improved completeness and timeliness of reporting of vector-borne disease surveillance data to monitor the epidemiology, incidence, and geographic spread of vector-borne diseases. TX-DSHS-19-1309-A-000448 156 3. Improved ecologic surveillance to detect and monitor vector species distribution, abundance, infection, and insecticide resistance to inform vector control and public health response. 4. Increased availability of timely and accurate information on vector-borne disease risk and prevention to public health partners, healthcare providers, vector control agencies, decision makers, and the public. 5. More rapid and complete identification of vector-borne disease outbreaks to facilitate timely and effective control measures. 6. Better prepared workforce to identify, diagnose, report, prevent, and respond to vector-borne disease cases and outbreaks. Funding Strategy: Funds are intended to support building a comprehensive vector-borne disease program based on a threetiered approach that focuses on the most relevant vector-borne diseases in the jurisdiction. Jurisdictions should document that they have existing capacity at lower tiers, if applying for high tier activities. Activities may include: • Tier 1 activities: Required core capacity for locally-relevant vector-borne disease surveillance, laboratory and response across all jurisdictions receiving funds; • Tier 2 activities: Enhanced capacities for vector-borne disease laboratory testing, surveillance, or response across a sub-set of jurisdictions; • Tier 3 activities: Comprehensive capacity to serve as reference centers for vector-borne disease laboratory testing, and surveillance, response, and coordination with multiple external partners. A summary of the capacities associated with each tier appears in Project H Appendix 1. Recipients should utilize funds for any combination of personnel, travel, supplies, equipment, or contractual support needed to execute proposed activities in line with jurisdictional need and proposed capacity tier(s). Two separate budgets should be included; one budget for Tier 1 activities and one budget for Tier 2 and Tier 3 activities. • Estimated total availability of funds: $16,000,000 • Estimated number of awards given: 60 • Estimated average award amount: Approximately $266,000. The average award will depend upon the project activities (tiers) in which a jurisdiction participates. In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities. These jurisdictions must document capacity at lower tiers to be granted higher tier funding. Successful applications should include the following information: • Discussion of overall vector-borne disease burden and population at risk • Discussion on completeness of vector-borne disease reporting and demonstrated success with past CDC funding • Description of existing surveillance, laboratory and vector-control capabilities • Description and relevance of proposed activities • Description of current or planned collaborations with external partners and local health departments Additionally, jurisdictions should provide a point of contact for each of the programmatic areas where relevant: • Arbovirus diseases TX-DSHS-19-1309-A-000449 157 • Lyme disease, plague, tularemia • Rickettsial diseases • Parasitic vector-borne diseases (non-malaria) Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1c: Improve human surveillance, outbreak response and reporting for vector-borne diseases Identify and report nationally notifiable vector-borne disease cases to CDC using standard CSTE case definitions with complete reporting of key variables (using NNDSS, supplemental case report forms or enhanced surveillance platforms, e.g. ArboNET). ☒Required b) Identify and report blood donations with evidence of vector-borne pathogens (including West Nile virus, Zika virus, Ehrlichia and Anaplasma spp. and Babesia spp.) to CDC ☒Required c) d) e) ☒Required ☐Optional ☒Required ☐Optional Analyze and interpret vector-borne disease surveillance data. Identify and report non-nationally notifiable vector-borne disease cases to CDC. ☒Optional Investigate and report vector-borne disease cases with new or unusual modes of transmission or clinical manifestations. ☐Required h) ☒Optional Perform expanded analysis and interpretation of vector-borne disease surveillance data to inform public health action. ☐Required g) ☐Optional Identify and report possible transfusion and transplant transmitted infections. ☐Required f) ☐Optional ☒Optional In coordination with CDC and other ELC-funded jurisdictions, conduct enhanced case investigations and surveillance for vector-borne diseases to: 1) improve estimates of disease incidence and burden; 2) describe clinical features and outcomes; and 3) identify groups at increased risk for infection or disease to target prevention. ☐Required ☒Optional TX-DSHS-19-1309-A-000450 158 i) Develop and maintain capacity to lead and coordinate complex investigations involving multiple jurisdictions or agencies (e.g., transfusion- or transplant-associated transmission, and complex outbreaks). ☐Required j) Evaluate novel ways to conduct improved public health surveillance and collaborate with CDC to evaluate next generation public health surveillance (including informatics modernization initiatives). ☐Required II. a) a) ☒Optional Implement advanced vector control activities i. Implement emergency vector control, as appropriate ii. Conduct insecticide field-testing and evaluate insecticide resistance management plans iii. Provide regional capacity for pathogen testing in vectors ☐Required III. ☒Optional Perform or obtain insecticide resistance testing results for mosquitos and submit, coordinate or verify submission of results to national systems (e.g. MosquitoNET). Use data to inform emergency mosquito control activities. ☐Required e) ☐Optional Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET). ☐Required d) ☐Optional Advise local agencies (e.g. mosquito abatement districts, health departments) on surveillance and control of vectors to reduce human disease where appropriate. ☒Required c) ☒Optional Strategy 1c: Improved ecological and vector surveillance, response and reporting Report passively collected ecologic surveillance data already being collected (e.g. veterinary cases, sentinel animal infections, vector abundance and infection prevalence) for vector-borne disease to the appropriate CDC systems (e.g. ArboNET, MosquitoNET) and local vector control programs. ☒Required b) ☒Optional ☒Optional Strategy 1e: Strengthen laboratory testing for vector-borne disease of relevance Maintain core capacity to perform testing for vector-borne diseases of public health importance to the jurisdiction, including but not limited to: i. PCR and IgM antibody testing for at least one arbovirus TX-DSHS-19-1309-A-000451 159 ii. Where relevant, PCR Rickettsia 510(k) assay and IFA for spotted fever group Rickettsia, Ehrlichia and Anaplasma spp. and typhus group Rickettsia ☒Required b) Participate in annual proficiency testing for vector-borne disease diagnostic testing. ☒Required c) a) ☒Optional Strategy 1a: Enhanced workforce capacity for vector-borne disease surveillance and response Participate in CDC coordinated national and/or regional vector-borne disease meeting (e.g. ELC annual meeting and/or vector-borne disease focused meeting). ☒Required b) ☒Optional Develop and maintain capacity to serve as a regional reference laboratory for other states and jurisdictions for advanced and confirmatory vector-borne disease diagnostic testing, including but not limited to plaque reduction neutralization testing. ☐Required IV. ☐Optional Maintain enhanced capacity to perform testing or confirmation for an expanded number of vectorborne diseases of public health importance to the jurisdiction such as for a panel of arboviral infections and PCR testing for Ehrlichia and Anaplasma spp. ☐Required d) ☐Optional ☐Optional Participate in relevant meetings and trainings to improve capacity for vector-borne diseases detection, reporting and response. ☐Required ☒Optional AREA B: PREVENTION AND INTERVENTION I V. a) Strategy 2a: Implement vector-borne disease interventions and tools In coordination with CDC and other partners, investigate and respond to vector-borne disease outbreaks, implement timely control measures, and disseminate findings. ☒Required b) Develop and maintain surveillance and response plans for vector-borne diseases (e.g. emerging infections, outbreaks) as appropriate for the jurisdiction. ☐Required c) ☐Optional ☒Optional Develop and implement a comprehensive integrated vector surveillance and control plan. TX-DSHS-19-1309-A-000452 160 ☐Required ☒Optional VI. Strategy 2c: Implement health promotion and education strategies to improve vector-borne disease recognition, diagnosis and prevention activities a) Conduct outreach and educational activities to increase awareness of healthcare providers, public health personnel and the public regarding the risks, clinical manifestations, diagnosis and prevention of vector-borne diseases. ☒Required I ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS VII. Strategy 3a: Enhance coordination and collaboration with external stakeholders a) Collaborate with CDC and other CDC-supported extramural programs to evaluate the effectiveness and feasibility of integrated strategies to prevent, control or reduce the burden of vector-borne diseases (e.g. vaccines, therapeutics, clinical management, vector control or public education). i. Possible collaborations include the Regional Centers of Excellence for Vector-Borne Diseases (CoE) or Emerging Infections Program (EIP) ☐Required b) ☒Optional Establish and manage regional collaborations with other state and local health departments to improve resource sharing, staffing and capacity for vector-borne disease surveillance and control measures ☐Required ☒Optional VIII. Strategy 3b: Disseminate relevant vector-borne disease information to stakeholders a) Post jurisdiction specific vector-borne disease surveillance data to health department website ☒Required b) c) d) e) ☐Optional Prepare up-to-date summaries of vector-borne disease data, and distribute to healthcare providers, public health partners, policy makers and the public. ☐Required ☒Optional ☐Required ☒Optional ☐Required ☒Optional Evaluate and modify prevention and control messages as appropriate. Develop comprehensive vector-borne disease communication plans. Develop and evaluate innovative communication approaches to improve information reach and retention. TX-DSHS-19-1309-A-000453 161 ☐Required f) ☒Optional Perform workforce training, intensive public outreach and/or clinician education. ☐Required ☒Optional Collaborations a. With CDC-funded programs: Jurisdictions are expected to collaborate with subject matter experts in the Division of Vector-Borne Diseases (DVBD) including the Arboviral Diseases Branch, Bacterial Diseases Branch, Dengue Branch and Rickettsial Zoonoses Branch and with the Parasitic Disease Branch in the Division of Parasitic and Malarial Diseases as well as DVBD and ELC programmatic staff. b. With organizations external to CDC: Jurisdictions are encouraged to increase collaborations with vector-borne disease stakeholders as they advance their programs. Collaborations could include the business community; universities (including the Centers of Excellence and EIP partners); emergency management groups; hospitals and physician offices; media; non-government and non-profit organizations; other federal, state, local government or tribal agencies. Applicants should describe plans for how they will interact with local jurisdictions including description of activities at local level, methods to assess local needs and description of funding mechanisms to support local vector control and vector-borne disease related activities. Target Populations: This guidance targets the entire U.S. population and the public health system within the U.S. and its territories. Funding awarded for vector-borne disease programs is intended to support the needs of jurisdictions impacted by vector-borne diseases and to ensure that the public health system is ready and capable to mitigate the impacts of endemic and new introductions or discoveries of vector-borne diseases. Evaluation and Performance Measurement: Measure 1: Diagnostic Capacity 1. Reported jurisdiction vector-borne disease diagnostic capability (Tables 1 and 2) 2. Participation in 2019-2020 CDC proficiency evaluation for vector-borne diseases I Table 1: Jurisdiction Arboviral Diagnostic Capability (check all that apply) Pathogen California serogroup† Chikungunya Colorado tick fever Dengue Eastern equine encephalitis ELISA IgM IgG MIA IgM IgG IFA IgM IgG PRNT PCR TX-DSHS-19-1309-A-000454 162 Japanese encephalitis Powassan St. Louis encephalitis Western equine encephalitis West Nile Zika Yellow fever †Such as La Crosse or Jamestown Canyon viruses Table 2: Jurisdiction Non-Arboviral Vector-Borne Diseases Diagnostic Capability (check all that apply) Pathogen Spotted fever group Rickettsia Typhus group Rickettsia Ehrlichia spp. Anaplasma spp. Yersinia pestis Francisella tularensis Relapsing fever Borrelia spp. 1. 2. 3. 4. ELISA IgG IgM IFA IgG IgM Culture PCR Measure #2 – Surveillance Capacity and Completeness of Reporting Estimated number of Lyme disease cases if using estimation or alternative approaches to surveillance procedures. Please also provide methodologic details. Number and proportion of counties that included in annual human surveillance for tick-borne diseases (please specify which tick borne diseases) Number and proportion of non-Lyme tick-borne diseases cases receiving confirmatory laboratory testing instead of only supportive laboratory evidence Completeness of reporting to ArboNET including: a. Number of probable or confirmed locally-transmitted arboviral disease cases reported to ArboNET b. Incidence of probable or confirmed locally-transmitted neuroinvasive arboviral disease cases reported to ArboNET c. Number of probable or confirmed imported arboviral disease cases reported to ArboNET d. Proportion of reported human disease cases reported to ArboNET with complete data for the following categories: age, sex, clinical syndrome, hospitalization, and death for 2014-2018 e. Number of West Nile and Zika virus viremic blood donors reported to ArboNET for 2014-2018 TX-DSHS-19-1309-A-000455 163 f. Proportion of total jurisdiction population that live in an area with environmental surveillance data (bird, mosquito, and sentinel animal; numerator and/or denominator) reported to ArboNET in 2018 g. Number of veterinary disease cases reported to ArboNET from 2014-2018 I Measure #3 – Vector Surveillance and Control Capacity 5. Number and proportion of counties that report data related to entomologic or ecologic investigations for vector-borne diseases 6. Submission of monthly mosquito vector monitoring data reported to MosquitoNET 7. Submission of monthly mosquito insecticide resistance data reported to MosquitoNET 8. Number of counties from which ticks were collected and reported to ArboNET 9. Percentage of vector-borne disease or vector control staff that are trained in tick identification and collection 10. Vector control capacities and enhancements reported to CDC in ELC annual report 11. Vector control activities undertaken in response to identified arboviral disease outbreaks I Measure #4 – Cross Cutting Coordination and Collaborations 12. Estimated number of stakeholders reached through presentations/outreach activities, including healthcare professionals (physicians, nurses, nurse practitioners, physician assistants), local jurisdictions, and public 13. Reported established collaborations between state or territorial health departments, CDC-supported extramural programs (e.g., regional Vector-Borne Diseases Centers of Excellence, EIP sites), other academic institutions, and mosquito control jurisdictions to improve arboviral disease prevention and response strategies in annual report. Project H Appendix 1: ELC Vector-Borne Disease Program Capacity Tiers Tier 1: Required core capacity for locally-relevant vector-borne disease surveillance, laboratory and response across all jurisdictions receiving funds • Identify and report nationally notifiable vector-borne disease cases to CDC using standard CSTE case definitions with complete reporting of key variables (using NNDSS, supplemental case report forms or enhanced surveillance platforms, e.g. ArboNET) • Identify and report blood donations with evidence of vector-borne pathogens (including West Nile virus, Zika virus, Ehrlichia and Anaplasma spp. and Babesia spp.) to CDC • Identify and report possible transfusion and transplant transmitted infections • Analyze and interpret vector-borne disease surveillance data • Report passively collected ecologic surveillance data already being collected (e.g. veterinary cases, sentinel animal infections, vector abundance and infection prevalence) for vector-borne disease to the appropriate CDC systems (e.g. ArboNET, MosquitoNET) and local vector control programs. • Advise local agencies (e.g. mosquito abatement districts, health departments) on surveillance and control of vectors to reduce human disease where appropriate • Maintain core capacity to perform testing for vector-borne diseases of public health importance to the jurisdiction, including but not limited to: TX-DSHS-19-1309-A-000456 164 o PCR and IgM antibody testing for at least one arbovirus o Where relevant, PCR Rickettsia 510(k) assay and IFA for spotted fever group Rickettsia, Ehrlichia and Anaplasma spp. and typhus group Rickettsia • Participate in annual proficiency testing for vector-borne disease diagnostic testing • Participate in CDC coordinated national and/or regional vector-borne disease meeting (e.g. ELC annual meeting and/or vector-borne disease focused meeting) • Participate in relevant meetings and trainings to improve capacity for vector-borne diseases detection, reporting and response • In coordination with CDC and other partners, investigate and respond to vector-borne disease outbreaks, implement timely control measures, and disseminate findings • Conduct outreach and educational activities to increase awareness of healthcare providers, public health personnel and the public regarding the risks, clinical manifestations, diagnosis and prevention of vector-borne diseases • Post jurisdiction specific vector-borne disease surveillance data to health department website Tier 2: Enhanced capacities for vector-borne disease laboratory testing, surveillance, or response across a subset of jurisdictions • Identify and report non-nationally notifiable vector-borne disease cases to CDC • Perform expanded analysis and interpretation of vector-borne disease surveillance data to inform public health action • Investigate and report vector-borne disease cases with new or unusual modes of transmission or clinical manifestations • Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET) • Perform or obtain insecticide resistance testing results for mosquitos and submit, coordinate or verify submission of results to national systems (e.g. MosquitoNET). Use data to inform emergency mosquito control activities • Maintain enhanced capacity to perform testing or confirmation for an expanded number of vectorborne diseases of public health importance to the jurisdiction such as for a panel of arboviral infections and PCR testing for Ehrlichia and Anaplasma spp. • Develop and maintain surveillance and response plans for vector-borne diseases (e.g. emerging infections, outbreaks) as appropriate for the jurisdiction • Prepare up-to-date summaries of vector-borne disease data, and distribute to healthcare providers, public health partners, policy makers and the public Tier 3: Comprehensive capacity to serve as reference centers for vector-borne disease laboratory testing, surveillance, response, and coordination with multiple external partners • In coordination with CDC and other ELC-funded jurisdictions, conduct enhanced case investigations and surveillance for vector-borne diseases to: 1) improve estimates of disease incidence and burden; 2) describe clinical features and outcomes; and 3) identify groups at increased risk for infection or disease to target prevention • Develop and maintain capacity to lead and coordinate complex investigations involving multiple jurisdictions or agencies (e.g., transfusion or transplant-associated transmission, and complex outbreaks) TX-DSHS-19-1309-A-000457 165 • • • • • • • • • • Evaluate novel ways to conduct improved public health surveillance and collaborate with CDC to evaluate next generation public health surveillance (including informatics modernization initiatives). Implement advanced vector control activities o Implement emergency vector control, as appropriate o Conduct insecticide field-testing and evaluate insecticide resistance management plans o Provide regional capacity for pathogen testing in vectors Develop and maintain capacity to serve as a regional reference laboratory for other states and jurisdictions for advanced and confirmatory vector-borne disease diagnostic testing, including but not limited to plaque reduction neutralization testing Develop and implement a comprehensive integrated vector surveillance and control plan Collaborate with CDC and other CDC-supported extramural programs to evaluate the effectiveness and feasibility of integrated strategies to prevent, control or reduce the burden of vector-borne diseases (e.g. vaccines, therapeutics, clinical management, vector control or public education). o Possible collaborations include the Regional Centers of Excellence for Vector-Borne Diseases (CoE) or Emerging Infections Program (EIP) Establish and manage regional collaborations with other state and local health departments to improve resource sharing, staffing and capacity for vector-borne disease surveillance and control measures Evaluate and modify prevention and control messages as appropriate Develop comprehensive vector-borne disease communication plans Develop and evaluate innovative communication approaches to improve information reach and retention Perform workforce training, intensive public outreach and/or clinician education TX-DSHS-19-1309-A-000458 166 Section III: Disease-Specfic Projects I: Mycotics: Detecting and Preventing Fungal Infections Program Activity Contact Information Brendan Jackson, iyn0@cdc.gov, 404-639-0536 Tom Chiller, tnc3@cdc.gov, 404-639-4753 Lynette Benjamin, bil0@cdc.gov, 404-639-5475 Funding Opportunity Description Background a. Overview The Mycotics activities are intended to help prevent disability and death as a result of fungal infections by improving state and local health departments’ capacity to: 1. Conduct surveillance for key endemic mycoses (coccidioidomycosis, histoplasmosis, blastomycosis, Cryptococcus gattii infection) 2. Detect and respond to emerging antifungal-resistant pathogens, like Candida auris and certain Aspergillus fumigatus 3. Improve outbreak response to fungal diseases 4. Engage with clinicians and the public to improve awareness of often neglected diseases to save lives by early detection b. Healthy People 2020 • EH-22 – Environmental health objective. Increase the number of States, Territories, Tribes, and the District of Columbia that monitor diseases or conditions that can be caused by exposure to environmental hazards • HAI-1 – Healthcare-associated infection objective. Reduce central line-associated bloodstream infections (CLABSIs) c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Fungi are environmental pathogens that cause a broad spectrum of illness, including community-acquired respiratory diseases, hospital-associated infections, and opportunistic infections among immunocompromised hosts. They are important causes of disease but are often overlooked and misdiagnosed. Improved surveillance can guide efforts to prevent exposures and improve early diagnosis. Several fungal diseases of particular concern include: • Certain endemic mycoses, specifically coccidioidomycosis (Valley fever), histoplasmosis, and blastomycosis, which are common causes of respiratory infections in some U.S. regions. These TX-DSHS-19-1309-A-000459 167 • • infections, usually acquired from soil and other environmental exposures, are widely misdiagnosed. Many patients with these diseases presumed to have bacterial pneumonia and receive multiple rounds of antibacterial drugs, which are ineffective against these fungal pathogens and pose risks to patients. All three of these endemic mycoses can lead to severe and invasive disease, and all have caused large outbreaks. Candida auris, an emerging drug-resistant yeast that spreads in healthcare facilities. Intensive public health response and use of infection control measures can help contain its spread. Resistant fungal infections in healthcare environments, especially those caused by certain Candida and Aspergillus species. These fungi are increasingly important issues for public health. Strains of Aspergillus fumigatus have recently been detected in the United States that are resistant to all triazole antifungals, a major concern for this deadly opportunistic pathogen. Such resistant strains have already emerged as an important cause of illness in Europe and have been linked to agricultural and environmental fungicide use Fungal disease outbreaks, like the fungal meningitis outbreak caused by contaminated steroids and numerous mucormycosis outbreaks in hospitals, represent an urgent need to build capacity to detect, respond, and control fungal infections. b. Purpose: The purpose of this project is to strengthen state health department epidemiologic and laboratory capacity to detect and prevent fungal diseases. Specifically, this project aims to: Strengthen epidemiologic data on endemic mycosis in order to guide prevention efforts, including targeted outreach to improve early diagnosis and treatment. • Build jurisdictions’ capacity to detect and respond to antifungal resistant fungal pathogens, including C. auris and A. fumigatus. • Improve epidemiologic capacity to investigate outbreaks, monitor trends, and track the emergence of fungal disease. • Enhance laboratory capacity to identify fungi from clinical and environmental samples and aid in diagnosis fungal diseases from clinical specimens. c. Outcomes: • 1. Improved epidemiologic data con coccidioidomycosis, histoplasmosis, and blastomycosis, including ability to assess geographic spread, temporal trends, and emerging risk factors, to guide prevention measures. 2. Tracking of emerging antifungal resistant fungal pathogens, including C. auris and A. fumigatus. 3. Increased public health, healthcare provider, and public awareness of fungal infections, their diagnosis and treatment (e.g., via local outreach, reports and participation in Fungal Disease Awareness Week activities). 4. Better laboratory detection of fungi from clinical and environmental sources, particularly those due to Coccidioides, Histoplasma, Blastomyces, and Cryptococcus from other clinical specimens and environmental samples. Funding Strategy: TX-DSHS-19-1309-A-000460 168 Funds should be utilized for personnel, travel, supplies, equipment, or contractual support for proposed activities • Estimated total availability of funds: ~ $600,000 • Estimated number of awards given: ~ 20 • Estimated average per award: ~ $10,000 - $30,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) II. a) b) III. a) b) Strategy 1a: Enhance workforce capacity Improve laboratory detection of fungal infections i. CDC Mycotic Diseases Branch - Mold Identification Course ☐Required ☒Optional ☐Required ☒Optional ☐Required ☒Optional ☐Required ☒Optional Strategy 1b: Enhance investigation and outbreak response Respond to fungal disease outbreaks and report findings to CDC Contain or prevent the spread of antifungal-resistant fungal pathogens Strategy 1c: Improve surveillance and reporting Use CSTE case definitions to conduct surveillance for fungal diseases Help improve standardized data collection for fungal disease surveillance, including revised case definitions and optional data elements harmonized across states ☐Required c) Conduct enhanced surveillance for one or more endemic mycoses to better characterize patient characteristics, diagnostics used, clinical illness, and possible exposures ☐Required d) ☒Optional ☒Optional Conduct active, population-based surveillance for invasive mold infections, including collection of clinical isolates and pathology specimens; states may consider using a case investigation form used by the Emerging Infections Program. ☐Required ☒Optional TX-DSHS-19-1309-A-000461 169 IV. Strategy 1e: Enhance laboratory testing for surveillance and reporting a) Establish or enhance fungal testing capacity by acquiring laboratory equipment or supplies (note that testing should not be duplicative with Candida AR Lab Network testing) I b) I V. ☐Required ☒Optional ☐Required ☒Optional Implement or improve testing protocols for fungal infectious diseases AREA B: PREVENTION AND INTERVENTION Strategy 2a: Implement public health interventions and tools a) Develop health promotion materials for healthcare providers and the public to increase health literacy about fungal disease prevention (e.g., participate in national Fungal Disease Awareness Week activities) ☐Required ☒Optional Collaborations a. With CDC-funded programs: Applicants should describe participation in the Antibiotic Resistance Lab Network (ARLN) for Candida, including involvement in coordinating isolate transfer to a regional laboratory or participation as a regional laboratory. Efforts to control C. auris also fall under ELC activities on healthcare-associated infections. b. With organizations external to CDC: • Applicants may wish to collaborate with other state health departments that have already developed educational materials to raise awareness of fungal infections (e.g., a Valley fever video produced by the New Mexico state health department or collaborations with the Valley Fever Center for Excellence in Arizona). • Local healthcare providers may be helpful in facilitating surveillance and providing clinical training. Target Populations: Systemic fungal diseases can affect a wide range of people. Endemic mycoses can cause disease in nearly anyone exposed and pose an even higher risk for outdoor workers in endemic areas. African-Americans appear to be at elevated risk for severe disease, including meningitis, from coccidioidomycosis. Immunocompromised people are at greater risk than the general population for nearly all systemic fungal infections, particularly those caused by Candida, Aspergillus, and mucormycetes. Evaluation and Performance Measurement: Measure #1) Number of fungal disease cases reported in your jurisdiction during 2018, grouped by pathogen. Measure #2) Participation during 2019 in efforts to improve standardized case definitions and data elements for fungal diseases. Measure #3) Number and types of fungal disease educational materials developed and outreach events held (please describe and report number of unique materials rather than number of copies distributed). TX-DSHS-19-1309-A-000462 170 Measure #4) For jurisdictions that received laboratory-related Mycotics funding: Describe implementation of fungal-related laboratory equipment, method, technique, or protocol to improve diagnostic capacity. TX-DSHS-19-1309-A-000463 171 J: Binational Border Infectious Disease Surveillance (BIDS) Program Program Activity Contact Information DGMQ Coordinator: Pamela Nonnenmacher, fsb6@cdc.gov ; 404 639 7112 Technical POC: Alba Phippard, ign7@cdc.gov , 619-692-8479 Funding Opportunity Description Background a. Overview The Binational Border Infectious Disease Surveillance (BIDS) Program was established to foster local, state, and federal collaboration to improve surveillance for infectious diseases of binational importance. b. Healthy People 2020 The BIDS Program supports the following Healthy People 2020 goals: • To strengthen and sustain communities’ abilities to prevent, protect against, mitigate the effects of, respond to, and recover from incidents with negative health effects • Improve public health and strengthen U.S. national security through global disease detection, response, prevention, and control strategies. c. Other National Public Health Priorities and Strategies By enhancing surveillance among binational populations and strengthening binational systems for communication, reporting, and collaborative response, BIDS activities support the following objectives of the Global Health Security Agenda: • • • Prevent the emergence and spread of antimicrobial drug resistant organisms and emerging zoonotic diseases Reduce the number and magnitude of infectious disease outbreaks Strengthen the global norm of rapid, and transparent reporting BIDS binational surveillance also supports the National Strategy to Combat Antibiotic Resistance Bacteria by improving international collaboration to detect antibiotic resistance in the border region. CDC Project Description a. Problem Statement: Numerous binational infectious disease outbreaks, including vector-borne, vaccine-preventable, foodborne, waterborne, mycotic, and mycobacterial diseases, have been documented over the last two decades. Many of these diseases have emerged with higher incidence in the U.S.-Mexico border region compared to other areas of the United States. Optimal investigation and control of binational disease cases and outbreaks requires better surveillance, quantification of disease burden, and epidemiological and laboratory collaboration with both U.S. and Mexico public health (PH) agencies at all levels. b. Purpose: The purpose of this funding is to improve disease detection, reporting and prevention of infectious diseases of binational concern in the U.S.-Mexico border region. Infectious diseases of binational concern are those affecting humans that can be introduced or amplified in the other country by virtue of the movement of people, products, or animals between countries; these often require binational coordination to identify, monitor and control. TX-DSHS-19-1309-A-000464 172 c. Outcomes: • Implementation of the U.S.-Mexico Guidelines for infectious disease prevention and control via the Operational Protocol for Binational Communication and Coordination for o Improved coordination and exchange of PH information in the border region and binationally; and o Rapid investigation and control of binational outbreaks • Improved surveillance through: o Improved detection of binational cases and completeness of binational case data o Improved timeliness of reporting binational cases • Improved understanding of the epidemiology and incidence of infectious diseases of binational importance • Electronic mechanisms for binational data exchange are in place Funding Strategy: U.S. states that share a border with Mexico are eligible to apply for BIDS funding. Funding may be used for personnel, travel, supplies, equipment, or contractual support for proposed activities. Awards will preferentially support integration of Binational Reporting Criteria and related variables into jurisdictions’ investigations and electronic disease surveillance systems, operationalization of the US-Mexico Guidelines, and implementation of the recommendations made for BIDS by the 2018 US-Mexico Border Disease Prioritization Work Group. For projects related to a specific infectious disease or technical area, program planning and funding decisions may be administered by the most appropriate state program or office to manage and implement activities, in consultation with the state ELC principal investigator, ELC, and CDC. Funding recipients will be required to attend an out-of-state BIDS grantee meeting. • Estimated total availability of funds: $750,000 • Estimated number of awards given: 1 - 4 • Estimated average per award: $50,000 - $750,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1i: Sustain and/or enhance information systems through integration of binational variables Assess the completeness, and data quality of Binational Variables (i.e., Binational Reporting Criteria, Country of Exposure, Country of Usual Residence and Country of Birth) in state and local systems by county i. This activity may be done during 1 or 2 discrete periods of time during years 2 and 4 on a sample of cases ☒Required b) Train state and local staff on the use of the Binational Reporting Criteria and related variables ☒Required c) ☐Optional ☐Optional Binational Case Reporting TX-DSHS-19-1309-A-000465 173 i. Facilitate the timely reporting of binational cases and outbreaks, with border jurisdictions, states, and federal partners, consistent with local protocols, International Health Regulations, and Binational Case Reporting Standards for BIDS. ☒Required d) Integrate the Binational Variables into local and state electronic disease surveillance systems i. The Binational variables are Binational Reporting Criteria, Country of Exposure, Country of Usual Residence and Country of Birth (endorsed by Council of State and Territorial Epidemiologists’ position statement 13-SI-02) ii. States should be working towards integration in 100% of border counties. iii. Once state has integrated these variables into the border county information systems, states may expand efforts to non-border counties. ☐Required e) a) ☒Optional Strategy 1b: Enhance investigation and outbreak response Implement or enhance human surveillance i. The state should prioritize surveillance activities as recommended by the 2018 Disease Prioritization for US Southern Land Border work group. ii. Surveillance must include laboratory testing for infectious diseases of binational concern among BIDS target populations iii. For sites proposing ILI or SARI surveillance, surveillance methods should be consistent with BIDS border-wide protocol for ILI/SARI surveillance iv. Enhanced surveillance activities includes activities beyond those routinely conducted, e.g. conducting lab testing on a greater number or broader scope of patients, performing laboratory testing not usually performed, or collecting additional exposure information during a case interview, not typically collected ☐Required b) ☒Optional Incorporate the Binational Variables into routine case notifications to the National Notifiable Disease Surveillance System i. per the Generic V2 HL7 message mapping guide, or through the existing state processes ☐Required II. ☐Optional ☒Optional Develop, test, and refine binational information sharing and collaboration protocols i. In conjunction with U.S. and Mexican state and local partners in the U.S.-Mexico border region, consistent with International Health Regulations (IHR), U.S.-Mexico Guidelines, and the Operational Protocol for Binational Communication and Coordination; or document the operationalization of the protocol at the local and state levels. Funding recipient will be TX-DSHS-19-1309-A-000466 174 required to report on the date protocols were exercised and the date the final After Action Report was approved by the state (and sister jurisdiction if applicable). ☐Required III. a) Strategy 1c: Improve surveillance and reporting Assess, enhance, or systematize data collection i. Data elements may relate to: 1) the population in the border states (such as detailed Hispanic/Latino origin categories, country of birth, years in the US, primary language spoken at home); 2) cross-border mobility, including frequency/reason for crossing, destination, and activities (such as visiting family, work, study); and 3) access to medical care and sources of health information. ii. This could be done on an ongoing basis by enhancing disease surveillance questionnaires, or through discrete projects ☐Required b) c) d) ☒Optional ☒Optional Share best practices through Peer to Peer training or consultation i. The requesting grantee must describe specific objectives of the training to be considered for the funds. ii. The grantee receiving the training is required to complete and submit a progress report detailing the training objectives, lessons learned, and anticipated outcomes within 30 days after completing the training. iii. Trainee may request a specific match, or to be matched through the program POC. ☐Required ☒Optional ☐Required ☒Optional Assist local health jurisdictions with binational outbreak investigations Train border region epidemiologists/disease investigators, or physicians to improve surveillance and response ☐Required ☒Optional Collaborations a. With CDC-funded programs: Sites should collaborate with NNDSS Program, Emerging Infections Program, ILI-Net, BioSense, PulseNet, and other states participating in the BIDS program, as applicable, and provide description of these collaborations in the application. Sites will collaborate closely with the CDC BIDS program within the Division of Global Migration and Quarantine’s US-Mexico Unit. CDC BIDS program staff will provide technical oversight and assistance; liaise with other CDC subject matter experts; and review products resulting from activities. b. With organizations external to CDC: TX-DSHS-19-1309-A-000467 175 Collaboration with infectious disease offices of local/regional/state health departments is required and must be described in the proposal, along with how the proposed activities fit into the state’s broader disease surveillance plans. Collaborations with universities and non-governmental institutions are encouraged, with associated letters of support. States proposing binational collaborations with Mexico should provide documentation of binational agreement to collaborate, such as a letter of support from a collaborating Mexican institution. Target Populations: Projects should target U.S.-Mexico border-crossing populations and their networks, and residents of the U.S.Mexico border region at risk for diseases of binational concern, with an emphasis on foreign-born Latino populations and those with limited English proficiency. Applicants should clearly identify which population(s) will be targeted by each proposed project. Evaluation and Performance Measurement: Measure #1 1.1 State’s electronic disease surveillance system’s electronic case reports include all Binational Reporting Criteria as defined in NNDSS 1.2 Number and percent of border counties in the state that include the Binational Reporting Criteria in case reports 1.3 Number and percent of all counties in the state that include the Binational Reporting Criteria in case reports 1.4 State electronic disease surveillance system case report includes: • Country of Exposure • Country of Usual Residence • Country of Birth I 1.5 List of diseases reported through the system(s) referenced in indicators 1.1-1.4 Additional Guidance: All reportable infectious diseases should be included in the indicator reporting. Binational Reporting Criteria, as defined in NNDSS, are: • Potentially exposed while in Mexico or Canada • Potentially exposed by a resident of Mexico or Canada • Resident of Mexico or Canada • Has case contacts in or from Mexico or Canada • Exposure to suspected product from Mexico or Canada • Other situations that may require binational notification or coordination of response) Border counties are defined as the 44 border counties with the majority of their area within the 100 km line, as established by the 1983 La Paz agreement. They are: Arizona: Cochise, Pima, Santa Cruz, Yuma; California: Imperial, San Diego; New Mexico: Doña Ana, Grant, Hidalgo, Luna, Otero, Sierra; Texas: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmit, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, TX-DSHS-19-1309-A-000468 176 Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata, Zavala. Performance Targets: By the end of the 2nd year of the cooperative agreement all states receiving BIDS funding will include the following variables, in the state’s electronic disease surveillance system: Binational Reporting Criteria, Country of Exposure, Country of Usual Residence and Country of Birth. Additionally, 100% of the states’ border counties will have integrated the Binational Reporting Criteria variable into the primary investigative and reporting systems. Measure #2 2.1 Establish and report on a measure of the Binational Reporting Criteria variable in border counties. I 2.2 Establish and report on a measure of the negative predictive value of the Binational Reporting Criteria variable in border counties. 2.3 Provide the number and percent of all border-county confirmed cases which have the following variables populated: Country of Exposure Country of Usual Residence Country of Birth Additional Guidance: CDC will provide specific guidance about how to conduct PPV and NPV studies after consultation with grantees. This will be issued within 6 months of the start of the performance period. Additionally, diseases of interest will be specified in year 1 and will be consistent throughout the project period. Performance Targets: For measure 2.1: at least 80% For measure 2.2: at least 90% In years 2-5, also report on the percent change from previous year. For measure 2.3: Country of Exposure variable completed: at least 80% Country of Usual Residence variable completed: at least 80% Country of Birth variable completed: at least 80% Measure #3 3.1 Report number and percent of all confirmed cases that are binational in border counties. I 3.2 Report, by disease, number and percent of confirmed cases that met each of the criteria of the Binational Reporting Criteria variable in border counties. TX-DSHS-19-1309-A-000469 177 3.3* Report, outcomes of binational case reports. Outcomes are (mutually exclusive): known public health follow-up in Mexico; binational collaboration on investigation or cluster/outbreak; and unknown public health follow-up in Mexico. 3.4 Report a list of all binational outbreaks and clusters detected. The list should describe each of the following elements or each outbreak or cluster: disease or syndrome investigated; month and year of notification; direction of notification; which authorities notified; collaborative response with Mexico; and the final outcome. 3.5 Report the number and percent of all confirmed cases reported to public health counterparts in Mexican sister jurisdictions within the timeframe specified by the Binational Case Reporting Standards for BIDS. Additional Guidance: *Measure 3.3: Binational collaboration is defined as responding to requests for further information after initial report, receiving information from other country regarding the event after the initial report, or communication to discuss the event or response activities. Any of these activities are considered binational collaboration. Performance Targets: Measure 3.5: 90% Measure #4 4.1 Provide number and percent of cases for which BIDS supported or facilitated laboratory testing, by surveillance project and by local jurisdiction. If the BIDS program limits the number of specimens to be tested (either number or %), describe the sampling frame for testing. I 4.2 Provide percent of states’ border county specimens tested for the pathogen that were facilitated or supported by BIDS. Provide additional description/justification of the target population if needed. For example, if the BIDS program contributes a very small % of specimens to the border county’s surveillance system, but targets a population for which there are existing surveillance gaps, please describe how the BIDS testing fills those gaps. 4.3 Provide number of specimens tested for antimicrobial resistance, by BIDS surveillance project. 4.4 Provide number and percent positive for antimicrobial resistance, by BIDS surveillance project. 4.5 For sites conducting influenza-like illness (ILI) surveillance, report the number and % of ILI cases tested for influenza. 4.6 For sites conducting ILI surveillance, report the number and percent of ILI cases tested that were positive for influenza (by type). 4.7 For sites conducting severe acute respiratory infection (SARI) surveillance, report the number and percent of cases tested that were positive for influenza, and other major respiratory pathogens (by type). TX-DSHS-19-1309-A-000470 178 4.8 For sites conducting BIDS enteric disease surveillance, report the number and percent of confirmed enteric cases for which genetic typing was performed. 4.9 For sites conducting BIDS enteric disease surveillance, report the number and percent of confirmed enteric cases that were part of a local, state or national cluster. Additional Guidance: If grantee does not conduct the specified type of surveillance through this Cooperative Agreement, the indicator is Not Applicable. Enhanced Surveillance project are defined as surveillance activities conducted that are beyond those routinely conducted, e.g. conducting lab testing on a greater number or broader scope of patients, performing laboratory testing not usually performed, or collecting additional exposure information during a case interview, not typically collected. For these indicators, “supported or facilitated” is defined as paid for, transported by or coordinated by BIDS staff. A cluster is defined as refers to an aggregation of cases grouped in place and time that are suspected to be greater than the number expected, even though the expected number may not be known. Performance Target: No performance target is provided due to the fact that numbers may vary for multiple reasons from year to year. TX-DSHS-19-1309-A-000471 179 K: Global Migration, Border Interventions and Migrant Health Program Activity Contact Information Pamela Nonnenmacher, DGMQ Coordinator, (404) 639-7112 Gayathri Kumar– Refugee/Immigrant Health Reena Gulati – Points of Entry Funding Opportunity Description Background a. Overview The mission of the Division of Global Migration and Quarantine is to reduce morbidity and mortality among globally mobile populations and to prevent the introduction, transmission, and spread of communicable diseases through regulation, science, research, preparedness, and response. b. Healthy People 2020 Topic Area: Global Health--Improve public health and strengthen U.S. national security through global disease detection, response, prevention, and control strategies c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Every day close to one million travelers arrive in the United States by air, sea, or land. Some arrive from countries with infectious disease epidemics and limited healthcare access. Due to tight seating space on conveyances and prolonged contact en route, communicable diseases can spread quickly and may result in cases or outbreaks in communities. Additionally, about 70,000 refugees and 400,000 immigrants settle in the United States every year. Refugees are particularly vulnerable because of limited access to healthcare in their country of origin and countries providing temporary asylum. They may have complex health-care issues, such as low baseline vaccination rates and high rates of infectious diseases. b. Purpose: The purpose of this funding is to mitigate the public health risks of travel-associated importation of pathogens into the U.S. and to improve public health surveillance, case management, and response of communicable diseases of public health concern among globally mobile populations. c. Outcomes: • Improved surveillance of diseases of public health concern associated with or identified by travel or border crossings • Improved completeness of travel associated case reports • Improved timeliness of travel-associated case reports • Improved coordination and exchange of data (e.g. linkage of overseas vaccination information for refugees from DGMQ's Electronic Disease Notification (EDN) system available for download in HL7.2.5.1 national standard into state immunization registries, linking between various databases to allow for long-term follow up of refugees and/or immigrants, etc.) • More efficient efforts in: o Detecting cases and outbreaks of diseases of public health concern TX-DSHS-19-1309-A-000472 180 o Responding to cases and outbreaks of diseases of public health concern (e.g., providing recommendations to health care providers) o Investigating cases and outbreaks of diseases of public health concern (e.g., determining risk factors) o Implementing disease control measures • Inform public health treatment approaches for, refugees and/or immigrants with a special emphasis given to approaches to address LTBI, hepatitis B, vaccine preventable diseases, and/or mental health (refugees only) • Inform program and policy development • Minimized transmission of infectious diseases in globally mobile populations • Improved health outcomes, quality, and equity Funding Strategy: Funding should be used for personnel, travel, supplies, equipment, or contractual support for proposed activities • Approximate total availability of funds: $250,000 • Approximate number of awards given: 3 - 5 • Approximate average per award: $50,000 • Approximate range of awards: $15,000 - $100,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation response and reporting Develop new investigation materials, processes, procedures, or technology that would more quickly and completely detect cases of immediate public health interest among globally mobile populations ☒Required II. a) Strategy 1c: Improve surveillance to drive public health action Analyze, report, and share surveillance, epidemiological, or clinical data for globally mobile populations ☒Required I ☐Optional ☐Optional AREA B: PREVENTION AND INTERVENTION III. Strategy 2a: Implement and evaluate standard, routine, accepted or evidence-based public health practice activities or interventions a) Implement interventions addressing the health needs of refugee and /or immigrant populations at conveyances or at border crossings b) Evaluate the effectiveness of interventions addressing the health needs of refugee and/or immigrant populations ☒Required I ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS TX-DSHS-19-1309-A-000473 181 IV. Strategy 3a: Coordinate and collaborate a) Enhance staff training and education on port of entry International Health Regulations core capacities (http://www.who.int/ihr/procedures/en) ☒Required V. ☐Optional Strategy 3a: Maintain and enhance integrated surveillance information a) Facilitate coordination/exchange of surveillance, epidemiological, or clinical data for globally mobile populations ☒Required ☐Optional Collaborations a. With CDC-funded programs: Collaboration with other CDC funded programs is optional. However, if applicant proposes to collaborate with other CDC funded programs to conduct activities, applicant should provide evidence of prior collaborations with these groups and should describe: 1) the work of the collaborating CDC-funded programs in their jurisdiction or community, 2) the programs’ success in achieving Cooperative Agreement outcomes; and 3) the way the applicant will work with the program. Prior evidence may be provided as a MOU, MOA, or letters of support. b. With organizations external to CDC: Collaboration with organizations external to the CDC is optional. However, if applicant proposes to collaborate with organizations external to CDC, applicant must provide evidence of prior collaborations with such groups, describe the organization’s success in achieving the Cooperative Agreement outcomes, and indicate how the applicant will interact with the organization in specific terms. Prior achievements and evidence may be provided as an MOU, MOA, or letters of support. Target Populations: Projects should target globally mobile populations such as refugees, immigrants, travelers, expatriates, migrants, asylees, those adjusting to LPR status in the United States (status adjusters), or communities with significant migrants or refugees. Applicants should clearly identify which population(s) will be targeted by the proposed project. Evaluation and Performance Measurement: Performance measures and evaluation activities used to monitor and track progress will be specific for each approved and funded project. This is necessary as the number and scope of projects may vary in the area of emphasis, strategy, and activity. As projects are approved and funded, CDC will work with awardees to develop the specific performance measurements that best meet the purpose and objective of that project. The performance measures will be closely tied to the pertinent strategies, activities, and outcomes. There may be both qualitative and quantitative data collected for evaluation purposes. Performance measures, other evaluation data and summaries of progress will be provided in the final report at the completion of the budget period. Any interim evaluation data and summaries of progress will also be collected via quarterly calls through verbal communication, although awardees are not required to provide a written summary of data during these times. However, a discussion guide for collection of interim evaluation data and progress will be TX-DSHS-19-1309-A-000474 182 provided to the awardee beforehand to guide discussions during these calls. Optional activities that awardees may be given an opportunity to share or present their work include Division-wide seminars and peer-to-peer networking calls (i.e., networking calls where awardees will be given an opportunity to present their work to one another). Overall, reports will be submitted at a minimum once in a budget period (i.e., final progress report), not including the ELC application. For instance, for improved completeness and timeliness of reporting the following performance measures may include: • • • • • • Time from detection of case to initial response to public health departments Number of reports with 90% of required information completed Retrospective review of cases to identify public health risks, areas for improving detection of and/or response to cases Measurable outcomes in public health surveillance, including increased numbers of complete screening records reported and increased number of reported records having high data quality Number of meetings and/or trainings conducted for planning exercises Number of reports, recommendations, and evidence-based policy change documentation TX-DSHS-19-1309-A-000475 183 L: Prion Surveillance Program Activity Contact Information Teresa Hammett, Tah5@cdc.gov 404-639-4389; Ryan Maddox, Zzp7@cdc.gov , 404.639.1170 Funding Opportunity Description Background a. Overview This project contributes to national surveillance of human prion diseases with goals of monitoring their incidence in the United States and assisting clinicians with accurate diagnoses. This family of diseases, which are progressive, transmissible, neurodegenerative disorders that are always fatal, includes variant CreutzfeldtJakob disease (vCJD), the human form of bovine spongiform encephalopathy (BSE, or “mad cow” disease). Other human prion diseases include sporadic Creutzfeldt-Jakob disease (sCJD, iatrogenic (iCJD), genetic CJD (gCJD), fatal familial insomnia (FFI), and Gerstmann-Sträussler-Scheinker (GSS) syndrome. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Prion diseases, or transmissible spongiform encephalopathies (TSEs), are a family of rare progressive neurodegenerative disorders that affect both humans and animals. These diseases are characterized by unusually long incubation periods often measured in years. They are 100% fatal and are caused by unconventional transmissible agents that are highly resistant to usual inactivation methods. Human prion diseases include the classic forms of Creutzfeldt-Jakob disease (sporadic, iatrogenic, genetic), the types most commonly occurring throughout the world, including the United States, and variant Creutzfeldt-Jakob Disease (vCJD), a type of human prion disease that emerged in the United Kingdom in the mid-1990s associated with eating meat products contaminated with the agent of BSE. Prion disease surveillance in the United Kingdom enabled recognition of the emergence of vCJD. Similarly, prion disease surveillance in the United States is monitoring for the emergence of vCJD and other potentially preventable new prion diseases (iatrogenic CJD and possible human chronic wasting disease (CWD)). In 2018, results of a study by researchers in Canada and Germany supported concerns that CWD may pose a risk to human health. The researchers reported that CWD was transmitted to cynomolgus macaques that were fed infected brain or muscle tissue from infected elk or deer. CWD has been identified in free-ranging cervids in increasing numbers of states (23 states as of 2018) and is regularly found in new areas. Once CWD is present in an area, it is difficult or impossible to eradicate. Prion disease surveillance data is also used in the assessment of the efficacy of ongoing U.S. prevention measures. Many clinicians and public health personnel have little experience dealing with prion diseases; funding of surveillance personnel at state health departments helps these departments to work more closely with CDC in developing and disseminating knowledge about prion diseases and enhancing prion disease surveillance. b. Purpose: Human prion disease surveillance serves to provide a better understanding of this illness and the prions that appear to cause it. The purpose of this project is to maintain and enhance surveillance for Creutzfeldt-Jakob TX-DSHS-19-1309-A-000476 184 disease (including sporadic, iatrogenic and genetic) as well as to detect the possible emergence of new forms of human prion disease such as variant CJD (vCJD) and possibly human CWD. Human prion disease surveillance is critical for the early detection of any new prion disease as well as monitoring for the occurrence of previously described rare classic forms of prion disease attributable to medical procedures. A sensitive human prion disease surveillance system can also help determine whether efforts and expenditures made to reduce and minimize exposures are adequate. For prion diseases, particularly for recognition of new human prion diseases, brain autopsies constitute the “gold standard” for confirmation of diagnoses. Hence, CDC currently pays the National Prion Disease Pathology Surveillance Center (NPDPSC) to provide to US clinicians and US public health surveillance personnel access to, free-of-charge, state-of-the-art prion disease diagnostic autopsy services. c. Outcomes: • Outcome 1: Follow-up investigations of all suspected CJD or clinically diagnosed cases reported to the state department of health especially for high priority cases: cases in persons less than 55 years of age; cases in hunters of cervids or consumers of venison from free ranging deer; reported case clusters of concern to the public; suspected iatrogenic cases. • Outcome 2: Effective coordination and exchange of information and data between state health departments, the National Prion Disease Pathology Surveillance Center, the CJD Foundation and CDC. • Outcome 3: Develop an effective collaborative network between pathologists, neurologists, funeral and mortuary directors, and other appropriate professionals within the state dealing with persons diagnosed with human prion disease and distribute educational materials about CJD surveillance and the role of state health departments, CDC and the National Prion Disease Pathology Surveillance Center. • Outcome 4: Effective coordination and exchange of information and data between the state departments of health and wildlife/natural resources • Outcome 5: Complete reporting of all suspected CJD cases to CDC through a biannual linelist of cases. Funding Strategy: • Estimated total availability of funds: $500,000 • Estimated number of awards given: 7 • Estimated average per award: $70,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation response and reporting Actively investigate all cases of suspected prion disease reported in state residents; refer out-of-state cases to the health department of patient’s residence. i. Track the number of suspected cases of prion diseases for which autopsy or biopsy was conducted. ii. Submit linelist of persons reported with suspected prion disease to CDC at least twice a year. ☒Required ☐Optional TX-DSHS-19-1309-A-000477 185 b) Within two weeks of a report, actively investigate all cases of suspected prion disease in higher priority cases of suspected prion disease (e.g., suspected cases in persons < 55 years of age, suspected cases of variant CJD or possible human CWD, suspected iatrogenic cases, and suspected case clusters. i. Submit to CDC the pertinent portions of the medical record for the highest priority cases of suspected prion disease in persons less than 45 years of age, or whenever variant CJD or possible human CWD is suspected, or whenever an unusual mode of transmission is suspected. (Medical records for persons 45 – 55 years of age are not required to be submitted unless an exogenous source of infection is suspected.) Pertinent sections of the medical record includes the admission summary, discharge summary, EEG reports, MRI reports, neurology consultation notes, psychiatry consultation notes, pathology reports from a biopsy, and pathology reports from autopsy. ii. Attempt to ascertain whether the case hunted (deer, elk, or moose) or consumed venison. If so, attempt to determine when and where the hunting occurred or from where the venison was harvested. ☒Required c) Cross check various data sources to ensure that all cases are identified in the project area. Specifically, access State Vital Statistics’ death certificate data looking for specific codes or terms appearing anywhere on the death certificate. (ICD-9 046.1 for deaths before 1999; ICD-10 A81.0 for deaths from 1999 to the present, 'jakob', 'jacob ', 'creutz’, 'crutz', 'critzfield', 'cjd', 'spongiform', 'spongioform’, 'spongeform', ‘sponaiform', 'tse', 'prion, 'gss', 'gerstman', 'gertsman', 'straussler', 'strausler', 'scheinker', 'ffi', 'familial insomnia', 'familial fatal insomnia', ‘sfi’, ‘sporadic fatal insomnia’) ☒Required I II. Strategy 2b: Advance policies to improve public health capabilities a) Utilize human prion disease surveillance to better inform and lessen undue concerns among health professionals and the public. b) ☐Optional Obtain scientific data to support development of evidence based and cost-effective policies ☒Required III. ☐Optional AREA B: PREVENTION AND INTERVENTION ☒Required I ☐Optional ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS Strategy 3a: Coordinate and engage with partners a) Work collaboratively with the state wildlife/natural resources department to ascertain the degree of CWD surveillance within the state, conduct chronic wasting disease related education and consider other activities aimed at persons who hunt within the state and those who consume venison provided by hunters. TX-DSHS-19-1309-A-000478 186 i. In areas where chronic wasting disease is endemic, inform/educate hunters about this disease in cervids and how to protect themselves from possible exposure to the disease agent. ☒Required b) c) Work collaboratively with CDC and other sites funded for enhanced surveillance of CJD and other prion diseases. ☒Required ☐Optional Work collaboratively with the National Prion Disease Pathology Surveillance Center at Case Western Reserve University by maintaining regular contact including at least twice-yearly phone or email contact. ☒Required d) ☐Optional Disseminate data and information on human prion disease within the state (e.g., reports, workshops, grand rounds, etc.) ☒Required h) ☐Optional Work collaboratively with pathologists, neurologists, funeral and mortuary directors, and other appropriate professionals within the state to ensure these professionals are aware of the state’s prion disease surveillance system as well as the prion disease-related resources available to support them, including at CDC, the National Prion Disease Pathology Surveillance Center, the state health department and the CJD Foundation. ☒Required g) ☐Optional Develop relationships with the CJD Foundation or comparable patient groups to enhance collaborative work and to educate and provide assistance to family members of persons affected by prion diseases. Conduct outreach with hospitals and facilities that care for persons with prion disease to educate caregivers, including family members and medical personnel, about prion disease-related infection control issues and about the importance of prion disease surveillance and confirming clinically suspected cases. ☒Required f) ☐Optional Identify facilities within the state that are able to perform brain autopsy on persons suspected of or clinically diagnosed with a prion disease. ☒Required e) ☐Optional ☐Optional Education of infection control practitioners and other relevant staff at hospitals and other facilities about the importance of appropriate infection control regarding human prion diseases. ☒Required ☐Optional TX-DSHS-19-1309-A-000479 187 Collaborations a. With CDC-funded programs: 1. States funded through ELC for enhanced prion surveillance will be actively collaborating with the National Prion Disease Pathology Surveillance Center located at Case Western Reserve University. CDC (NCEZID/DHCPP/PPHO) funds this Center. 2. Referrals to the CJD Foundation to educate and assist family members of persons affected by prion diseases. CDC (NCEZID/DHCPP/PPHO) funds in part this Foundation. b. With organizations external to CDC: 1. There will be collaborations with health care facilities within the state that are able to perform brain autopsy on persons suspected of or clinically diagnosed with a prion disease. 2. When applicable, state health departments funded for enhanced prion surveillance through ELC are asked to work collaboratively with state wildlife/natural resources to conduct chronic wasting disease related education and other activities aimed at persons who hunt within the state and those who consume venison provided by hunters. Target Populations: Clinicians who see suspected and diagnosed cases of human prion disease, infection control personnel in hospitals, others in the community who work with patients suspected of having or been diagnosed with a human prion disease and their families. When applicable, hunters and consumers of venison. Evaluation and Performance Measurement: #1) Number of cases of suspected prion disease received via surveillance (by reporting source) and the number of investigations conducted. #2) Number of suspected and clinically diagnosed cases of prion disease for which a brain biopsy or brain autopsy was conducted. (If possible human CWD is suspected, tissues other than brain may be requested.) #3) Submission of semi-annual (July and January) linelist report of all persons with a suspected or confirmed diagnosis of CJD, indicating which reports your project area accepts as a case (i.e., definitive, probable, possible, neurologist diagnosed). For each case submitted, the following information should be included: a) Year of death, b) State of residence, c) Sex, d) Age, e) Date of birth, f) CJD Status, g) Was the case diagnosed by a neurologist?, h) Is the case still under investigation and if yes, please explain, i) Was CJD noted on the death certificate?, j) Was an Autopsy performed?, k) Was a Biopsy performed?, l) Were specimens sent to NPDPSC?, m) Were specimens sent to another laboratory?, n) Were clinical data for cases < 45 years of age sent to CDC?, o) Was the CJD Surveillance Report Form completed for cases < 55 years of age? #4) Number of suspected or confirmed case of CJD in a person less than 55 years of age, suspected cases of variant CJD or possible human CWD, suspected iatrogenic cases, and suspected case clusters reported to CDC within two weeks of the report to the state department of health. For those less than 45 years of age and for each of the other above investigations: the number of persons for whom the pertinent portions of the medical record were submitted to CDC. #5) Number of suspected cases of CJD identified through at least annual review of death certificate- data or other data sources; the number of newly identified cases found by this review; the number of cases identified TX-DSHS-19-1309-A-000480 188 through surveillance that did not indicate CJD on the death certificate; and where possible, for those cases where CJD was not indicated on the death certificate, what was listed as the cause and underlying cause of death. #6) Description of collaborative work conducted with the National Prion Disease Pathology Surveillance Center, the CJD Foundation, health care facilities within the state, relevant health care professionals (pathologists, neurologists, funeral and mortuary directors, infection control professionals, hospice staff, etc.), state wildlife/natural resources department, other state departments of health (when appropriate) and CDC. This may include mention of how these parties confront issues such as barriers to reporting and obtaining consent for autopsy. #7) Number and types of educational interactions (presentations, dissemination of printed materials, poster presentation, workshops, Grand Rounds, etc.) provided to pathologists, neurologists, funeral and mortuary directors, infection control professionals, hospice staff, etc. to maximize knowledge about human prion diseases and reporting of suspected and diagnosed cases of CJD and ensure they are knowledgeable about the appropriate infection control recommendations related to prion disease. #8) Description of how surveillance data is used to 1) describe human prion disease within the state, 2) redirect surveillance activities and strategies within the state and 3) inform evidence-based state/national policy recommendations, guidelines, etc. #9) For awardees where CWD has been identified: Number of meetings with wildlife/natural resources department to conduct CWD-related education and other activities aimed at persons who hunt within the state and those who consume venison provided by these hunters. TX-DSHS-19-1309-A-000481 189 M: Rabies Surveillance Program Activity Contact Information Jesse D. Blanton, Rabies Surveillance and Epidemiology Unit Lead, asi5@cdc.gov, 404-639-2289 Funding Opportunity Description Background a. Overview Improved communication between laboratories conducting rabies diagnosis and those supporting clinical decisions of exposed individuals is critical for improving adherence to national recommendations for postexposure prophylaxis. In addition, more timely transfer of standards based laboratory information for national notification improves the ability to respond to regional and national changes in the epidemiology of rabies. This is particularly critical in relation to the national oral rabies vaccination programs conducted by USDA. b. Healthy People 2020 Goal Immunization and Infectious Diseases-21: Increase the number of States that use electronic data from rabies animal surveillance to inform public health prevention programs. c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: An estimated 35,000 to 55,000 persons receive rabies post-exposure prophylaxis (PEP) each year due to potential rabies exposures. Another 180,000 persons each year have a potential rabies exposure that is ruled out by diagnostic testing of the suspect animal; and hundreds of thousands more by public health observation of suspect animals. Managing a person who has a suspect rabies exposure involves information sharing between public health, personal health care, laboratory, animal control, and veterinary providers to provide timely and appropriate care. Delays or inability to share information while managing a suspect exposure case can result in unnecessary administration of rabies biologics or, more worrisome, failure to provide timely treatment. Electronic management systems can help increase access and accountability of all persons involved in managing rabies exposures, but are not widely available across state health departments. b. Purpose: Funding will support public health partners in developing electronic laboratory reporting mechanisms or improving existing systems for the electronic management of suspect rabies exposures. Such systems should provide a web accessible application combining demographic and exposure information, laboratory data, and animal observation data to aid local officials in the management and follow-up of potential rabies exposure cases. The system should reflect recommendations contained within the Advisory Committee on Immunization Practices – human rabies prevention guidance- to help ensure that national guidance is followed and will ideally capture case management data for evaluation purposes. Preference will be given to applications that can show adaptation of currently available platform, particularly those that might be extensible or adaptable for use in other state or jurisdiction platforms. c. Outcomes: TX-DSHS-19-1309-A-000482 190 Improved timeliness of the exchange of state laboratory and animal observation data within reporting jurisdictions, for the management of potential rabies exposure cases • Improved data accuracy and timeliness for reporting and national notification of laboratory diagnosis of rabies in animals • Improved completeness of data reported to CDC for the national notification of animal rabies cases Funding Strategy: Funds should be utilized for workshop travel, supplies, equipment, or contractual support for proposed activities. Estimated total availability of funds: $100,000 - $150,000 Estimated number of awards given: 2 Estimated average per award: $50,000-$75,000 Strategies and Activities: • I I. AREA A: SURVEILLANCE, DETECTION, AND RESPONSE Strategy 1f: Improve laboratory coordination and outreach/information flow a) a) Develop or improve electronic systems that facilitate real-time flow of results between local and state agencies responsible for managing suspect rabies exposure cases ☒Required II. Strategy 1h: Advance electronic information exchange implementation a) Develop or improve electronic systems that facilitate electronic laboratory reporting based on standard message mapping guides for national notification of animal rabies ☒Required b) III. ☐Optional Improve sharing of laboratory data to help facilities confirmatory testing of samples between state and federal laboratories ☐Required I ☐Optional ☒Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS Strategy 3a: Coordinate and collaborate a) a) Improve real-time laboratory data sharing to facilitate coordination of rabies response activities between local, state, and federal agencies ☒Required ☐Optional Collaborations a. With CDC-funded programs: NCEZID/DHCPP/Poxvirus and Rabies Branch b. With organizations external to CDC: Association of Public Health Laboratories (APHL) TX-DSHS-19-1309-A-000483 191 Target Populations: Human rabies exposures are generally higher among children and in rural populations; declines in rabies diagnosis quality or case management would affect these populations disproportionately. Evaluation and Performance Measurement: Required performance measures for the project period are listed below. Data will be reported on an annual basis (calendar year), and are used to indicate progress made toward program outcomes. Measure #1) Number of state and local staff trained on new case management system Measure #2) Proportion of suspected rabies exposures in jurisdiction managed using an electronic case management system (Number of suspected rabies exposures in jurisdiction/ number managed using an electronic case management system) Measure #3) Average time from rabies suspected exposure reported to end of follow-up (e.g. received final guidance on PEP) TX-DSHS-19-1309-A-000484 192 N: Parasitic Diseases Surveillance Program Activity Contact Information Yvonne Qvarnstrom, bvp2@cdc.gov, 404-718-4123 Robin Nilson, niu3@cdc.gov, 404-718-5668 Funding Opportunity Description Background a. Overview This project aims at strengthening the capacity and capability of public health departments to control and prevent parasitic infections. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Several parasitic infections that are transmitted in the United States can cause serious health problems, including Babesiosis, Chagas disease, eosinophilic meningitis due to Angiostrongylus cantonensis infection, neurocysticercosis, toxocariasis, toxoplasmosis, and trichomoniasis. The burden of disease in the United States for these parasitic infections, and others that were historically endemic, such as soil transmitted helminth infections, is poorly defined. Health care providers often have limited familiarity with diagnosis and management of these diseases. Many parasitic infections are treatable but may not be detected or diagnosed in a timely manner. Activities in this project will increase capacity in public health departments to diagnose parasitic infections, identify parasitic diseases that represent a burden in their population and implement control measures. b. Purpose: CDC will support state led efforts to increase or maintain laboratory capacity to monitor and track parasitic diseases of public health importance in their jurisdiction. c. Outcomes: More efficient and accurate diagnosis of parasitic infections More effective public health workforce better prepared to detect parasitic disease threats in the United States • Improved identification of parasites to the species level, which will help to manage cases of infections more efficiently. • More rapid detection of cases and outbreaks • More timely, complete and effective investigation efforts including more complete ascertainment of cases and detection of cases through laboratory confirmation. • Improved detection of soil-transmitted helminth infections in areas of the United States where soil transmitted helminth transmission may persist. Funding Strategy: • • TX-DSHS-19-1309-A-000485 193 Funding for implementation and training in use of diagnostic parasitology tools, including hands-on workshops, telediagnosis, and molecular diagnostic detection of parasitic diseases. • Estimated total availability of funds: $100,000 • Estimated number of awards given: 10 • Estimated average per award: $10,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1a: Enhance workforce capacity for use of diagnostic parasitology tools Training in use of diagnostic parasitology tools i. Participate in CDC-sponsored diagnostic parasitology workshops or other equivalent training events ☐Required II. a) Strategy 1c: Improved Surveillance and reporting Expand surveillance for soil transmitted helminth infections i. Expand surveillance activities for STH infections in areas of the United States where STH infections formerly were known to be endemic and that remain at risk for ongoing transmission (AL, GA, KY, LA, MS, NC, SC, TN) and implement control strategies if ongoing transmission is identified ☐Required III. ☒Optional ☒Optional Strategy 1e: Enhance laboratory testing for surveillance and reporting a) Maintain or improve the use of appropriate diagnostic parasitology tools for case detection, surveillance and outbreak investigations i. Implement or maintain internet-based telediagnosis, which involves the generation and exchange of images captured from diagnostic specimens in which confirmation of parasitic disease is needed ii. Implement or maintain molecular diagnosis of the following parasitic diseases that represent a public health burden in the grantee’s jurisdiction • Babesiosis in states where this disease is considered endemic: Connecticut, Massachusetts, Minnesota, New Jersey, New York, Rhode Island, and Wisconsin. Other states with evidence of wellestablished tick-borne transmission may also qualify. • Angiostrongyliasis in states with high disease burden. ☐Required ☒Optional Collaborations: a. With CDC funded programs: N/A b. With organizations external to CDC: TX-DSHS-19-1309-A-000486 194 N/A Target Populations: N/A Evaluation and Performance Measurement: Measure #1) Number of clinical specimens from cases of suspected parasitic diseases that the grantee processed for diagnostic testing. Measure #2) Description of activities/tests that were introduced or changed as the result of ELC-supported trainings. Measure #3) • Number of adequately trained public health laboratorians required for the diagnostic parasitology workload in jurisdiction (Denominator) • Number of public health laboratorians currently proficient in performing diagnostic parasitology tests (Numerator). Measure #4) • Number of patients, divided into age groups and region of residence, at risk for STH infections in a defined area (denominator) • Number of patients, divided into age groups and region of residence, diagnosed with STH infections in a defined area (numerator). TX-DSHS-19-1309-A-000487 195 O: Enhanced Vaccine-Preventable Disease (VPD) Program Activity Contact Information Sandra W. Roush (Overall NNDSS VPD Surveillance Coordination), swr1@cdc.gov, 404-639-8741; Amy Blain (meningococcal disease), wgi9@cdc.gov, 404-639-2563; Adriana Lopez (varicella and AFM), ail7@cdc.gov, 404639-8369 Funding Opportunity Description Background a. Overview The overall goal of the ELC Cooperative Agreement for Enhanced VPD Surveillance (O Project, previously R1) is to strengthen and coordinate VPD case-based and outbreak surveillance, building upon established surveillance systems to provide more complete and representative data. Four required activity areas for this cooperative agreement include overall VPD surveillance coordination and enhanced surveillance specifically for meningococcal disease, varicella, and acute flaccid myelitis (AFM). Current guidelines for VPD surveillance can be found in the Manual for the Surveillance of Vaccine-Preventable Diseases (https://www.cdc.gov/vaccines/pubs/surv-manual/index.html). Additional guidance/guidelines referenced throughout this document can be found on CDC disease-specific websites. b. Healthy People 2020 The Public Health Infrastructure Objectives 11 and 13 include: increase the proportion of tribal, state, and local public health agencies that provide or assure comprehensive laboratory and surveillance/epidemiology services, respectively, to support essential public health services. https://www.healthypeople.gov/2020/topics-objectives/topic/public-health-infrastructure/objectives The Immunization and Infectious Diseases 2020 Objectives include: IID-1 Reduce, eliminate, or maintain elimination of cases of vaccine-preventable diseases, IID-3 Reduce meningococcal disease, and IID-4 Reduce invasive pneumococcal infections. https://www.healthypeople.gov/2020/topicsobjectives/topic/immunization-and-infectious-diseases/objectives The Immunization and Infectious Diseases 2020 Objectives specifically call for reducing the number of varicella cases among children <17 years of age (IID-1.10), helping maintain 2-dose varicella vaccination coverage levels above 95% among kindergarteners (IID-10.5), and helping increase 2-dose varicella vaccination levels among adolescents aged 13-15 years (IID-11.2). https://www.healthypeople.gov/2020/topicsobjectives/topic/immunization-and-infectious-diseases/objectives The Immunization and Infectious Diseases 2020 Objectives call for reducing the number of meningococcal disease cases by 10% (IID-3). The Objectives also call for increasing the vaccination coverage level of 1 dose meningococcal conjugate vaccine for adolescents by age 13 to 15 years (IID-11.3). https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectiousdiseases/objectives c. Other National Public Health Priorities and Strategies The CDC Surveillance Strategy calls for improving the timeliness, quality, and completeness of surveillance data available to CDC programs; state, tribal, local, and territorial (STLT) agencies; and other stakeholders. https://www.cdc.gov/surveillance/Improving-Surveillance-Background.html TX-DSHS-19-1309-A-000488 196 CSTE determines the list of nationally notifiable diseases/conditions and indicates the timeframes for case notification within NNDSS. https://www.cste.org/page/About_CST CDC Project Description a. Problem Statement: Surveillance activities are critical for detecting VPDs and obtaining critical information to help control disease and address public health problems. However, both case reporting and notification are dependent on many factors, including reporting source, timeliness of investigation, completeness of data, and ability of surveillance systems to collect and transmit data representing historically recognized and newly identified variables of public health importance. In addition, various surveillance methods are used to collect information, depending on disease incidence, specificity of clinical presentation, available laboratory testing, control strategies, public health goals, and stage of vaccination program. Support for overall NNDSS VPD surveillance coordination, in addition to support specifically for enhanced meningococcal disease, varicella, and AFM surveillance, will help address the problems in case reporting and notification. Specific challenges within each of the four required activity areas are described below: Overall NNDSS VPD Surveillance Coordination: NNDSS supports assessment of epidemiologic trends and programmatic impact. However, NNDSS data has known limitations (e.g., missing data for key variables) and those surveillance data have not been sufficient to fully assess the impact of vaccine programs. NNDSS data are collected by states/jurisdictions and are electronically transmitted to CDC. Variations in VPD reporting within jurisdictions and case notification to CDC may be due to disease/condition characteristics (e.g., symptoms, incidence, severity); availability of laboratory diagnostics; patient and provider awareness; jurisdiction attributes (e.g., laws, regulations); disease transmission setting; ability to coordinate across epidemiology, laboratory, immunization, and informatics; and/or capacity for electronic data exchange. However, interpretation of incomplete and untimely data for any of these reasons poses challenges for measuring disease burden and vaccine program impact. These challenges negatively impact decision making and public health action. Meningococcal disease is a serious bacterial infection that can lead to death or severe long-term sequelae. Serogroups B, C, and Y are the major causes of meningococcal disease in the United States. Meningococcal conjugate vaccines protect against serogroups C and Y and are routinely recommended for adolescents. Serogroup B meningococcal vaccines have also recently been licensed in the United States. With the incidence of disease at historic lows, surveillance and vaccine program evaluations through established systems are challenging. High quality surveillance data and collection of circulating isolates from a broad and representative population are key for following disease trends, making vaccine program policy recommendations, and monitoring vaccine program impact. Recent outbreaks among special populations (e.g., college students, homeless, MSM) reinforce the need for particular emphasis on high quality and complete surveillance data. Varicella was added to the list of nationally notifiable conditions in 2003 and is reportable in 40 states as of 2017. In 2007, routine two-dose varicella vaccination was recommended for children, primarily in response to outbreaks of varicella in populations with high 1-dose coverage. Data from the first 5 years of the two-dose varicella vaccination program demonstrated reductions in the number and size of outbreaks. Varicella outbreak surveillance supports assessment of vaccine program impact and informs public health TX-DSHS-19-1309-A-000489 197 interventions. Case-based surveillance is the only data source currently available to monitor trends in varicella incidence. Improving varicella surveillance by increasing reporting completeness for varicella-specific clinical and epidemiologic variables of reported cases, including severe cases (e.g., hospitalizations), will allow monitoring for the impact of the 2-dose varicella vaccine program and enhance understanding of changing varicella epidemiology. Acute Flaccid Myelitis (AFM) is characterized by flaccid limb weakness and abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI) scan. Acute Flaccid Paralysis (AFP) has numerous etiologies including viruses, genetic conditions, and environmental toxins and can prove diagnostically challenging. Anterior horn cell disease, or AFM, is a subset of AFP, and is caused by poliovirus, West Nile virus, and other viruses including non-polio enteroviruses. Since the widespread implementation of polio vaccination worldwide, AFM due to poliovirus has decreased substantially and had been eliminated in the United States, but not yet eradicated globally. AFM is not a nationally notifiable syndrome, but may be reportable within specific jurisdictions. Ensuring that imported and indigenously acquired poliomyelitis cases are detected in the U.S. and interpreting any apparent increase in reports of AFM has been challenging in the absence of baseline incidence of AFP due to AFM (https://www.ncbi.nlm.nih.gov/pubmed/27318332). Additional information about investigations of AFM and guidance for clinicians and health departments can be found on the CDCs AFM webpage (https://www.cdc.gov/acute-flaccid-myelitis/index.html). b. Purpose: The purpose for providing resources for NNDSS VPD Surveillance Coordination is to enhance and strengthen case-based and outbreak surveillance for VPDs and related conditions, allowing public health agencies to effectively collect and provide timely and complete surveillance data. This CoAg will build on established immunization programs and surveillance systems (e.g., NNDSS) to provide broader and more representative data for nationally notifiable diseases. Along with surveillance coordination, this CoAg will also focus specifically on enhancing surveillance for meningococcal disease and varicella, and supporting/establishing surveillance for AFM. In addition, jurisdictions may choose to participate in optional activities to further enhance VPD surveillance. c. Outcomes: Outcomes for Required Tier 1 Activities (VPD Surveillance Coordination, Meningococcal Disease, Varicella, and AFM): • Improved coordination and exchange of surveillance data and information across jurisdictions’ programs and partners • Improved surveillance data quality and completeness (e.g., completeness of vaccine history, importation) • Improved timeliness of case notifications to NNDSS and associated surveillance systems • Improved timeliness of detection, investigation, and response to cases, outbreaks, and deaths • Increased support for and utilization of surveillance data assessments to inform public health practice • Improved linkages between epidemiology, immunization, laboratory, and health information partners to support surveillance-related activities and resources • Improved educational awareness to health care providers and other public health partners • Enhanced support for laboratory testing as appropriate for investigation and control TX-DSHS-19-1309-A-000490 198 • Enhanced standardization, interoperability, and use of surveillance information systems by jurisdiction and CDC Outcomes for Optional Tier 2 Activities: Enhance surveillance for severe cases of varicella: • Improved completeness of data collected for severe (e.g., hospitalized) cases of varicella (e.g., vaccination history, clinical presentation, reason for hospitalization) to monitor severe varicella disease during the mature varicella vaccination era Enhance pertussis surveillance: • Enhanced monitoring for molecular changes in pertussis through submission of isolates to CDC • More complete and timely surveillance data (e.g., vaccination history, clinical presentation, laboratory results) to monitor the incidence and epidemiology of pertussis • Increased notification of suspected pertussis-related deaths Enhance Haemophilus influenzae surveillance: • More complete and timely surveillance data to monitor the incidence and epidemiology of H. influenzae, with particular focus on children < 5 years of age • Availability of isolates sent to CDC for H. influenzae serotyping Enhance Invasive Pneumococcal Disease (IPD) surveillance: • More complete and timely surveillance data to monitor the incidence and epidemiology of IPD • Enhanced serotype monitoring of changes in IPD through testing of appropriate sterile site isolates Enhance measles surveillance: • Surveillance data used to identify subpopulations at risk for measles • Identification of appropriate interventions or tailoring of standard/evidence-based interventions to the specific needs of a particular outbreak in order to prevent measles in subpopulations at increased risk Enhance mumps surveillance: • Surveillance data used to identify risk factors responsible for increased number of mumps cases and outbreaks • Enhanced characterization of mumps cases (e.g., in high 2-dose vaccination coverage settings, in outbreak settings) through improved completeness of clinical, laboratory, and epidemiologic data • Improved molecular surveillance for mumps Enhance AFM surveillance and long-term follow-up for AFM cases: • Increased jurisdiction capacity to increase awareness for AFM among healthcare providers • Increased number of jurisdictions reporting AFM patients under investigation (PUIs) to CDC (NOTE: A suspected AFM case is considered a PUI when the patient summary form is received by CDC) • Increased completeness and timeliness of surveillance data submitted and used to monitor AFM PUIs and cases • Increased timeliness of laboratory specimens sent to CDC laboratories for etiologic testing • Increased understanding of AFM outcomes through long-term follow-up of confirmed and probable cases Enhance surveillance for other VPDs and related conditions: TX-DSHS-19-1309-A-000491 199 If optional activities for other VPDs and related conditions are proposed, outcomes should be defined in collaboration with CDC programs to improve surveillance and public health response Funding Strategy: • Tier 1 funds should be used for personnel (e.g. VPD Surveillance Coordinator, varicella epidemiologist) and shipping of specimens and isolates. Funds to support shipping costs to CDC are not to exceed ~$5,000 per site. Jurisdiction participation on CoAg-related phone calls and communications is a requisite of funding. The total funded amount for Tier 1 activities per site is expected to fund approximately one full-time person, with the understanding that if there is already a specified VPD Surveillance Coordinator in the jurisdiction, this funding does not need to be used to support that specific person. • Estimated total availability of funds: $6.4 million • Estimated number of awards given: 64 • Estimated average per award: $100,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation and outbreak response VPD surveillance coordinator will serve as the point of contact for VPDs and related conditions for which surveillance is conducted through NNDSS or the ELC O Project (previously R1) i. Support surveillance for VPDs and related conditions, including, but not limited to measles, mumps, rubella, congenital rubella syndrome, varicella, pertussis, H. influenzae, meningococcal disease, tetanus, diphtheria, IPD, paralytic poliomyelitis, non-paralytic poliovirus infection, and AFM (understanding that the individual surveillance activities may or may not be duties specifically assigned to the VPD Surveillance Coordinator) ii. Ensure the use and implementation of standard investigative questionnaires, data collection/sharing tools, and methods iii. Lead/assist in the timely investigations of and data submissions for cases, clusters, and outbreaks iv. Engage in and evaluate ELC O Project activities (e.g., participate on quarterly All-Jurisdiction VPD Surveillance calls, submit Quarterly Surveillance Coordination Activity Summaries) ☒Required b) Collect case data on key and enhanced variables, as described in CDC guidance ☒Required c) ☐Optional Provide surveillance data to support evaluations of public health response to meningococcal disease, as appropriate (e.g., risk factors for meningococcal disease, serogroup B meningococcal vaccine effectiveness, retrospective record review to identify cases among the same household) ☒Required d) ☐Optional ☐Optional Ensure reporting sources follow jurisdiction requirements to inform state/local health departments of varicella outbreaks; for jurisdictions where varicella is not a reportable condition but outbreaks of all TX-DSHS-19-1309-A-000492 200 etiologies are reportable, processes should be put into place to facilitate reporting of varicella outbreaks II. a) b) c) ☒Required ☐Optional ☒Required ☐Optional ☒Required ☐Optional Strategy 1c: Improve surveillance and reporting Develop, implement, and maintain surveillance systems Evaluate and enhance surveillance systems based on CDC guidelines Conduct regular assessment of surveillance data and implement processes to improve completeness, timeliness, and quality of case data i. Review surveillance indicator reports at least annually (e.g., provisional, final) to identify areas for improvement (e.g. electronic, programmatic) ii. Review surveillance data regularly (e.g. quarterly) to identify areas for improvement (e.g. electronic, programmatic) iii. For meningococcal disease: check immunization information system (IIS) for vaccination information for cases; check HIV registry for HIV status for cases (if feasible in accordance with jurisdiction policies and procedures), check previous sexually transmitted infections (STI) investigations for MSM status, follow-up with providers and/or parents regarding clinical presentation iv. For varicella cases in jurisdictions where varicella is a reportable condition: check IIS for vaccination information for cases, check databases for varicella-related hospitalizations, follow-up with providers and/or parents regarding clinical presentation ☒Required d) ☐Optional Facilitate coordination/exchange of surveillance data with CDC i. Provide case notifications and other surveillance data reports to CDC with complete information on key and enhanced variables for confirmed and probable meningococcal disease cases ii. Provide outbreak-related case data to CDC quarterly, including the number and characteristics of varicella outbreaks reported to the jurisdiction iii. In jurisdictions where varicella is a reportable condition and varicella case-based surveillance is in progress, enhance established case notification processes for submitting case-based varicella data to CDC iv. In jurisdictions where varicella is a reportable condition and varicella case-based surveillance is in progress, provide annual summaries to CDC listing the varicella-related variables collected and the data completeness for those variables in the previous year TX-DSHS-19-1309-A-000493 201 v. In jurisdictions where AFM cases are reported to the local/state health department and specimens are submitted, notify/report to CDC the suspect cases of AFM (https://www.cdc.gov/acute-flaccid-myelitis/index.html) ☒Required III. a) Strategy 1d: Enhance laboratory testing for surveillance and reporting For each disease/condition, support maintenance of the availability of appropriate surveillance testing capacity (e.g., culture, serotyping/serogrouping, molecular sequencing) within jurisdiction public health laboratories, VPD Reference Centers (RCs), and/or CDC laboratories ☒Required b) a) a) ☐Optional Coordinate activities to increase access to specimens and isolates so that laboratory data are available to inform surveillance activities i. Ensure routine transportation of clinical isolates to jurisdiction public health or other lab ii. Ship isolates from confirmed and probable cases of meningococcal disease to CDC for molecular characterization ☒Required V. ☐Optional Strategy 1f: Improve laboratory coordination and outreach to improve efficiency Support linkage of laboratory specimens, isolates, and results with epidemiologic and clinical casepatient data ☒Required b) ☐Optional Collect isolates from confirmed and probable cases of meningococcal disease and test for serogroup and additional molecular characterization ☒Required IV. ☐Optional Implement a flexible plan for se and acquisition of laboratory supplies and testing that addresses changing needs/purposes for each disease/condition ☒Required c) ☐Optional ☐Optional Strategy 1g: Enhance coordination between partners between epi-lab-HIT Support and integrate epidemiology, laboratory, immunization, and health information activities i. Foster collaboration between VPD program and other public health programs (e.g., STD) to facilitate collection of key and enhanced variables for confirmed and probable meningococcal disease cases TX-DSHS-19-1309-A-000494 202 ii. iii. Ensure coordination between partners (e.g., immunization, epidemiology, health information) to facilitate access to IIS data for assessing meningococcal vaccination status for confirmed and probable meningococcal disease cases Ensure coordination between partners (e.g., immunization, epidemiology, health information) to facilitate access to IIS data for assessing varicella vaccination status of varicella cases, including cases associated with outbreaks ☒Required VI. a) ☐Optional Strategy 1i: Sustain and/or enhance information systems Support VPD surveillance through coordination between epidemiology, laboratory, immunization, and health information systems (e.g., NNDSS, IIS, electronic lab reports (ELR), electronic case reports (eCR), Health Level 7 (HL7) messages) to enhance use and exchange of electronic data files ☒Required ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I VII. a) Strategy 3a: Enhance coordination between partners Foster collaboration among city, county, state, federal, and other internal and external partners to improve outbreak and case-based reporting for VPDs and related conditions (e.g., AFM) ☒Required b) Engage and collaborate with stakeholders by providing surveillance data to inform and support policies and public health evaluations for VPDs and related conditions (e.g., AFM) ☒Required c) ☐Optional ☐Optional Communicate and coordinate with public health partners to ensure appropriate investigation, testing, and case-based reporting for VPDs and related conditions (e.g., AFM) i. Ensure public health partners receive ongoing training and education so they are informed of the importance of collecting the key variables for meningococcal disease surveillance ii. Ensure public health partners receive ongoing training and education so they are informed of the importance of collecting the key variables for varicella case-based surveillance iii. Disseminate information to reporting sources (e.g., schools, physicians’ offices) to raise awareness of varicella reporting requirements (e.g., what variables to report, how to report, when and how to report cases/outbreaks) iv. Educate and increase awareness for AFM by ensuring that public health partners (e.g., infectious disease specialists, intensive care physicians, pediatricians, neurologists, radiologists/neuroradiologists, infection preventionists, primary care providers, emergency departments, microbiology laboratories) are provided AFM-related clinical, epidemiologic, and laboratory information (e.g., importance of early collection of 2 stool specimens at least 24 hours apart to rule out poliovirus infection) TX-DSHS-19-1309-A-000495 203 v. vi. In jurisdictions where AFM cases are reported to the local/state health department and specimens are submitted, ensure awareness of access to laboratory testing of appropriate specimens (e.g., stool, respiratory, serum, and cerebrospinal fluid specimens for poliovirus, non-polio enteroviruses, West Nile virus, and other known infectious etiologies) to support surveillance In jurisdictions where AFM is a reportable condition, communicate reporting requirements to clinicians (e.g., report suspect cases of AFM to local/state health department, collect specimens from cases as early in the course of illness as possible, collect 2 stool specimens at least 24 hours apart and as early ☒Required ☐Optional OPTIONAL TIER 2 ACTIVITIES TO EXPAND/ENHANCE SURVEILLANCE I In addition to the required Tier 1 outcomes and strategies/activities listed above, applicants may select one or more additional pathogen-specific activities from those listed below. Applicants may select optional Tier 2 activities that a) expand and enhance current surveillance infrastructure based on the priorities and public health needs of their jurisdiction, and b) will make progress toward the outcomes defined in the “Outcomes” section of this ELC Project O (previously R1) guidance. Jurisdictions must address all of the Tier 1 activities in order to also be eligible to apply for any of the Tier 2 enhanced activities. VIII. a) Strategy: Activities to Expand/Enhance Surveillance Enhance surveillance for severe cases of varicella i. Improve completeness of data collected for severe (e.g., hospitalized) cases of varicella, including reason for hospitalization and clinical presentation, in sites where varicella is reportable and case-based surveillance is conducted (1b) ii. Submit hospitalization data to CDC (1c) ☐Required b) Enhance pertussis surveillance i. Collect complete data on key and enhanced variables (e.g., clinical course of infection, vaccination history, maternal Tdap history for infant cases aged <1 year, laboratory testing) for cases of pertussis (1b) ii. Notify CDC of suspected pertussis-related deaths via e-mail for non-reportable cases or via NNDSS for cases meeting the public health case definition for nationally notifiable conditions (1c) iii. Collect isolates of Bordatella pertussis, when available, and routinely ship to CDC for further laboratory characterization (1e) NOTE: if the optional pertussis activity is proposed, the plan must include collection and shipment of isolates to CDC iv. Utilize IIS to obtain/verify pertussis vaccination history (1i) ☐Required c) ☒Optional ☒Optional Enhance H. influenzae surveillance TX-DSHS-19-1309-A-000496 204 i. ii. iii. Collect complete data on key and enhanced variables (e.g. serotype, outcome) for cases of H. influenzae (1b) Enhance existing surveillance systems and submit H. influenzae case data to CDC (1c) Collect isolates from cases of H. influenzae for serotype confirmation (1e) ☐Required d) Enhance IPD surveillance i. Establish/support surveillance for IPD (e.g., all ages, among children <5 years of age) and submit case data to CDC (1c) ii. Collect complete data on key and enhanced variables (e.g., age, race, ethnicity, vaccination status, dates of administration, and vaccine type) for cases of IPD (e.g., all ages, among children <5 years of ages) (1b) iii. Evaluate completeness of case ascertainment (1b) iv. Identify laboratories capable of isolating Streptococcus pneumoniae within the jurisdiction (1g) v. Collect sterile-site isolates of S. pneumoniae from children <5 years old and submit those isolates for serotyping at VPD RCs (e.g., Minnesota Department of Health, Wisconsin Department of Health) (1e) vi. Implement surveillance among targeted at-risk populations; however, if this tier 2 IPD activity is proposed, planning should be done in collaboration with CDC (1b) ☐Required e) ☒Optional Enhance measles surveillance i. Use local/jurisdiction vaccine data (e.g., IIS) to identify and describe populations/communities/cohorts that are potentially at risk for measles outbreaks (1i) ii. Describe specific community data (e.g., groups by ethnicity, religion, objector/hesitancy status, geography) that would place individuals and populations at risk for measles (1b) iii. Use epidemiologic and surveillance data to 1) describe potential impact of a measles outbreak, 2) plan for appropriate interventions, and 3) describe impact of those interventions (1b) ☐Required f) ☒Optional ☒Optional Enhance mumps surveillance i. Collect complete data on key and enhanced variables (e.g., symptoms, complications, incubation period) for cases of mumps, ensure lab testing, and support inclusion of lab results in case notifications to CDC (1b) ii. Review mumps data (e.g., vaccination history, symptoms and complications, laboratory information, transmission and source data), characterize high risk groups, and further identify risk factors for infection and modes of transmission (1b) TX-DSHS-19-1309-A-000497 205 iii. iv. Submit data for outbreak-associated cases to CDC routinely and establish mumps outbreak resources (1c) Collect specimens for molecular surveillance and submit for testing in accordance with CDC guidelines (1e) ☐Required g) ☒Optional Enhance AFM surveillance i. Ensure timely and appropriate collaborations with pediatric hospitals and tertiary referral centers to increase awareness and understanding of AFM, reporting mechanisms, and appropriate laboratory testing (3a) ii. Report all patients under investigation for AFM to CDC, including submission of AFM patient summary form (1c) iii. Collect complete information on key variables (e.g., medical history, radiologic reports, vaccine history) and submit to CDC in a timely manner (1b) iv. Establish and maintain processes to reduce the interval between symptom onset and clinical specimen collection (1b) v. Establish and maintain processes to improve the timeliness between symptom onset, submission of AFM case report form to the CDC, and completion of the medical chart abstraction (1c) NOTE: Only jurisdictions that have reported at least one PUI to CDC in the previous 4 years are eligible to apply for funding through this Tier 2 activity. This funding should be used to support surveillance personnel. ☐Required h) ☒Optional Enhance long-term follow-up for AFM cases i. Establish and maintain processes to collect information about clinical outcomes for confirmed and probable AFM cases for the first year after onset of limb weakness (1b) ii. Ensure coordination with pediatric hospitals, tertiary referral centers, rehabilitation centers, and physicians to collect complete information about the long-term disposition of AFM cases and submit data to CDC in a timely manner (1c) NOTE: Only jurisdictions that have, in the previous year, reported a PUI to CDC that was subsequently classified as a confirmed or probable case are eligible to apply for funding through this Tier 2 activity. This funding should be used to support surveillance personnel. ☐Required i) ☒Optional Enhance surveillance for other vaccine preventable diseases i. If tier 2 activities for other VPDs and related conditions are proposed, activities should be defined in collaboration with CDC programs to improve surveillance and public health response TX-DSHS-19-1309-A-000498 206 ☐Required ☒Optional Collaborations: a. With CDC funded programs: Collaboration with ELC, epidemiology, laboratory, health information and immunization programs (including Immunization Program Manager) is required. b. With organizations external to CDC: APHL, VPD Reference Centers, CSTE Target Populations: For Overall NNDSS VPD Surveillance Coordination: VPD surveillance should be coordinated across epidemiology, laboratory, immunization and health information partners within the jurisdiction. See additional guidance in the Manual for Surveillance of Vaccine-Preventable Diseases http://www.cdc.gov/vaccines/pubs/surv-manual/index.html. For Meningococcal Disease: Monitoring individual cases of meningococcal disease in all ages is important to track progress of the vaccination program. See additional guidance in the Manual for Surveillance of VaccinePreventable Diseases http://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. For Varicella: Monitoring individual cases of varicella in all ages is important to track progress of the vaccination program. See additional guidance in the Manual for Surveillance of Vaccine-Preventable Diseases http://www.cdc.gov/vaccines/pubs/surv-manual/chpt17-varicella.html. For AFM: Focus should be on patients with acute onset of flaccid limb weakness. Although AFM has been more commonly reported in children, monitoring reports of cases in all ages will be important for understanding the full spectrum of illness. See additional guidance on the CDC AFM website https://www.cdc.gov/acute-flaccid-myelitis/hcp/case-definition.html. Evaluation and Performance Measurement: Required performance measures are listed below and will be used to indicate progress toward the specific CoAg outcomes. Surveillance data will be submitted electronically to CDC through NNDSS or through regular disease-specific reports. Data for the performance measures will be provided to jurisdictions by CDC, will be submitted by jurisdictions during the annual ELC application process, or will be submitted by jurisdictions throughout the project year via required reports. See footnotes regarding sources of data for the performance measures. 1) For Overall NNDSS VPD Surveillance Coordination: • Identification of a VPD Surveillance Coordinator1 • Participation in VPD Surveillance calls (e.g., Quarterly All-Jurisdiction calls, meningococcal diseasespecific calls, AFM-specific calls)1 • Proportion of cases with complete and timely information for key surveillance indicator variables2 • Percentage of reports of selected reportable diseases (e.g., measles, meningococcal disease, pertussis) for which initial public health control measure(s) were initiated within appropriate timeframe3 TX-DSHS-19-1309-A-000499 207 • • Review of Surveillance Indicator Reports at least annually (e.g., provisional, final) and documentation of regular (e.g. quarterly) utilization of surveillance data and Surveillance Indicator Reports to improve and/or make changes to current processes in order to improve the quality of surveillance data4 Utilization of HL7 messaging to enhance standardization, interoperability, and use of surveillance information systems by jurisdiction and CDC1 2) For Meningococcal Disease: • Proportion of meningococcal disease cases with isolates and enhanced surveillance data submitted to CDC1 • Proportion of cases with complete information for key surveillance indicator variables (e.g., serogroup, vaccination status, outcome)2 • Proportion of cases with complete information for enhanced surveillance variables (e.g., clinical presentation, college attendance, MSM, HIV status5, homelessness)6 3) For Varicella: • Number of varicella outbreak-associated cases with enhanced surveillance data submitted to CDC1 • For sites where varicella is a reportable condition and case-based varicella surveillance is conducted, proportion of cases with complete information for key surveillance indicator variables (e.g., age, number of lesions, hospitalization status, confirmation status, laboratory testing, relation to outbreak, vaccination status)1,2 4) For AFM: • Documentation that AFM education is in place in jurisdiction and description of educational tools developed/outreach conducted4 • Number of AFM cases investigated, confirmed, and ruled out4 These data will be maintained by CDC and will be informed by jurisdiction activity participation and submission of required reports throughout the project year (e.g. Quarterly Surveillance Coordination Activity Summary, Biannual Meningococcal Data/Isolate Submission, Quarterly Varicella Outbreak Report). 2 These data will be provided to jurisdictions via the VPD Surveillance Indicator Reports. VPD Surveillance Indicator Reports are created by NCIRD for the 50 states, New York City, and Washington DC, as those are the jurisdiction codes specified in NNDSS. Jurisdictions that do not receive jurisdiction-specific surveillance indicator reports from NCIRD are still required to conduct internal surveillance data reviews and must document how their reviews are used to make improvements to the quality of surveillance data. 3 These data will be collected via the Public Health Emergency Preparedness Cooperative Agreement (13.2); awardees may be expected to verify these data for measures through ELC but will not be expected to report on these data. 4 These data will be submitted by jurisdictions in the ’Performance Measures’ section of the annual ELC application. 5 Completeness of HIV status will only be assessed when the CDC meningococcal program is able to receive this data in a manner that complies with jurisdiction and federal policies and procedures. 6 These data will be provided to jurisdictions via CDC meningococcal program feedback reports. 1 TX-DSHS-19-1309-A-000500 208 Performance measures for the optional tier 2 activities selected by the awardee should be defined in collaboration with CDC. TX-DSHS-19-1309-A-000501 209 P: Legionnaires’ Disease Prevention Program Activity Contact Information Candis M. Hunter, MSPH, REHS, hlb8@cdc.gov, 770-488-1347 Laura Cooley, MD, MPHTM, whz3@cdc.gov, 404-639-2096 Funding Opportunity Description Background a. Overview The goals of this program are to build epidemiologic, environmental, and laboratory capacity for Legionnaires’ disease (LD) response and prevention through: 1) enhanced case surveillance and reporting 2) improved environmental assessments and outbreak response 3) increased utilization of water management programs (WMPs) compliant with industry standards b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: From 2000 to 2016, there has been a 350% increase in the incidence of LD in the United States. The burden of LD is substantial, with case fatality rates of 10% (25% among healthcare-associated cases) and hospitalization cost estimates of $433 million per year. LD outbreaks comprise over half of all reported potable water outbreaks. In the United States, LD case surveillance is currently conducted through the National Notifiable Diseases Surveillance System (NNDSS) and the Supplemental Legionnaires’ Disease Surveillance System (SLDSS). SLDSS collects exposure information such as travel history and exposure to healthcare facilities. CDC’s Legionella program is in the process of transitioning to an HL7-based reporting mechanism using the Respiratory and Invasive Bacterial Diseases (RIBD) Message Mapping Guide (MMG). LD outbreak surveillance is conducted through the National Outbreak Reporting System (NORS). Transmission of Legionella depends on environmental transmission through inhalation of aerosolized water rather than person-to-person spread. LD outbreak investigations require an environmental assessment to identify potential sources of exposure. Environmental health capacity varies widely across jurisdictions. Lapses in routine maintenance of large, complicated building water systems can almost always be identified during outbreak investigations. An industry standard for the primary prevention of LD in building water systems was published in 2015, although awareness, implementation, evaluation, and regulation of these preventive maintenance strategies remains limited. In 2016, CDC published a toolkit entitled Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings to translate the industry standard into plain language for wider audiences, including health department staff, building owners and managers, and healthcare facility staff. The document serves as a step-by-step overview to creating and TX-DSHS-19-1309-A-000502 210 implementing WMPs to reduce Legionella growth and spread. State and local health departments need environmental, laboratory, epidemiological, and communication resources to reduce the risk of Legionella growth and spread in their jurisdictions. b. Purpose: Cases of LD must be identified in a timely manner for clusters and outbreaks to be recognized. Once clusters and outbreaks are identified, an environmental assessment must be performed to identify possible sources of exposure. Implementation of maintenance strategies for the primary prevention of LD in building water systems can interrupt the amplification, aerosolization, and transmission of Legionella, thereby reducing incidence of disease as well as outbreaks. As such, CDC wishes to build capacity at the state and local levels among epidemiologists, environmental health specialists, and public health laboratorians regarding 1) enhanced surveillance and reporting, 2) improved environmental assessment and outbreak response, and 3) understanding, implementation, evaluation, and regulation of industry standards for primary prevention. c. Outcomes: • Improved timeliness, completeness, and number of LD cases reported with exposure information • More timely, efficient, and coordinated outbreak detection, investigation, and response and implementation of control measures (i.e. best practices for outbreak response) • Increased awareness of WMPs compliant with industry standards among target audiences (e.g., state/local health departments, building owners and managers) Funding Strategy: Funding may support personnel, laboratory or office supplies, training and communications materials, code/licensing/regulatory expenses, specimen storage and shipping costs, and other supplies needed for capacity building and/or an effective response to a situation involving LD or the implementation of preventive maintenance strategies. Future year funding is not guaranteed. • Estimated total availability of funds: $3,000,000 • Estimated number of awards given: 25 • Estimated average per award: $50,000 - $150,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1a: Enhance workforce capacity Develop an LD investigative team consisting of epidemiology, environmental health, and laboratory staff ☐Required II. a) ☒Optional Strategy 1b: Enhance investigation and outbreak response Develop and implement a comprehensive, multi-disciplinary LD outbreak response protocol. The protocol should include the following: i. Epidemiology, laboratory, and environmental health response activities (e.g., staff roles and responsibilities in an outbreak setting, identification of surge capacity) ii. For environmental health activities, steps specific to performance of environmental assessments and coordination of Legionella environmental sampling, which can be used to TX-DSHS-19-1309-A-000503 211 iii. iv. identify contributing factors, root causes, immediate control measures, and long-term prevention strategies Plans for other outbreak preparedness activities (to be conducted prior to the identification of an outbreak, e.g., cooling tower identification/development of a registry, lab workflow outline) Plans for coordination between state and local jurisdictions Please see the following resources for additional guidance on outbreak response protocols: • CDC Outbreak Response Considerations • CDC Environmental Investigation Resources • CDC Laboratory Response Toolkit ☒Required b) ☐Optional Evaluate interventions resulting from outbreak investigations. For each investigation, identify and report: i. Deficiencies identified from the environmental assessment (e.g., process failures [status of WMPs], human errors, equipment failures, unmanaged external changes) ii. Recommended facility actions (e.g, provide training, increase hot water temperatures, adjust residual disinfectant, implement flushing protocol) iii. Follow-up activities with facility to confirm which interventions were implemented Please see the following for more information on deficiency reporting: • Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease — North America, 2000–2014 ☐Required III. a) Strategy 1c: Improve Surveillance and Reporting Attempt to interview all suspect and confirmed legionellosis cases to obtain exposure information (e.g., using a form similar to the SLDSS Case Report Form or the RIBD MMG) ☒Required b) c) ☒Optional ☐Optional Report all cases including exposure information to CDC via SLDSS (using a data extract, if possible) or an HL7-based reporting mechanism using the RIBD MMG ☒Required ☐Optional ☐Required ☒Optional Participate in RIBD MMG transition TX-DSHS-19-1309-A-000504 212 d) Perform enhanced surveillance to improve capture of possible sources of exposure. Activities could include: i. Routine use of an extended hypothesis-generating questionnaire in addition to a standard legionellosis case report form ii. Environmental testing of possible sources for single cases ☐Required ☒Optional Please see the following example of an adaptable hypothesis-generating questionnaire: CDC Template Hypothesis-Generating Questionnaire e) Utilize software packages such as SaTScan for geospatial detection of LD clusters and outbreaks ☐Required IV. a) Strategy 1d: Strengthen laboratory testing for response Operationalize clinical Polymerase Chain reaction (PCR) capacity at the state laboratory ☐Required b) c) d) ☒Optional ☒Optional Become CDC Environmental Legionella Isolation Techniques Evaluation (ELITE) member laboratory ☐Required ☒Optional ☐Required ☒Optional Build internal capacity for analysis of Legionella whole genome sequencing Collaborate with hospital and clinical laboratory systems to increase number of respiratory specimens cultured for Legionella ☐Required ☒Optional AREA B: PREVENTION AND INTERVENTION I V. a) Strategy 2a: Implement public health interventions and tools Develop and implement an LD Primary Prevention Strategy i. Designate and/or collaborate with environmental health personnel to improve environmental health expertise in LD response and prevention within the health department ii. Proactively conduct WMP outreach to building and facility staff in healthcare and nonhealthcare settings iii. Engage building and facility staff during outbreak investigations to develop or revise WMPs ☒Required ☐Optional TX-DSHS-19-1309-A-000505 213 b) (OPTIONAL) Develop and implement an LD Primary Prevention Strategy i. Plans for collaborating with industry partners ii. Plans for collaborating with state and local regulatory bodies iii. Plans for evaluating WMP implementation in buildings at increased risk ☐Required ☒Optional Please see the following resources for additional guidance on implementing WMPs: Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings CDC WMP Considerations c) Evaluate uptake of WMPs in buildings at increased risk ☐Required d) ☒Optional Evaluate effectiveness of policies and public health approaches to the implementation of industry standards for primary prevention of LD ☐Required ☒Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I VI. a) Strategy 3d: Information dissemination Prepare and distribute communication materials regarding programmatic activities to relevant audiences. Activities may include: i. Newsletters, trade journal articles, manuscripts (please send courtesy copy of publications to CDC; publications should acknowledge CDC ELC support if applicable) ii. Fliers, fact sheets, infographics, checklists, toolkits, templates, and other printed materials iii. Surveillance reports iv. Press releases v. Lessons learned ☐Required ☒Optional Collaborations: a. With CDC funded programs: N/A b. With organizations external to CDC: Per applicant’s LD Primary Prevention Strategy, collaborations and outreach could include health departments, building managers, healthcare facilities, industry organizations, and other groups involved in WMPs Target Populations: TX-DSHS-19-1309-A-000506 214 Populations at increased risk for developing LD include people who are 50 years or older, current or former smokers, have chronic lung disease, and have weakened immune systems. Investigations of buildingassociated outbreaks show the most common places for getting the disease are hotels, long-term care facilities, and hospitals. Health departments, building managers, and healthcare facilities can facilitate implementation of maintenance strategies for the primary prevention of LD in building water systems Evaluation and Performance Measurement: Awardees are required to demonstrate that measurable progress is being made throughout the project period and share this progress in workgroup and partner conference calls. To indicate progress made toward program outcomes, data will be reported through: • Bimonthly (every two months) conference calls • Bimonthly (every two months) written updates to submitted via email prior to conference calls • Performance Measures for Tier 1 activities Measure #1 Development of LD Outbreak Response Protocol • Comprehensive outbreak response protocol was developed, approved, and shared with CDC and relevant partners (yes/no) and is inclusive of the following: o Designates epidemiology, laboratory, and environmental health activities (yes/no) o Specifies a Point of Contact for epidemiology, laboratory, and environmental health activities (yes/no) o Addresses outbreak preparedness and coordination with state and local jurisdictions (yes/no) Measure #2 Implementation of LD Outbreak Response Protocol • Number and % of LD outbreak investigations utilizing outbreak response protocol • Number and % of LD outbreak investigations for which environmental assessments were performed • Number and % of LD outbreak investigations for which Legionella sampling was performed • Number and % of LD outbreak investigations for which a clinical isolate was obtained Measure #3 Completeness of Legionellosis Surveillance and Reporting • Number and % of total suspect and confirmed legionellosis cases that were interviewed • Number and % of total cases reported to CDC that were reported with exposure information (to SLDSS or RIBD) Measure #4 Development of LD Primary Prevention Strategy • LD Primary Prevention Strategy was developed, approved, and shared with CDC and relevant partners (yes/no) and is inclusive of the following: o Strengthening WMP expertise within the health department (yes/no) o Proactively conducting WMP outreach to building and facility staff in healthcare and nonhealthcare settings (yes/no) o Engaging building and facility staff during outbreak investigations to develop or revise WMPs (yes/no) Measure #5 Implementation of LD Primary Prevention Strategy • Number and type (e.g., hospital, long-term care facility, hotel) of buildings/facilities engaged in WMP outreach activities proactively (i.e., not as part of an outbreak investigation) o Number and % of buildings/facilities engaged for which an WMP compliant with industry standards was in place I I I I I TX-DSHS-19-1309-A-000507 215 • • Number and % of total local health departments for which WMP outreach activities were performed Number and type of WMP outreach activities (e.g., webinars, trainings, workgroups, presentations, table top exercises, consultations, written guidance) TX-DSHS-19-1309-A-000508 216 Q: Influenza Surveillance and Diagnostic Testing Program Activity Contact Information Lenee Blanton, MPH, acy9@cdc.gov, 404-639-1400 or Lynnette Brammer, MPH, lsb1@cdc.gov, 404-639-1303 or Alicia Budd, MPH, acp4@cdc.gov, 404-718-5380 (for Tier II Enhancement Activities) Funding Opportunity Description Background a. Overview The U.S. influenza surveillance system is a collaborative effort between CDC and its many partners in state, local, and territorial health departments, public health and clinical laboratories, vital statistics offices, healthcare providers, clinics, and emergency departments. Information in five categories is collected from eight different data sources that allows CDC to find out when and where influenza activity is occurring, track influenza-related illness, determine what influenza viruses are circulating, detect changes in influenza viruses, and measure the impact influenza is having on hospitalizations and deaths. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Influenza is an acute respiratory disease caused by infection with influenza viruses. Influenza types A and B viruses are responsible for epidemics of respiratory illness that occur almost every winter in temperate climates and are often associated with increased rates of hospitalization and death. Although the highest rates of illness occur among school-aged children, the highest rates of hospitalizations from influenza-related causes occur among infants and pre-school children, persons of any age with certain chronic medical conditions and among those ≥ 65 years of age. The estimated rates of influenza-associated illnesses, hospitalizations and deaths vary substantially from one influenza season to the next, depending, in part, on the characteristics of the circulating influenza virus strains. Therefore, there is a need for CDC and public health partners to implement and maintain a comprehensive plan for detecting, measuring, and reducing the impact of influenza. The CDC/Influenza Division continuously works to make improvements to each of the components of the U.S. Influenza Surveillance System and expand surveillance capacity to fill gaps. In collaboration with the Council of State and Territorial Epidemiologists (CSTE), CDC supports the enhancement of influenza surveillance at state and local health departments to leverage available resources and maximize the utilization of existing influenza surveillance systems. Three priority influenza surveillance gaps have been identified at the national level: 1) inability to determine the proportion of outpatient visits for influenza-like illness (ILI) that is due to influenza virus infection; (2) lack of information about the severity of illness associated with influenza viruses tested at public health laboratories (PHL); (3) inability to calculate rates of outpatient ILI. Therefore, there is a need for CDC and public health partners to implement modifications to existing surveillance components to address these gaps. TX-DSHS-19-1309-A-000509 217 b. Purpose: The required activities will fund influenza surveillance and diagnostic testing strategies. CDC wishes to build capacity for the detection, investigation, and reporting of influenza to enable future prevention initiatives. This requires building and strengthening epidemiologic and laboratory health capacity at the state and local level, which the proposed sub-activities should address. These efforts lead to more timely and efficient efforts to improve turnaround time, detection of outbreaks, response to outbreaks, investigation of outbreaks, and implementation of control measures. The enhancements (optional activities) will fund any one or more of the activities described below that address the following gaps in routine surveillance at the national level: • Influenza-attributable proportion of ILI: Through the U.S. Outpatient Influenza-like Illness Surveillance Network (ILINet), providers report the number of patients meeting the case definition for ILI; no laboratory confirmation of influenza is required. While the ILI case definition is used for surveillance due to the high positive predictive value during periods of influenza virus circulation, influenza illness is often clinically indistinguishable from other respiratory pathogens. The influenza attributable proportion of ILI, not biased by clinician-directed testing, is needed to better inform influenza disease burden estimates and improve interpretation of data from ILINet and other influenza surveillance components. • Level of care associated with specimens tested for influenza: PHLs throughout the United States conduct testing for influenza, and report specimen level results electronically to CDC through the Public Health Laboratory Interoperability Project (PHLIP). A subset of specimens are sent to CDC for antigenic and genetic characterization, and antiviral resistance testing. The clinical level of care (inpatient, outpatient) is not uniformly reported to CDC along with the specimen-level virologic surveillance data, but could be used as an indicator of illness severity. Identification of care level associated with specimens tested at the PHL would allow for evaluation of differences by virus characteristics. • Outpatient ILI rates: Population-based rates of influenza allow for disease burden comparisons across seasons, geographic regions, and influenza viruses. Population based rates can be calculated from the current national influenza hospitalization (FluSurvNet) and mortality (NCHS and pediatric death) surveillance components but not from the outpatient ILI component (ILINet). An estimate of the population served by ILINet providers would allow outpatient ILI rates to be calculated and used to inform disease burden estimates. c. Outcomes: Required activities will result in: • Comprehensive national influenza surveillance • Better coordination and exchange of influenza surveillance data among eight components of influenza surveillance (http://www.cdc.gov/flu/weekly/overview.htm) across jurisdictions and to CDC • Improved completeness and timeliness of reporting of influenza surveillance data • Trained laboratory staff proficient in PCR methods for influenza virus detection, typing, and subtyping. The compilation of data from each enhancement activity across awardees will contribute to improved influenza disease burden estimation and a greater understanding of influenza viruses across illness severity TX-DSHS-19-1309-A-000510 218 levels by providing information about the proportion of ILI due to influenza, severity of illness associated with influenza viruses and rates of outpatient ILI. More specifically, the surveillance system enhancements funded by this project will facilitate collection of data that will allow CDC to: • Determine weekly the proportion of ILI that is due to influenza through systematically collecting respiratory samples from patients presenting meeting the ILI case definition and presenting to a subset of ILINet providers. • Assess the effect of virus characteristics on influenza disease severity by identifying the level of care (inpatient/outpatient) at the time of specimen collection for patients with specimens tested at the PHL. • Estimate population-based rates of outpatient ILI by enumerating the patient population size for a subset of ILINet providers. Funding Strategy: For the required activities, funds will support a minimum of 0.5 FTE personnel to conduct influenza surveillance and a minimum of 0.5 FTE personnel to conduct influenza diagnostic testing. Both of these positions serve as the CDC point of contact for influenza surveillance and laboratory diagnostics, respectively. If available, awards will support the purchase of laboratory supplies and reagents not provided through the Influenza Reagent Resource (IRR). Since 2016, IRR will not offer the plastics previously available. Activities related to determining and achieving the optimal volume of laboratory testing for surveillance purposes, such as shipping supplies and transport costs, as outlined in the CDC-Association of Public Health Laboratories (APHL) Influenza Virologic Surveillance Right Size Road Map document distributed in June 2013 may be supported if funds are available. • Estimated total availability of funds: $8.1 million • Estimated number of awards given: 57 • Estimated total availability of funds: $138,596 For the optional activities, recipients are responsible for allocating appropriate amounts to support activities influenza compensation for providers and to supplement the PHL for the duration of the project. Funding will not be automatically renewed yearly. Award amounts will be determined commensurate with activities outlined in the proposal and may vary based on the optional activities included and the complexity of the methods for each activity. Although the financial plans provide support for this program, awards pursuant to this funding opportunity are contingent upon the availability of funds and the number of applications received. • Estimated total availability of funds: $770,000 • Estimated number of awards given: 15 • Estimated average per award: $51,333 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation and outbreak response Use standard investigative tools (i.e. influenza-associated pediatric death and novel influenza A case report forms), data sharing tools, and methods TX-DSHS-19-1309-A-000511 219 ☒Required b) II. ☐Optional Participate in influenza outbreak investigations and assist local jurisdictions in large, complex outbreaks ☒Required ☐Optional ☒Required ☐Optional ☒Required ☐Optional Strategy 1c: Improve surveillance and reporting a} Identify and maintain an influenza surveillance coordinator b} Recruit, retain, and encourage timely reporting from ILINet providers c) d) e) Develop, implement and maintain the components of the U.S. Influenza Surveillance System ☒Required ☐Optional ☒Required ☐Optional Collect, analyze, and disseminate influenza surveillance data Advance meaningful public health use of electronic health records, including exploring the availability and utility of existing sources of electronic influenza morbidity (including influenza hospitalization data) and mortality data ☒Required f) Facilitate the improvement of influenza surveillance as recommended by the Council of State and Territorial Epidemiologists (CSTE) ☒Required III. a) ☐Optional Strategy 1e: Enhance laboratory testing for surveillance and reporting Utilize modern techniques for diagnosis (i.e. real-time RT-PCR) for typing and subtyping of influenza viruses, including detection of novel influenza viruses, year-round ☒Required b) ☐Optional ☐Optional Identify and maintain a laboratorian who is proficient in influenza diagnostic testing (i.e. PCR methods for influenza virus detection, typing, and subtyping ☒Required ☐Optional TX-DSHS-19-1309-A-000512 220 IV. a) Strategy 1f: Improve laboratory coordination and outreach to improve efficiency Continue to assess your capacity for achieving the guidance and goals within the Right Size Road Map by evaluating and updating your implementation plans for achieving the Right Size objectives. ☒Required V. ☐Optional Strategy 1g: Enhance coordination between epi-lab a) Maintain weekly reporting of influenza test results from the U.S. World Health Organization (WHO) collaborating laboratories in your jurisdiction ☒Required b) Coordinate connections between epidemiology and laboratory functions, at state and local levels ☒Required c) ☐Optional ☐Optional Implement and maintain electronic mechanisms for exchange of public health information, including the Public Health Laboratory Interoperability Project (PHLIP) system to transmit specimen-level data to CDC each week ☒Required ☐Optional VI. Strategy 1c: Improve surveillance and reporting. Optional Enhancement Activities. Applicants may apply for one or more of the following 3 activities: a) Systematic surveillance sampling of patients meeting the ILI case definition and presenting to ILINet providers. i. Identify a subset of ILINet providers (can be existing providers or recruited new for the 2019-2020 season) who are willing to (a) Collect respiratory specimens from patients meeting the ILI case definition AND (b) Report weekly ILI visits by age group and total patient visits to ILINet. ii. Determine a sampling scheme based on the number of providers participating that will yield at least 100 - 150 specimens per ILINet age group per season. ILINet age groups are 0-4 yrs, 5-24 yrs, 24-49 yrs, 50-64 yrs and ?65 yrs. iii. For each specimen collected, report to CDC the following information: date of birth (age is acceptable), specimen collection date, and a means to identify that the specimen was collected as part of this project. iv. Specimens should be tested at the PHL using the CDC IVD kit including influenza A subtype and influenza B lineage. v. Test results and additional information (iii above) must be reported to CDC. (a) Ideally this would occur as part of the PHL routine transmission of influenza test result data via PHLIP by including a project flag and the ILINet provider ID for each specimen. TX-DSHS-19-1309-A-000513 221 vi. (b) If this is not feasible, an alternative mechanism such as an Excel spreadsheet can be utilized as long as there is a method for linking the PHL test results transmitted via PHLIP with the information indicating that the specimen was collected as part of this activity. Prioritize specimens from this activity for routine submission to the National Influenza Reference Centers while maintaining adherence to the stated specimen submission guidance. ☐Required b) Report level of care (inpatient or outpatient) for patients with specimens tested at the PHL. i. Determine level of care (inpatient or outpatient) at the time of specimen collection for patients with specimens tested for influenza at the PHL. Supplying this information for a subset of specimens is acceptable. ii. Report test results and level of care information to CDC. (a) Ideally this would occur as part of the PHL routine transmission of influenza test result data via PHLIP by populating the optional data element "patient location" with "inpatient" or "outpatient." (b) If this is not feasible, an alternative mechanism such as utilization of an alternative PHLIP field or an Excel spreadsheet is acceptable provided there is a method for linking the PHL test results transmitted via PHLIP with the level of care information collected as part of this activity. iii. Prioritize specimens from this activity for routine submission to the National Influenza Reference Centers while maintaining adherence to the stated specimen submission guidance. ☐Required c) ☒Optional ☒Optional Estimate population served by ILINet providers. i. Identify a subset of ILINet providers (can be existing providers or recruited new for the 2019-2020 season) who (a) Estimate their total population served for each of the ILINet age groups (0-4 years, 5-24 years, 24-49 years, 50-64 years and ?65 years) AND (b) Report weekly ILI visits by age group and total patient visits by age group to ILINet. ii. This can be achieved using one of the following methods or a different method if clearly described in the application. (a) Total number of patients registered with the provider. (b) Average over at least 3 years of the number of unique persons that were seen by the provider in a given year. iii. This activity needs to occur once a season. ☐Required ☒Optional TX-DSHS-19-1309-A-000514 222 AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I VII. a) Strategy 3a: Enhance coordination between partners Foster general collaboration and relationship building among city, county, state, and federal partners and other external partners (e.g. CSTE, APHL) ☒Required b) ☐Optional Coordinate epidemiologic services throughout the state, including developing a collaborating relationship between ELC and FluSurv-NET staff (if applicable) ☒Required ☐Optional Collaborations a. With CDC-funded programs: N/A b. With organizations external to CDC: APHL/Influenza Virologic Surveillance Right Size Project Council of State and Territorial Epidemiologists (CSTE) Target Populations: N/A Evaluation and Performance Measurement: Required performance measures for the project period are listed below. Data will be reported to CDC/Influenza Division in a timely manner, as described below, and are used to indicate progress made toward program outcomes. Measure #1) ILINet recruitment target: One regularly reporting ILINet provider (a provider who reports ≥17 of the 33 weeks from beginning of October to the end of May or ≥26 weeks per year for year-round surveillance) for every 250,000 residents, or for states with smaller populations, a minimum of 10 regularly reporting ILINet providers. Measure #2) Per specimen submission guidelines, influenza viruses (if available) will be submitted to the designated National Influenza Surveillance Reference Center every two weeks, year-round. Target: A minimum of 40 specimens over 10 shipments shipped at two week intervals Measure #3) Jurisdictions will identify the appropriate number of influenza positive specimens calculated for each jurisdiction to achieve the Right Size virologic surveillance novel event detection goals. Target: meet the 1/700 goal for at least one week during the peak of influenza season Measure #4) Percentage of influenza A viruses tested by the public health laboratory that are subtyped. Target: >95% Measure #5) For Strategy II, activity a (systematic surveillance sampling of patients meeting the ILI case TX-DSHS-19-1309-A-000515 223 definition and presenting to ILINet Providers). Establish methods for and demonstrate implementation of systematic sampling of patients meeting the ILI case definition through (1) identifying a subset of ILINet providers who report to ILINet at least half of the 33 weeks AND submit samples for influenza testing each week that ≥10 ILI cases are reported and (2) identifying for CDC which specimens received through routine laboratory surveillance transmissions were collected as part of this activity. Measure #6) For Strategy II, activity b (report level of care for patients with specimens tested at the PHL). Establish methods for and demonstrate implementation of reporting to CDC level of care data for patient with specimens tested at the PHL through routine weekly laboratory surveillance transmissions or linking of independently reported level of care data with data included in laboratory surveillance transmissions. Measure #7) For Strategy II, activity c (estimate population served by a subset of ILINet providers). Establish methods for and demonstrate implementation of a process for providing data needed to calculate rates of outpatient ILI through identifying a subset of ILINet providers who (1) report to ILINet at least half of the 33 weeks AND (2) provide an estimate of the population served. TX-DSHS-19-1309-A-000516 224 R: Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance Program Activity Contact Information Mila Prill, mprill@cdc.gov, (404) 639-8292 Funding Opportunity Description Background a. Overview The primary objective is to strengthen the capacity of state and local health departments to conduct surveillance, outbreak support, and laboratory testing for non-influenza respiratory viruses and transmit the data to CDC. b. Healthy People 2020 N/A c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: Non-influenza respiratory viruses cause a large burden of illness each year, including severe lower respiratory tract infections. Viruses of particular public health importance include respiratory syncytial virus (RSV), human metapneumovirus, parainfluenza viruses, rhinoviruses, enteroviruses, coronaviruses, and adenoviruses, as well as re-emergent and novel viruses such as adenovirus type 14, SARS-coronavirus, Enterovirus-D68, and Middle East Respiratory Syndrome coronavirus (MERS-CoV). Identification of these viruses and appropriate public health response measures have been critical in mitigating their spread. For instance, surveillance for MERS-CoV and other viruses requires ruling out common viral etiologies of severe pneumonia, and not all states currently have the capacity to detect non-influenza respiratory viruses using the most sensitive molecular techniques. To track the epidemiology of these viruses on a national level, CDC developed several surveillance systems including: the National Respiratory and Enteric Virus Surveillance System (NREVSS), the Public Health Laboratory Interoperability Project (PHLIP)/NREVSS collaboration, the National Adenovirus Type Reporting System (NATRS), and the National Enterovirus Surveillance System (NESS). These systems track the seasonality and circulating subtypes of these viruses and may help identify outbreaks across jurisdictions. CDC relies on health departments with the capacity to test for these viruses to report results to these systems and to help CDC collect data from clinical, academic, and reference laboratories within their jurisdiction. In addition, there are several vaccines under development to prevent RSV infections, so it is increasingly important to have current baseline measures of severe morbidity and mortality associated with RSV to understand populations at risk and to monitor the success of future public health treatments and interventions. b. Purpose: This project will strengthen laboratory capacity at the state and local level to identify non-influenza respiratory virus cases including novel viruses. Additionally, the purpose is to streamline data collection of test results and epidemiologic data via national surveillance systems. Working closely with public health partners to identify and characterize seasonal trends of respiratory viruses will help identify outbreaks and implement prevention measures. RSV infection data will help determine the timing and impact of current and future interventions. c. Outcomes: TX-DSHS-19-1309-A-000517 225 Trained laboratory and public health workforce better prepared to detect and respond to respiratory illness associated with non-influenza respiratory viruses • Improved surveillance capacity resulting in more rapid detection of emerging respiratory infectious diseases • Improved completeness and timeliness of reporting laboratory and epidemiologic data to the CDC via national surveillance systems. • Better coordination and exchange of laboratory and epidemiologic data related to non-influenza respiratory virus infections between private, local, state, and federal stakeholders • More timely detection, response, and investigation of outbreaks of non-influenza respiratory viral illness Funding Strategy: Funding may support personnel, laboratory or office supplies, specimen storage and shipping costs, and other supplies needed for capacity building and/or an effective response to a situation involving respiratory viruses. Given the year-to-year nature of funding for this component, requests for new full-time personnel may not be funded. • • Estimated total availability of funds: $750,000 • Estimated number of awards given: 10-15 • Estimated average per award: $55,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1d and 1e: Strengthen and enhance laboratory testing for surveillance, reporting, and response Perform diagnostic testing for non-influenza respiratory viruses in eligible ELC public health state and local laboratories i. Include a brief description of current laboratory capacity, including the testing methods and platforms being used or undergoing validation, and your primary criteria for testing respiratory specimens for non-influenza respiratory viruses. Specifically, were all specimens tested, a subset of all surveillance specimens, a subset or all of the influenza negatives, all fatal cases, all outbreak specimens, only upon request, on a case-by-case basis, some combination of the above, or using some other criteria? ☐Required II. a) ☒Optional Strategy 1c: Improve surveillance and reporting Increase or maintain the number of clinical laboratories that report respiratory virus laboratory results to CDC via the National Respiratory and Enteric Virus Surveillance System (NREVSS), either directly or by pass-through from local and state public health departments. i. Target enrollment for each jurisdiction to be determined in consultation with CDC. ☒Required ☐Optional TX-DSHS-19-1309-A-000518 226 b) Establish or improve non-influenza respiratory virus surveillance ☐Required c) Assist CDC in investigations of deaths associated with RSV among children less than five years of age ☐Required d) ☒Optional Report appropriate type-specific respiratory virus results from public health laboratories to CDC via the National Enterovirus Surveillance System (NESS) and/or the National Adenovirus Type Reporting System (NATRS) i. This activity is only applicable to laboratories that perform typing for enterovirus or adenovirus positive specimens. ☐Required III. ☒Optional Work with CDC to determine rates of RSV-associated ICU admissions for some or all ages in specific catchment areas ☐Required e) ☒Optional ☒Optional Strategy 1b: Enhance investigation and outbreak response a) Participate in respiratory illness outbreak investigations and assist local jurisdictions in outbreaks as needed. ☐Required IV. a) Strategy 1h: Advance electronic information exchange implementation Transmit information regarding non-influenza respiratory virus testing from public health laboratories to CDC via the Public Health Laboratory Interoperability Project (PHLIP) system, including clinical variables when feasible. i. If reporting via PHLIP is not possible, then these data should be reported directly to the NREVSS system on a weekly basis by manual data entry or data upload. ☐Required b) ☒Optional ☒Optional Collaborate with CDC to implement electronic data transfers from clinical or health department laboratories to CDC of respiratory virus laboratory results, including epidemiologic and clinical data when feasible such as age, specimen collection date, illness onset date, location, severity/outcome measures (e.g., hospitalization, ICU admission, death). i. This strategy is primarily applicable to clinical laboratories as well as local health department jurisdictions that are not currently eligible for reporting via PHLIP. ☐Required ☒Optional TX-DSHS-19-1309-A-000519 227 Collaborations: a. With CDC-funded programs: Depending upon the capacity of applicants, collaborations with CDC programs, including NREVSS, NATRS, NESS, and PHLIP, may be expected. b. With organizations external to CDC: Applicants are expected to work with organizations such as local health departments; academic, clinical, and commercial medical facilities and laboratories; and the public health community, as needed to achieve the NOFO outcomes. Target Populations: Not applicable. Evaluation and Performance Measurement: I Measure #1 I Measure #2 I Measure #3 I Measure #4 I Measure #5 I Measure #6 I Measure #7 I Measure #8 Ability to test for non-influenza respiratory viruses, including respiratory syncytial virus (RSV), human metapneumovirus, parainfluenza viruses, and respiratory adenoviruses. Some states may have also developed or are working to build the capacity to test for coronaviruses, rhinoviruses, and enteroviruses, including EVD68. Baseline/target: No progress / some progress / great progress / completed. Number of specimens associated with respiratory virus surveillance and outbreaks that were received from clinics, hospitals, coroners, local health departments, or other sources. Target goal- as circumstances warrant and considering criteria such as severity of outbreaks and capacity for testing. Number of specimens associated with respiratory virus surveillance and outbreaks that were tested for noninfluenza respiratory viruses. Target goal- as circumstances warrant and considering criteria such as frequency of testing, capacity for testing, severity of outbreaks, and representativeness of specimens. Number of aliquots shipped to CDC for additional or confirmatory non-influenza respiratory virus testing (as needed). Reporting has been implemented from health department laboratories to CDC via HL7 messages in PHLIP for respiratory specimens tested for a non-influenza respiratory virus (including clinical variables such as hospitalization/ICU/death when feasible) and have been validated for inclusion in NREVSS. Baseline/target: No progress / undergoing validation / post-validation updates in progress / completed The number of weeks a health department submits at least one non-influenza health department laboratory test result to CDC for inclusion in the National Respiratory and Enteric Virus Surveillance System (NREVSS). Periodic reporting from health department labs to CDC for the National Enterovirus Surveillance Systems (NESS) (if applicable, based on current testing capacity). TX-DSHS-19-1309-A-000520 228 Periodic reporting from health department labs to CDC for the National Adenovirus Type Reporting Systems (NATRS) (if applicable, based on current testing capacity). I Measure #9 I Measure #10 I Measure #11 I Measure #12 I Measure #13 Number of clinical labs whose aggregate test results were transmitted to CDC for inclusion in NREVSS on a weekly basis, either directly or on their behalf with pass-through reporting by a health department. (Target enrollment for each jurisdiction to be determined in consultation with CDC.) Identification and reporting of RSV-associated deaths among children <5 years of age in which key clinical and other data are obtained and transmitted to CDC. Target goal >50% of all RSV-associated deaths from 2014 to the present, ideally within 2 months of death. If applicable, briefly describe any progress made toward calculating a rate of RSV-associated ICU admissions for one or more hospitals or for a catchment area within your jurisdiction. Indicate steps accomplished, including: initiating work with hospitals, developing a standardized approach for data collection, collecting denominator data, collecting numerator data, data cleaning. (Indicate “N/A” if the jurisdiction did not propose working on this activity.) Number of investigations conducted for respiratory outbreaks. If applicable, briefly describe any progress made toward facilitating reports of laboratory and epidemiologic data from clinical or health department laboratories to CDC for individual respiratory specimens with accompanying key data, including age, relevant dates (e.g., onset date, specimen collection date, testing date), location, and severity/outcome measures (e.g., hospitalization, ICU admission, death). Indicate steps accomplished: No progress / initiating work with clinical laboratories / developing a standardized approach for data collection and messaging / implementing the mapping and coding for messaging / testing the messaging / validating the messaging / completed. (Indicate “N/A” if the jurisdiction did not propose working on this activity.) Target goal of initiating reporting for at least one new institution. TX-DSHS-19-1309-A-000521 229 S: Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Program Activity Contact Information Karen Schlanger, Lead Epidemiologist, khs4@cdc.gov, 404-718-5660 Funding Opportunity Description Background a. Overview The “Threat of Antibiotic-Resistant Gonorrhea (ARGC): Rapid Detection and Response Capacity” program, also called “Strengthening United States Response to Resistant Gonorrhea (SURRG)”, employs four strategies to achieve outcomes of interest. The first strategy is to strengthen local resistant gonorrhea (GC) threat coordination and epidemiological capacity through workforce development. Activities under this strategy include: (1) maintaining and training key staff to fill the following roles: project director (SURRG principal investigator or PI), epidemiologist coordinator, laboratorian(s), disease investigator(s) (DIS), epidemiologist/analyst, consulting STD clinician, and data manager; (2) continuing to develop, implement, and improve project protocols and IT systems to facilitate ARGC rapid detection and response clinic, laboratory, surveillance, investigations, and data management-related activities; and (3) (optional) develop/implement additional ARGC rapid detection and response messaging, outbreak response exercises, and surge capacity planning. The second strategy is to continue and improve local processes to enhance timely detection of resistant GC threats. For this strategy, activities include: (1) robust collection of genital and extragenital specimens for GC culture in STD clinics and in at least two other health care settings with high GC morbidity; (2) the use of GC specimen collection and transport techniques, GC culture, Etest antimicrobial susceptibility testing, other diagnostic tools, and laboratory information management systems (LIMS) to increase laboratory capacity and the speed and success at which resistant GC infections are identified and reported to the local health department for action; and (3) collection, processing and submission of required laboratory isolates and associated data to assigned regional Antibiotic Resistance Laboratory (ARLN), and CDC per CDC protocols. The third strategy is to conduct robust field investigations with the following goals: enhance GC case investigations to confirm infection resolution; identify and engage sexual and social contacts of partners in GC testing (including culture) and treatment; document the impact of GC partner services on case identification and transmission disruption; identify and describe the network structure and epidemiological characteristics of cases and those in the network of cases; and assess transmission dynamics of GC and emerging resistant GC threats. Activities related to this strategy include: epidemiologic investigation of selected cases, elicitation of and outreach to recent sexual partners (and their sexual partners’ other recent sex partners); elicitation and outreach to others in the social network of the cases, and testing (including culture) and treatment (if indicated). The fourth strategy is to collect and analyze data for ongoing process and outcome evaluations and quality improvement activities, and enhanced epidemiological characterization of GC and resistant GC (including network analysis), to inform effective and efficient prevention and control interventions to mitigate the spread of GC and antimicrobial-resistant GC threats locally, and through the dissemination of findings and lessons learned, nationally as well as locally. Activities related to this strategy include: (1) conducting routine TX-DSHS-19-1309-A-000522 230 process and outcome evaluations on core clinic and laboratory activities; (2) conducting two SURRG-specific quality improvement projects; (3) conducting analyses on SURRG field investigation activities to document impact and value; and (4) compiling and disseminating ARGC rapid detection and response activities and lessons learned locally and nationally b. Healthy People 2020 This project supports Healthy People 2020 objectives to: reduce gonorrhea rates among men and women ages 15-44 (Objectives STD-6.1 and STD-6.2), as well as to strengthen public health laboratory services to support diagnosing and investigating health hazards in the community; support emergency response; support disease control and surveillance, and; support specialized testing (Objectives PHI-11.1–PHI-11.3; PHI-12.2–PHI-12.4; and PHI-12.6–PHI-12.7). This work will also support objectives to assure comprehensive epidemiology services (Objective PHI-13.4). c. Other National Public Health Priorities and Strategies This project supports two goals of the National Strategy for Combating Antibiotic-Resistant Bacteria (CARB): (1) Slow the emergence of resistant bacteria and prevent the spread of resistant infections (Objective 1.1); and (2) Advance use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria (Objective 3.2). CDC Project Description a. Problem Statement: GC is the second most commonly reported communicable disease in the United States with over 500,000 cases reported in 2017. Untreated GC can lead to pelvic inflammatory disease, ectopic pregnancy and infertility in women, epididymitis in men, serious disseminated infection in men and women, and can facilitate HIV acquisition and transmission. Timely and effective treatment for GC can prevent these severe adverse health outcomes and onward transmission in the community. However, N. gonorrhoeae has progressively acquired resistance to each of the antimicrobial agents that have been recommended for treatment over the past 70 years. In the past several years, N. gonorrhoeae has rapidly become less susceptible to the thirdgeneration cephalosporins and macrolides, the components of currently recommended combination therapy. Particularly as the antibiotic pipeline has dwindled, the threat of untreatable GC is increasing. Development and spread of strains with cephalosporin and macrolide resistance will severely complicate control and prevention of GC. Because GC is primarily diagnosed through nucleic acid amplification testing (NAAT) technologies, rather than culture, few clinicians readily have access to gonococcal susceptibility testing. While the Gonococcal Isolate Surveillance Project (GISP) is critically important for monitoring long-term trends in gonococcal susceptibility to inform treatment guidelines, the susceptibility results are not available quickly enough to allow for rapid local responses to resistant strains. Developing local and state public health capacity for timely detection of and rapid response to emerging resistant GC threats is urgently needed to mitigate the spread of resistant GC. b. Purpose: Activities funded as a part of this project will strengthen state and local GC public health infrastructure and build capacity in high-risk local jurisdictions to support rapid detection of and response to threats of antibioticresistant GC. High-risk jurisdictions include: (1) geographic areas at elevated risk of experiencing emergence of resistant GC based on the historical epidemiologic factors associated with the development of penicillin and fluoroquinolone resistance in the U.S ( e.g. areas in the western part of the U.S.(2) areas with local GC TX-DSHS-19-1309-A-000523 231 epidemics that include large percentages of gay, bisexual, or other men who have sex with men (MSM); or (3) geographic areas with high GC rates. c. Outcomes: By the end of the project period, awardees are expected to show measurable progress toward the following outcomes: • Maintenance of a trained state and local public health workforce better prepared to respond to GC and antimicrobial-resistant GC threats. • Improved capacity (e.g. informatics infrastructure, laboratory infrastructure, etc.), coordination, and implementation of clinical, laboratory and rapid response activities designed to quickly identify, fully investigate, treat, and interrupt transmission of reduced susceptible/resistant GC threats. • Expanded data sharing between clinicians, laboratorians, field epidemiologists, and programmatic staff to facilitate rapid detection and response activities. • Increased specimen collection for GC culture at selected STD clinics and community partner locations with high GC morbidity for antibiotic susceptibility testing across gender and anatomic sites. • Improved surveillance of GC antibiotic susceptibility patterns in local jurisdictions and robust epidemiological analyses (including network analyses) that supports: 1) improved characterization of GC and resistant GC epidemiology and social and sexual networks in local jurisdictions, and informs targeting of prevention and control interventions. • Ongoing and increased collection and use of process and impact evaluations and quality improvement efforts to document and improve implementation of core GC rapid detection and response-related clinic, laboratory, and field investigation activities, and to inform effective and efficient prevention and control interventions to mitigate the spread of GC and antimicrobial-resistant GC threats. • Compilation and dissemination of programmatic lessons learned and findings via grantee calls, grantee meetings, presentation at national conferences and publication. • Long term outcomes include: modernization of approaches for GC and resistant GC detection and rapid response; improved treatment and prevention of GC and resistant GC threats; development of data-driven control strategies for GC and resistant GC informed by network and epidemiologic analyses, and potentially data from genomic analyses; minimized transmission of GC and resistant GC; and overall improvement in the population’s health. Funding Strategy: It is anticipated that $5,164,038 of funding will be available to support up to eight (8) sites to provide capacity for the rapid detection and response of antibiotic resistant GC. The selection of sites will be determined through demonstrated background and capacity in the application. Funding can be used to support costs for personnel, staff travel and training, laboratory supplies, local specimen transport, IT equipment, contractual support for surveillance or public health information system enhancements, and approved innovative GC prevention activities. Direct assistance is available if needed. CDC may not be able to fund grantees at prior levels including for positions that may have been necessary while building up project infrastructure (e.g. IT staff needed to build or modify existing databases; data entry clerks needed prior to improved automated or electronic data processing). Requests must include funding to support attendance and travel of the project Epidemiologist Coordinator, and at least two additional key project staff (typically the local SURRG Director/Principle Investigator, the laboratory lead for the project, TX-DSHS-19-1309-A-000524 232 and/or the lead project data analyst or manager) to an annual resistant GC rapid detection and response capacity (SURRG) meeting (to be held in Atlanta in late 2019 or early 2020). All budget justifications should be clear and detailed enough to guide funding decisions (e.g. clearly defined project role of each funded position; itemized list of the type of supplies, with per unit item costs and number of items requested; contract deliverables, etc.). Funded state health department applicants are expected to collaborate with local health department partners to implement activities at the local (city or county) level. Activities will focus on local health department STD clinics and collaboration with at least two community-based sites (i.e. non-STD clinic healthcare settings) with high GC morbidity and capacity to collect genital and extragenital specimens from clinic attendees for gonococcal culture and antimicrobial susceptibility testing (AST) by Etest. All project activities should directly relate to improvements in ARGC rapid detection and response-related laboratory, surveillance, epidemiology, and clinical capacity, as well as informing innovative GC control efforts in the designated local jurisdiction. An appropriate local health department should have, at a minimum, the below features, and ideally, a proven track record of the following: 1. a) Health department leadership committed to implementing program strategies outlined in this NOFO; b) STD and community partner clinic staff with the capacity and commitment to follow project protocols related to effectively collecting, handling, and transporting GC culture specimens; c) proximity of a laboratory (state or local) with demonstrable experience and proven quality performance in culturing GC specimens and conducting timely Etest AST; d) capacity to conduct high quality field investigations consistent with the SURRG protocol, e) functional data systems capable of absorbing and storing project data in a usable fashion, and staff capacity to input, manage, store, extract, and clean project data; f) staff capacity to clean and electronically submit required data to CDC at scheduled intervals and in specified formats; and g) staff capacity and commitment to analyze locally-collected programmatic, clinical, laboratory, epidemiological, and network data for local programmatic efforts, quality improvement efforts, and dissemination, including through local and national presentations. 2. A high GC case-count in the local health department jurisdiction, and the presence of a categorical STD clinic that diagnoses at least 200 cases of GC per year; 3. Agreements in place with at least two community partner sites that serve groups known to experience high rates of GC (e.g. MSM, adolescent females), that have capacity to collect genital and extragenital specimens from clinic attendees for gonococcal culture and antimicrobial susceptibility testing (AST). Each community partner site must submit on average 6 specimens for GC culture per month. 4. The capacity and ideally proven track-record to conduct AST testing (by Etest) on at least 15% of total reported GC cases in the jurisdiction per year, or 1,000 cases, whichever is less. This includes isolates collected at STD clinics and community partner sites. Grantees will also be required to collect on average at least 10 specimens for GC culture from women per month (any anatomic site), and at least 40 extragenital specimens for GC culture from men (rectal or pharyngeal specimens) 5. Commitment of state and local STD Directors, STD clinic medical director, epidemiology and laboratory staff to work actively and collaboratively to implement this project, and lead on-going improvement efforts. Strong applicants for funding consideration can demonstrate current capacity in the background section. Strategies and Activities: TX-DSHS-19-1309-A-000525 233 AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1a: Strengthen local resistant GC threat coordination and epidemiological capacity Identify and maintain appropriate staffing. i. Maintain appropriate staffing in place, including staff members who can fill the role(s) of: a Project Director (i.e. SURRG PI), an epidemiologist coordinator (responsible for coordinating and managing local project and resistant GC activities); an epidemiologist (with capacity to conduct programmatic, epidemiologic and network data analyses); data manager (with capacity to manage, clean, extract, and submit to CDC required data in specified formats), laboratorians capable of performing N. gonorrhoeae culture and susceptibility testing by Etest, case investigators, a clinician with expertise in STDs (especially gonorrhea), and others to support local ii. The STD clinician should ideally be medical director of the STD clinic or otherwise serve in a leadership role with influence on STD clinic operations. The STD clinician can, but does not necessarily have to serve as the Project Director, but must be readily accessible to the project team to guide protocol development, and to clinical staff from both the STD and community partner clinics for training and case consultation (such as providing sound management, treatment, and follow-up guidance on patients with infections with reduced antibiotic susceptibility). iii. Individuals can serve in more than one role if their skillsets are clearly conducive to effective completion of required responsibilities for the roles. ☒Required b) ☐Optional Maintain and update (as needed) local SURRG project protocols and IT systems to address clinic, laboratory, surveillance, investigation, and data management GC rapid detection and response activities. i. SURRG project protocol should be sufficiently detailed and include at minimum: project staff roles and responsibilities; data and specimen flow charts; specimen collection and transport; laboratory processes for GC culturing, AST, and reporting of results; SURRG epidemiologic investigation processes and patient messaging; clinic, epi investigation and laboratory data management, including processes for completion of CDC-required monthly and annual metrics reports, and extraction, cleaning and submission to required line listed data to CDC; processes for submission of isolates and associated data to regional laboratories; and local process and outcome evaluation and analysis processes and plans ii. SURRG clinic protocols must be developed for both STD and community partner sites, and include at minimum: project purpose; criteria for culturing; culture specimen collection, labeling, requisitioning and transport procedures; required data collection; results interpretation; key messages for providers to provide to patients found to have GC with reduced antibiotic susceptibility; processes for DIS contacting patients infected with gonorrhea with reduced susceptibility; processes for clinic handling of contacts of index cases with infections found to have reduced susceptibility (including collecting specimens for culture from such contacts); any test of cure procedures; and contact information of key TX-DSHS-19-1309-A-000526 234 project staff including SURRG Epi Coordinator and Lab POC, and a lead clinician who clinic staff can contact to address relevant clinical questions, and provide case consultation, as needed. ☒Required c) Community messaging, workforce development, and training related to rapid response to resistant GC i. Grantees are encouraged to implement at least one of the following types of activities during the project year: 1) conduct a resistant GC outbreak tabletop or other planning exercise; 2) develop resistant GC media messages; 3) identify and train additional local clinical sites that could conduct GC testing (including culture) and treatment in the event of a large-scale resistant GC outbreak; 4) identify and establish partnerships with additional local laboratories that could receive specimens for and perform N. gonorrhoeae culture in the event of a large-scale resistant GC outbreak; 5) implement webinars, public health detailing, HANs, or other educational activities for local providers about resistant GC and how to access susceptibility testing for patients with suspected treatment failure or resistant GC. ☐Required II. a) ☒Optional Strategy 1d: Perform robust and timely detection of resistant GC threats Robust collection of specimens for gonococcal culture and performance of AST i. Specimens must be collected from at least one STD clinic and two community-based sites. Each partnering community site must collect on average at least 6 specimens for GC culture per month. ii. During the project period, AST via Etest must be conducted on isolates from at least 15% of total GC cases reported in the jurisdiction per year, or a total of 1,000 unique isolates, whichever is less. Grantees must also collect on average at least 10 specimens for GC culture each month from women (any anatomic site), and on average at least 40 extragenital specimens for GC culture each month from men. These requirements can include isolates from both STD clinics and partnering community-based sites. ☒Required b) ☐Optional ☐Optional Conduct timely GC culture and AST via Etest, and maintain associated data i. Conduct timely GC culture and AST via Etest on collected specimens following CDC’s SURRG Etest SOP ii. Rapidly communicate Etest results to ordering clinicians (using accurate and easy to understand interpretive language), and local SURRG Epidemiology Coordinator with a goal of reporting Etest results, on average, within 5 business days from specimen collection. iii. Rapidly report Etest results indicating reduced antibiotic susceptibility to local SURRG Epidemiology Coordinator, jurisdiction surveillance staff, and CDC SURRG program and lab contacts within 1 business day. TX-DSHS-19-1309-A-000527 235 iv. v. Collect required lab data in LIMS system Extract and clean data (as needed) for timely submission of required monthly and annual metric reports, and line listed data to CDC, following CDC guidance. ☒Required c) Ship GC isolates and transmit manifests to the appropriate Antibiotic Resistance Laboratory (ARLN) for confirmatory agar dilution AST and whole genome sequencing. i. Following CDC protocols, ship all GC isolates and electronically transmit associated completed manifests to the appropriate Antibiotic Resistance Laboratory (ARLN) for confirmatory agar dilution AST and whole genome sequencing (weekly for isolates with reduced cefixime, ceftriaxone, or azithromycin susceptibility; monthly for batched isolates). ☒Required III. a) ☐Optional Strategy 1b: Conduct enhanced SURRG GC case investigations Rapidly initiate SURRG case investigations on all patients with elevated ASTs i. Rapidly (within 48 hours of AST results) disease investigators/disease intervention specialists (DIS) initiate SURRG case investigation (i.e. treatment confirmation, symptom resolution, partner services, epi investigations), ideally in-person, of all patients found through laboratory diagnostics or clinical presentation (e.g. unsuccessful treatment) to be infected with a gonococcal strain with reduced susceptibility to cefixime, ceftriaxone, or azithromycin. ii. DIS should attempt to collect all SURRG epi investigation case data elements, including eliciting named sexual partners and up to 5 social contacts on all index cases. Following CDC-developed SURRG guidance documents, DIS will attempt to contact, bring in for testing, culturing (and treatment if indicated) and collection of epi data on any named contacts, and sex partners of any named sex partners (i.e. 2nd generation sex partners). Any new case of GC identified through these investigations (whether susceptible GC or not) should be classified as a new index case, and subsequently DIS are required to attempt to conduct these investigate two generations out from these newly identified cases. iii. All epi investigation and partner services data should be entered into a data system that allows for routine data extraction and tracking of partnerships between cases and sexual and social contacts. ☒Required b) ☐Optional ☐Optional Initiate SURRG investigations/partner services/epi investigations on at least an additional 12 seed index cases (with susceptible GC) in the jurisdiction (and their social contacts, sex partners, and sex partners of sex partners as per the SURRG Epi Investigation protocol). i. Applicants should propose a local population of interest focus and sampling strategy for these supplemental investigations. TX-DSHS-19-1309-A-000528 236 ii. iii. DIS should attempt to collect all SURRG epi investigation case data elements, including eliciting named sexual partners and up to 5 social contacts on all index cases. Following CDC-developed SURRG guidance documents, DIS will attempt to contact, bring in for testing, culturing (and treatment if indicated) and collection of epi data on any named contacts, and sex partners of any named sex partners (i.e. 2nd generation sex partners). Any new case of GC identified through these investigations (whether susceptible GC or not) should be classified as a new index case, and subsequently DIS are required to attempt to conduct these investigate two generations out from these newly identified cases. All epi investigation and partner services data should be entered into a data system that allows for routine data extraction and tracking of partnerships between cases and sexual and social contacts ☒Required ☐Optional AREA B: PREVENTION AND INTERVENTION I IV. Strategy 2a: Collect and analyze data for ongoing process and outcome evaluations, quality improvement activities, and enhanced epidemiological characterization of GC and resistant GC, with the goal of informing implementation of effective and efficient prevention and control interventions to mitigate the spread of GC and antimicrobial-resistant GC threats both locally, and through the dissemination of findings and lessons learned, nationally. a) Conduct routine process and outcome evaluations on core clinic and laboratory activities (e.g. monitor implementation and success of specimen collection criteria for gonococcal culture and AST, transport time, or culture yield by anatomic site). i. Propose 5-10 salient process or outcome metrics related to core clinic and laboratory activities that team will review on a monthly or quarterly basis ii. Develop monitoring plan, including measure definitions, benchmarks, frequency of data review, roles and responsibilities for extracting, analyzing, and reviewing data, and for sharing findings. ☒Required b) ☐Optional Analyze program data for programmatic quality improvement efforts. i. Awardees must conduct two local quality improvement (QI) projects; one should be focused on an important SURRG laboratory activity and the other on either a programmatic ARGC outbreak response activity or SURRG clinical activity. For each QI project, a quality improvement change should be made and the impact measured through collecting and analyzing prospectively collected data. Local data should be analyzed to establish a baseline. Additional guidance and details will be provided by the Division of STD Prevention at CDC. ii. Develop quality improvement plan including QI project description, measures, proposed modifications, roles and responsibilities, timeline, and analysis plan ☒Required ☐Optional TX-DSHS-19-1309-A-000529 237 c) Develop and implement a plan to conduct analyses on GC rapid detection and response epi investigation and partner services activities. These analyses should attempt to 1) document of the impact and value of conducting local partner services and outbreak response activities, and 2) improve local understanding of GC and resistant GC epidemiology and transmission dynamics. These analyses may include partner services metrics, network information, epi, clinical, AST and/or genomic data. i. Develop analysis plan, including analytic questions, data definitions, analysis timelines, roles and responsibilities, etc. ☒Required d) ☐Optional Evaluate routinely collected programmatic data related to test-of-cure among persons tested and treated for GC who return for a test-of-cure visits. ☐Required ☒Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS I V. a) Strategy 3b: Information Dissemination To inform and improve GC and ARGC prevention and control efforts more broadly, awardees are required to disseminate (through documentation and/or presentation) lessons learned, best practices, local protocols, or results of programmatic analyses. i. Awardees are required to participate in a SURRG lessons learned and best practices report or SURRG journal supplement. In consultation with CDC, awardees will select a topic(s) to contribute to the report or supplement (e.g. culturing criteria and yield; media selection, specimen viability and contamination; successes and challenges with conducting field investigations; ARGC communication strategies with patients and/or providers; use of epidemiological or network data for programmatic action, etc.). Additional guidance and details will be provided by the Division of STD Prevention at CDC. ii. In addition to any SURRG best practices report or supplement, awardees are also required to disseminate clinical, laboratory, and epidemiological analyses and programmatic best practices with community partners, on grantee calls, at the annual SURRG grantee meeting, and ideally also at local and national conferences and through publication. ☒Required ☐Optional Collaborations a. With CDC-funded programs: Awardees are required to work with the Antibiotic Resistant Lab Network (ARLN) laboratories, which serve as reference labs, performing confirmatory resistance testing and advanced molecular characterization of locally tested specimens. Programs will also be expected to work with state and local STD prevention programs funded through Strengthening STD Prevention and Control for Health Departments (STD PCHD), and with state and local HIV prevention programs that receive CDC funding. b. With organizations external to CDC: TX-DSHS-19-1309-A-000530 238 N/A Target Populations: All persons diagnosed with or at risk for GC will represent the target population. Evaluation and Performance Measurement: Evaluation and performance measures are collected both in the ELC Application as well as submitted directly to the CDC DSTDP SURRG Team, as outlined below. Every other month, awardees must submit to CDC (via SAMS portal following CDC project guidance documents) required variables for: 1) all GC cases identified in the STD clinics via GC NAAT; 2) all patients for whom a specimen was collected for GC culture; 3) culturing and antibiotic susceptibility test results, and 4) any GC case investigations (including data on 1st and 2nd generation sexual and social contacts) initiated. Strategy I: Strengthen local resistant GC treat coordination and epidemiological capacity 1. List of qualified personnel hired or retained to support activities and other in-kind key-project staff and their role on SURRG. (report in ELC renewal application) 2. Indicate the number of trained personnel who can perform GC culture using Etest. (report in ELC renewal application) 3. Local SURRG project protocols (and protocol updates), including participating clinic protocols, will be submitted annually (submit annually via email directly to DSTDP SURRG Team) Strategy II: Perform robust and timely detection of resistant GC threats The following performance measures under Strategy II are required to be reported monthly and annually to CDC via email using PDF fillable forms created by the DSTDP SURRG Team, “SURRG Clinic and Laboratory Monthly Performance Metrics”, and “SURRG Annual Clinic and Laboratory Performance Metrics”: 1. Number of specimens collected for GC culture and number cultures determined to be positive for GC at each participating clinic (by specimen source, patient sex/gender identity, and sex of sex partner). 2. Number of GC NAATS performed and proportion positive from each participating clinic, by anatomic site. 3. Minimum, maximum, and average number of days from specimen collection (at participating clinics) to Etest completion and reporting of results, and number and percent of GC isolates processed within 5 and 7 business days. 4. Number and proportion of GC isolates found to have reduced susceptibility or resistance to antibiotics tested; and number and proportion with reduced susceptibility or resistance for which results were reported within 1 working day to the local health department, the ELC-funded health department, and CDC. 5. Number of GC cases reported in the jurisdiction; Number of in and out of jurisdiction GC cases diagnosed at participating STD clinics Strategy III: Conduct enhanced SURRG GC case investigations: The following performance measures under Strategy III are required to be reported annually to CDC via email using PDF fillable forms created by the DSTDP SURRG Team, “SURRG Annual Clinic and Laboratory Performance Metrics”: 1. Number and percent of GC index patients’ case investigations opened (“initiated”), reached, interviewed, named ≥ 1 sex partner, named ≥ 1 social contact. TX-DSHS-19-1309-A-000531 239 2. Number and percent of index patients’ sex partners and social contacts “initiated”, reached, interviewed, GC NAAT-positive, GC culture-positive, identified with reduced susceptible GC 3. Number of SURRG investigation index patients identified through STD clinics, non-STD clinics, and SURRG investigations Strategy IV: Collect and analyze data for ongoing process and outcome evaluations, quality improvement activities, and enhanced epidemiological characterization of GC and ARGC The following performance measures and evaluation requirements under Strategy IV will be reported annually to CDC via email using templates created by the DSTDP SURRG Team 1. Brief summary of the 5-10 grantee defined routinely reviewed SURRG process and outcome measures and evaluation results from the previous 12 months 2. Brief summary of the two SURRG quality improvement initiatives implemented during the project year, including description of each QI project, measures, modifications attempted, and results over time. 3. Brief description of salient locally initiated epi investigation and partner services analyses conducted that year (including: analytic question, methods, and results) 4. List of titles, dates and venues for any SURRG-related talks, presentations, or publications of local SURRG staff during the previous 12 months. TX-DSHS-19-1309-A-000532 240 T: Gonococcal Isolate Surveillance Project (GISP) Program Activity Contact Information Sancta St. Cyr, Medical Epidemiologist, oew3@cdc.gov, 404-718-5447 Funding Opportunity Description Background a. Overview The Gonococcal Isolate Surveillance Project (GISP) was established in 1986 to monitor antimicrobial susceptibility trends in Neisseria gonorrhoeae in the United States and to establish a rational basis for the selection of gonococcal therapies. The project collected urethral gonococcal isolates and accompanying clinical/ demographic data from symptomatic men presenting to participating sentinel sites. In 2017, an enhanced project (eGISP) was introduced to evaluate gonococcal antimicrobial resistance at additional anatomic sites and in expanded populations. It also allowed for a more robust characterization of isolates by gathering epidemiology on Neisseria meningitidis isolates found within the surveillance population. GISP is now a combined project made up of both GISP and eGISP components. The project functions to phenotypically characterize isolates collected through this surveillance system and uses this data to assist in national gonococcal treatment recommendations. b. Healthy People 2020 The Gonococcal Isolate Surveillance Project (GISP) supports Healthy People 2020 topic areas. The first supported topic area is Sexually Transmitted Diseases (STDs). One of the objectives in this area is to decrease the rates of gonorrhea in males and females ages 15 to 44 years (STD-6). This project assists in decreasing gonorrhea rates by analyzing antimicrobial susceptibility trends to help determine and encourage use of appropriate and effective antimicrobial therapies. By collecting data on sex of sex partners as a standard part of the surveillance system, GISP contributes to another STD objective to increase the number of populationbased data systems that include in their core a standardized set of questions that identify lesbian, gay, bisexual, and transgender populations (LGBT-1). The eGISP component of this project evaluates the epidemiology of meningococcal infections in collected urethral, pharyngeal, rectal and cervical isolates. This project aims to better characterize N. meningitidis in the surveillance system and use that information to help reduce meningococcal disease, which is an objective (IID-3) of the Immunization and Infectious Diseases topic area. c. Other National Public Health Priorities and Strategies The National Strategy for Combating Antibiotic-Resistant Bacteria (CARB) is also supported by this project. Neisseria gonorrhoeae is considered one of three urgent threat level pathogens. Goal one of the National Strategy is to slow the emergence of resistant bacteria and prevent the spread of resistant infections. By monitoring for antimicrobial resistance, especially in areas where resistance has previously been imported, this project is contributing to this goal. The CDC’s strategic priorities of (1) excellence in surveillance, epidemiology, and laboratory services and (2) strengthening support for state, tribal, local, and territorial public health have been supported by GISP through its more than 30 years of gonococcal surveillance and partnerships with state and local health departments. This project also aligns with the priorities of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention (NCHHSTP) to reduce the rate of non-HIV STDs. In addition, GISP addresses the goals of the Division of STD Prevention (DSTDP) strategic plan, which TX-DSHS-19-1309-A-000533 241 includes addressing the threat of antibiotic-resistant N. gonorrhoeae and building capacity to respond to emerging STD threats. CDC Project Description a. Problem Statement: N. gonorrhoeae is the second most common notifiable disease in the United States. Prevention and control of gonococcal infections relies on timely and effective antibiotic treatment. N. gonorrhoeae’s ability to mutate and develop antibiotic resistance has tested the ability to provide effective treatment. Due to the development of antimicrobial resistance to multiple classes of antibiotics, including current first line therapies, the organism has been designated as one of three urgent threat level pathogens in the United States. N. gonorrhoeae is, therefore, a priority of both the National Strategy for Combating Antibiotic-Resistant Bacteria and the CDC’s Antibiotic Resistance Solutions Initiative. Surveillance is a critical process for monitoring and defending against antimicrobial resistance. The National Strategy for Combating Antibiotic-Resistant Bacteria has made the strengthening of surveillance a fundamental component of its action plan. The Gonococcal Isolate Surveillance Project (GISP) is a collaborative project between local and state jurisdictions, regional laboratories and CDC that collects and analyzes gonococcal isolates across the United States. The core component of GISP involves the surveillance of male urethral isolates only and the enhanced component involves the surveillance of vaginal, endocervical, pharyngeal and rectal isolates. By having geographic, gender and anatomic diversity as part of the project, GISP may be able to better detect changes in susceptibility patterns sooner. The enhanced component of GISP, which was added to the project in 2017, includes the collection of N. meningitidis in addition to N. gonorrhoeae. Although believed to be less commonly associated with urethritis, N. meningitidis has been identified with increasing frequency in some GISP jurisdictions. Therefore, evaluating the burden of urethritis associated with N. meningitidis better maximizes the specificity of the GISP surveillance. N. meningitidis also has different resistance profiles than N. gonorrhoeae, making it critical that jurisdictions identify what proportion of presumed N. gonorrhoeae infections are actually N. meningitidis infections. Therefore, it is not only the timely detection of gonococcal infections that allow for an effective local response to the threat of resistant N. gonorrhoeae, but also having the maximal specificity for the surveillance efforts performed. b. Purpose: The Gonococcal Isolate Surveillance Project (GISP) monitors trends in antimicrobial susceptibilities of strains of N. gonorrhoeae in the United States to establish a scientific basis for the selection of treatment options. It supports changes in gonococcal treatment recommendations and practices before widespread treatment failures due to resistance occur. The enhanced GISP (eGISP) increases state and local capacity to detect and monitor resistant gonorrhea among additional important populations, such as gay, bisexual, and other men who have sex with men (MSM) (in whom gonococcal resistance has often initially emerged) and women, a population from whom specimens have not been previously collected systematically for surveillance of resistance in the United States. c. Outcomes: By the end of the project period, the following outcomes are expected to be achieved: TX-DSHS-19-1309-A-000534 242 Improved surveillance of resistant Neisseria gonorrhoeae at the local and state level (GISP, eGISP) Maintenance or improvement of laboratory culture capacity for Neisseria gonorrhoeae at the local and state level (GISP, eGISP) • Improved understanding of the epidemiology of Neisseria meningitidis in urethral, pharyngeal, rectal and cervical isolates at the local and state level (eGISP) • Increased collaboration between local and state jurisdictions, regional Antibiotic Resistance Laboratory Network (ARLN) laboratories and CDC (GISP, eGISP) • Increased awareness of antibiotic resistant gonorrhea risk factors, protective actions and appropriate public health actions (GISP, eGISP) Funding Strategy: GISP: Core GISP Component (GISP) Activities (required) This funding is open to all jurisdictions who have identified at least one STD clinic in their jurisdiction with the capacity to collect cultures for N. gonorrhoeae from male urethral samples. Applicants who are currently funded to perform similar activities in selected STD clinic(s) in their jurisdiction through ELC J1: Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity are eligible to apply, but must identify at least one different STD clinic(s) in different geographic location(s) in their jurisdiction for activities funded through this project. • • The jurisdiction must have the organizational and project management capacity to support and/ or operate a STD specialty clinic and public health laboratory over the course of the project period. The jurisdiction must also have the capacity to execute the program strategies and activities and demonstrate the ability to meet the project period outcomes. Jurisdictions must also identify in writing, as part of the funding application, the burden of gonococcal infection in their proposed STD specialty clinic(s) by providing the number of infections seen in the two years prior to the application year for each clinic. The anticipated level of specific project management capacity needed to execute the GISP approach successfully includes the: 1) Ability to enroll men for the collection of urethral samples, culture isolation of N. gonorrhoeae, storage of duplicate isolates and shipment of viable and non-contaminated isolates, 2) Ability to collect and electronically transmit requested demographic and clinical data elements, 3) Organizational leadership and support to support the GISP approach, and 4) Human resource management and financial management to support the GISP approach. Funding should be used to support costs for personnel, training, laboratory supplies, IT equipment, and contractual support for surveillance or public health information systems enhancements. Funds may also be used to support FTE who are trained in epidemiology/data management, since it is required that a jurisdiction must demonstrate data management and epidemiologic capacity to review local data to inform public health action and prepare data for transmission to CDC. All funding should support core GISP component activities. A detailed, itemized budget of each category is required for each funding year. • • Estimated total availability of funds: $300,000 Estimated number of awards given: 25 TX-DSHS-19-1309-A-000535 243 • Estimated average per award: $12,000 GISP: Enhanced GISP Component (eGISP) Activities (optional) While any Tier 2 section is optional for applicants, if a jurisdiction is applying for a Tier 2 project then all the activities within that project are required. This optional additional funding is only open to jurisdictions who apply for the Core GISP Component activities. Enhanced GISP Component funding is open to those jurisdictions that are eligible for the Core GISP Component and who have identified at least one STD clinic in their jurisdiction with the capacity to collect cultures for N. gonorrhoeae at multiple anatomic sites (i.e., vagina, cervix, rectum, and oropharynx). The jurisdiction must have the organizational and project management capacity to execute the program strategies and activities and demonstrate the ability to meet the project period outcomes. The anticipated level of specific project management capacity needed to execute the eGISP approach successfully includes the: 1) Ability to enroll men and women for the collection of genital and extragenital samples, culture isolation and NAAT testing of N. gonorrhoeae, storage of duplicate isolates and shipment of viable and non-contaminated isolates, 2) Ability to collect and electronically transmit requested demographic and clinical data elements, 3) Organizational leadership and support to support the GISP approach, and 4) Human resource management and financial management to support the GISP approach. Funding should be used to support costs for personnel, training, laboratory supplies, IT equipment, and contractual support for surveillance or public health information systems enhancements. Funds may also be used to support FTE who are trained in epidemiology/data management, since it is required that a jurisdiction must demonstrate data management and epidemiologic capacity to review local data to inform public health action and prepare data for transmission to CDC. All funding should support enhanced GISP component activities. A detailed, itemized budget of each category is required for each funding year. This itemized budget should be separate from the itemized budget for core GISP component activities. • • • Estimated total availability of funds: $360,000 Estimated number of awards given: 6 Estimated average per award: $60,000 Strategies and Activities: I I. AREA A: SURVEILLANCE, DETECTION, AND RESPONSE Strategy 1c: Improve surveillance and reporting of Neisseria gonorrhoeae isolates from men with symptomatic urethritis – GISP a) Identify one or more categorical STD clinics and a local public health laboratory in a jurisdiction that will execute the program activities and meet the project period outcomes TX-DSHS-19-1309-A-000536 244 i. Selected STD clinics must demonstrate a known significant burden of gonococcal disease by providing yearly number of gonococcal infections for each participating clinic for years 2017 and 201 ☒Required b) Collect urethral N. gonorrhoeae isolates from the first 25 men with symptomatic gonococcal urethritis seen in the STD clinic each month ☒Required c) ☐Optional Review antibiotic susceptibility test results received from the ARLN laboratory, describe the epidemiology of resistant N. gonorrhoeae in submitting jurisdictions, and use results to help inform patient management and local public health response ☒Required h) ☐Optional Maintain and store duplicates of submitted isolates in the local public health laboratory ☒Required g) ☐Optional Assign isolates an identifying number, freeze the isolates and ship them monthly to the assigned GISP regional Antimicrobial-Resistance Laboratory Network (ARLN) reference laboratory for antibiotic susceptibility testing ☒Required f) ☐Optional Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination ☒Required e) ☐Optional Inoculate specimens for culture onto selective media at the STD clinic(s). Subculture gonococcal isolates from the selective primary medium to a non-inhibitory medium in the local public health laboratory, as described in the GISP protocol ☒Required d) ☐Optional ☐Optional Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols ☒Required ☐Optional TX-DSHS-19-1309-A-000537 245 II. Strategy 1c: Improve surveillance and reporting of Neisseria gonorrhoeae isolates from female genital and male and female extragenital sites- eGISP a} Identify one or more categorical STD clinics in the jurisdiction and a local public health laboratory that will execute the program strategies and meet the project period outcomes ☒Required b) Collect urethral swabs for Gram stain, gonococcal culture and urethral/urine specimens for nucleic acid amplification testing (NAAT) from the first 25 men presenting to the participating STD clinic(s) each month with symptomatic urethritis i. These isolates should be the exact same isolates submitted for the first 25 men with urethritis as part of core GISP component ☒Required c) ☐Optional Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination ☒Required g) ☐Optional Inoculate specimens for culture onto selective media at the STD clinic(s). Subculture gonococcal isolates from the selective primary media to a non-inhibitory medium in the local public health laboratory, as described in the eGISP protocol ☒Required f) ☐Optional Collect cervical swabs for gonococcal culture and NAAT from women undergoing pelvic examinations with concerns of cervicitis, women with known exposures to a GC case and women with a positive NAAT result in the participating STD clinic(s) until 25 cases of gonococcal genital infections in women are identified each month. A urine specimen for NAAT (rather than a swab) is acceptable ☒Required e) ☐Optional Collect pharyngeal and/or rectal swabs for culture and NAAT from patients (men or women) seen in the participating STD clinic(s) reporting pharyngeal and/or rectal exposure (e.g., men reporting oral sex or receptive anal sex) until 25 cases of gonococcal infection at extragenital sites are identified each month i. The local public health lab will isolate and ship the gonococcal isolates to the assigned laboratory in the CDC-supported Antibiotic Resistance Laboratory Network (ARLN) ☒Required d) ☐Optional ☐Optional Assign isolates a unique identifying number, freeze the isolates and ship them monthly to the assigned eGISP regional Antimicrobial-Resistance Laboratory Network (ARLN) reference laboratory for antibiotic susceptibility testing TX-DSHS-19-1309-A-000538 246 ☒Required h) Ship isolates associated with positive gonorrhea NAAT results monthly to the assigned ARLN laboratory for antimicrobial susceptibility testing by agar dilution and possible molecular characterization (including whole genome sequencing) i. CDC may request that selected specimens of interest be shipped from the ARLN to CDC for additional laboratory investigation and archival storage ii. Isolates with negative gonorrhea NAATs will be shipped to the CDC Meningitis Branch laboratory (see Strategy III, Activities a and b) ☒Required i) ☐Optional Review antibiotic susceptibility test results received from the ARLN laboratory, describe the epidemiology of resistant N. gonorrhoeae in submitting jurisdictions, and use results to help inform local public health response ☒Required j) ☐Optional ☐Optional Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols i. Awardees will collect and transmit standardized data elements for domains such as anatomic site (from which the specimen was collected), gender of recent sex partners, recent sex with anonymous partners, HIV status (including results from HIV testing at the clinic visit when the specimen was collected), travel history, recent sexual practices (such as insertive oral sex or receptive anal sex), and NAAT results of the specimen ii. The unique identifying number assigned to each isolate will enable identification of multiple isolates that were collected from the same patient. This identifier will be included with the line-listed transmitted data ☒Required ☐Optional III. Strategy 1c: Improve the specificity of surveillance and reporting of Neisseria gonorrhoeae by monitoring Neisseria meningitidis isolates from male and female genital and extragenital sites- eGISP a} Identify and maintain records of all urethral, pharyngeal, rectal, and cervical isolates that are suggestive of N. meningitidis i. Isolates are suggestive of N. meningitidis when they have “discordant results” demonstrated by bacterial growth on culture consistent with N. gonorrhoeae (positive culture) and have a negative gonorrhea NAAT results, or in the case of urethral specimens, demonstrate Gram-negative intracellular diplococci (GNID) by microscopy, but have a negative gonorrhea NAAT results ☒Required ☐Optional TX-DSHS-19-1309-A-000539 247 b) Ship the identified presumed N. meningitidis isolates monthly directly to the CDC Meningitis Branch Laboratory in Atlanta, Georgia for antibiotic susceptibility testing, confirmatory identification, and molecular characterization (including whole genome sequencing) ☒Required c) Maintain adequate specimen handling quality control to maximize isolate viability and minimize contamination ☒Required d) ☐Optional Review antibiotic susceptibility test results received from the CDC Meningitis Branch Laboratory, describe the epidemiology of N. meningitidis in urethral, pharyngeal, rectal and cervical isolates in their jurisdiction to help inform patient management and local public health response i. Annual reports of isolate data for specific sentinel sites can be provided upon request ☒Required e) ☐Optional ☐Optional Collect line-listed, coded specified demographic and clinical data elements associated with each isolate and electronically submit to CDC following standardized protocols i. In addition to the epidemiological variables described in Strategy II, Activity j, data collection for these isolates will also include epidemiological data of meningococcal vaccination status ☒Required ☐Optional Collaborations: a. With CDC funded programs: All awardees will be assigned to an Antibiotic Resistance Laboratory Network (ARLN) laboratory that will serve as the regional reference laboratory for their clinical sites. ARLN laboratories will receive all of their jurisdiction’s isolates and perform the antimicrobial susceptibility testing on them. Assigned ARLN laboratories will also be responsible for providing each awardee with its specific antimicrobial testing results. Awardee programs will also be encouraged to work with state and local STD prevention programs, which may include programs funded through CDC’s Improving Sexually Transmitted Disease Programs through Assessment, Assurance, Policy Development, and Prevention Strategies (STD AAPPS). b. With organizations external to CDC: Awardees are also expected to work with clinical providers in the participating STD clinic(s) in their jurisdictions Target Populations: The core GISP component targets men with symptomatic gonococcal urethritis only. The enhanced GISP component performs surveillance of gonococcal isolates from men and women at genital and extragenital sites. Awardees, therefore, are expected to identify persons with urethral, pharyngeal, rectal, or cervical TX-DSHS-19-1309-A-000540 248 gonococcal infections, including racial, ethnic, and sexual minorities, for the purposes of surveillance of gonococcal antibiotic resistance. Evaluation and Performance Measurement: I Measure #1 Improved surveillance of resistant Neisseria gonorrhoeae at the local and state level • GISP o Ability to collect 25 male urethral isolates monthly from participating clinics o Ability to collect and transmit the following clinical and demographic data for each isolate o Patient gender o Ethnicity o Race o Date of clinic visit o Age o Sex of sex partner o Presence of symptoms o Previous history of gonorrhea o Number of previous confirmed episodes of gonorrhea in past year o HIV status at time of clinic visit for gonorrhea (including results of HIV testing at the time of the clinic visit) o Travel outside the United States during the 60 days prior to clinic visit o History of giving or receiving drugs / money for sex in the 12 months prior to clinic visit o Any antibiotic use during the 60 days prior to clinic visit o History of injection drug use in the 12 months prior to clinic visit o History of non-injection recreational drug use (excluding alcohol) in the 12 months prior to clinic visit o Primary treatment for gonorrhea (such as ceftriaxone, if recommended dual therapy administered) o Secondary treatment for gonorrhea (such as azithromycin 1 g, if recommended dual therapy administered; previously considered co-treatment for presumed chlamydia) • eGISP o Ability to collect 25 female genital isolates monthly from participating clinics o Ability to collect 25 male or female extragenital isolates monthly from participating clinic o Ability to collect and transmit the following clinical and demographic data for each isolate o Anatomic site of isolate collection o Nucleic acid amplification test (NAAT) result o Patient gender o Ethnicity o Race o Date of clinic visit o Age o Sex of sex partner o Presence of symptoms o Previous history of gonorrhea 249 TX-DSHS-19-1309-A-000541 I o Number of previous confirmed episodes of gonorrhea in past year o HIV status at time of clinic visit for gonorrhea (including results of HIV testing at the time of the clinic visit) o Travel outside the United States during the 60 days prior to clinic visit o History of giving or receiving drugs / money for sex in the 12 months prior to clinic visit o Any antibiotic use during the 60 days prior to clinic visit o History of injection drug use in the 12 months prior to clinic visit o History of non-injection recreational drug use (excluding alcohol) in the 12 months prior to clinic visit o Primary treatment for gonorrhea (such as ceftriaxone, if recommended dual therapy administered) o Secondary treatment for gonorrhea (such as azithromycin 1 g, if recommended dual therapy administered; previously considered co-treatment for presumed chlamydia) o Meningococcal vaccination history Measure #2 Maintenance or improvement of laboratory culture capacity for Neisseria gonorrhoeae at the local and state level • GISP o Ability to culture and isolate Neisseria gonorrhoeae from clinical specimens o Ability to limit contamination and maintain viability of Neisseria gonorrhoeae isolates o Ability to ship isolates to the regional laboratory for standardized antibiotic susceptibility testing o Ability to transmit the following laboratory data to the regional laboratory o GISP identification number o Sentinel site code • eGISP o Ability to culture and isolate Neisseria gonorrhoeae from clinical specimens o Ability to limit contamination and maintain viability of Neisseria gonorrhoeae isolates o Ability to ship isolates to the regional laboratory for standardized antibiotic susceptibility testing o Ability to transmit the following laboratory data to the regional laboratory o Patient identification number o eGISP identification number o Sentinel site code o Age o Possibility of N. meningitides o Gender o Specimen collection date o Specimen source Table 1. Core GISP Component (GISP) Project Measures Table Aug 2018- December Jan 2019- July GISP activities/objectives 2018 2019 TX-DSHS-19-1309-A-000542 250 No./% No./% Number of cases of gonococcal urethritis diagnosed in men attending the participating clinic Number and percentage of urethral gonococcal isolates submitted to the assigned GISP regional laboratory Percentage of submitted isolates that were found by the GISP regional laboratory to be non-viable or contaminated Percentage of monthly isolate batches that were shipped to the GISP regional laboratory within one week after the end of monthly collection Percentage of monthly demographic/clinical data transmissions that were submitted to CDC within one month of the completion of specimen collection Percentage of collected isolates for which the following data elements were reported: • Age • Gender of sex partners/sexual orientation • HIV status • Antibiotic use • Treatment Table 2. Enhanced GISP Component (eGISP) Neisseria gonorrhoeae Project Measures Table Men eGISP Activities/ Objectives I Women Urethral Pharyngeal Rectal Cervical or Vaginal # (%) # (%) # (%) # (%) Number of men who presented to the affiliated STD clinic(s) with urethritis Of the men who presented to the STD clinic(s) with urethritis, the number and percentage from whom urethral specimens for Gram stain, culture and urethral or urine specimens NAAT were collected Number and percentage of urethral specimens that demonstrated typical growth by culture (i.e., were positive cultures) Number of urethral gonococcal isolates submitted to the ARLN for susceptibility testing from the affiliated STD clinic(s) Number of men reporting oropharyngeal exposure TX-DSHS-19-1309-A-000543 251 Number/percentage of men reporting oropharyngeal exposure from whom pharyngeal specimens for culture and NAAT were collected Number and percentage of pharyngeal specimens from men that demonstrated typical growth by culture (i.e., were positive cultures) Number of pharyngeal gonococcal isolates from men submitted to the ARLN for susceptibility testing from the affiliated STD clinic(s) Number of men reporting rectal exposure Number/percentage of men reporting rectal exposure from whom pharyngeal specimens for culture and NAAT were collected Number/percentage of rectal specimens from men that demonstrated typical growth by culture (i.e. were positive cultures) Number of rectal gonococcal isolates from men submitted to the ARLN for susceptibility testing from the affiliated STD clinic(s) Number of women undergoing a pelvic examination at the affiliated STD clinic(s) Number/percentage of women undergoing a pelvic exam from whom cervical/vaginal specimens for culture and cervical/vaginal or urine specimens for NAAT were collected Number/percentage of cervical/vaginal specimens that demonstrated typical growth by culture (i.e., were positive cultures) Number of cervical/vaginal gonococcal isolates submitted to the ARLN for susceptibility testing from the affiliated STD clinic(s) Number/percentage of submitted isolates, stratified by anatomic site, that were found by the ARLN laboratory to be non-viable or contaminated TX-DSHS-19-1309-A-000544 252 Number/percentage of collected isolates, stratified by anatomic site, for which complete epidemiological data were reported to CDC I Measure #3 Improved understanding of the epidemiology of Neisseria meningitidis in urethral, pharyngeal, rectal and cervical isolates at the local and state level • eGISP Ability of local or state laboratory to identify potential Neisseria meningitidis isolates based on culture and NAAT results Ability to ship possible Neisseria meningitidis isolates to CDC for antimicrobial susceptibility testing Ability of the clinic to collect and transmit the following clinical and demographic data for each isolate • Anatomic site of isolate collection • Nucleic acid amplification test (NAAT) result • Patient gender • Ethnicity • Race • Date of clinic visit • Age • Sex of sex partner • Presence of symptoms • Previous history of gonorrhea • Number of previous confirmed episodes of gonorrhea in past year • HIV status at time of clinic visit for gonorrhea (including results of HIV testing at the time of the clinic visit) • Travel outside the United States during the 60 days prior to clinic visit • History of giving or receiving drugs / money for sex in the 12 months prior to clinic visit • Any antibiotic use during the 60 days prior to clinic visit • History of injection drug use in the 12 months prior to clinic visit • History of non-injection recreational drug use (excluding alcohol) in the 12 months prior to clinic visit • Primary treatment for gonorrhea (such as ceftriaxone, if recommended dual therapy administered) • Secondary treatment for gonorrhea (such as azithromycin 1 g, if recommended dual therapy administered; previously considered co-treatment for presumed chlamydia) • Meningococcal vaccination history Table 3. Enhanced GISP Component (eGISP) Neisseria meningitidis Project Measures Table eGISP Neisseria meningitidis Measures All Nm Isolates Urethral Nm Isolates Cervical or Vaginal Oropharyngeal Nm Isolates Rectal Nm Isolates TX-DSHS-19-1309-A-000545 253 I # (%) # (%) Nm Isolates # (%) # (%) # (%) Total number of isolates, stratified by anatomic site (positive cultures for Neisseria) Number of isolates, stratified by anatomic site, identified that had discordant laboratory results (i.e. GNID by Gram stain/positive cultures and negative gonorrhea NAAT) Number of isolates, stratified by anatomic site, with discordant results that were shipped to CDC, stratified by anatomic site Number of isolates, stratified by anatomic site, with discordant results shipped to CDC that were non-viable or contaminated Number/percentage of isolates, stratified by anatomic site, for which requested epidemiological data were reported to CDC I Measure #4 Increased collaboration between local and state jurisdictions, Regional Antibiotic Resistance Laboratory Network (ARLN) laboratories and CDC • GISP Ability of the local and state laboratory to provide viable, non-contaminated Neisseria gonorrhoeae male urethral isolates and associated documentation to the regional ARLN laboratories Ability to retrieve completed antibiotic susceptibility test results performed by the regional ARLN laboratory Ability to have bidirectional communication with the regional ARLN laboratory • eGISP Ability of the local and state laboratory to provide viable, non-contaminated Neisseria gonorrhoeae male and female genital and extragenital isolates and associated documentation to the regional ARLN laboratories in a timely manner Ability to retrieve completed antibiotic susceptibility results performed by the regional ARLN laboratory Ability to have bidirectional communication with the regional ARLN laboratory TX-DSHS-19-1309-A-000546 254 - I Ability of the local and state laboratory to provide viable, non-contaminated suspected Neisseria meningitidis isolates and associated documentation to the CDC laboratories Measure #5 Increased awareness of antibiotic resistant gonorrhea risk factors, protective actions and appropriate public health actions • GISP and eGISP o Regularly discuss and share the importance of gonorrhea surveillance and the role of GISP/ eGISP o Review antibiotic susceptibility test results provided by the regional ARLN laboratories o Review local and state GISP/ eGISP data including the annual GISP Profiles and Supplements o Review National STD Treatment Guidelines and encourage recommended treatment for gonococcal infections TX-DSHS-19-1309-A-000547 255 U: Syphilis and HIV Prevention Through Social, Sexual and Phylogenetic Networks Program Activity Contact Information Matthew Hogben, mhogben@cdc.gov, 404 639-1833 Funding Opportunity Description Background a. Overview The goal of the MATRIX project is to improve HIV and STD prevention and care for vulnerable MSM and Transgender women in local settings. Partners in New York City and North Carolina health departments will 1) uncover and follow networks of racial and ethnic minority gay, bisexual and other MSM and transgender women who are either HIV-infected or at risk of HIV and STDs; and 2) efficiently implement high-impact prevention interventions within those networks (i.e. HIV pre-exposure prophylaxis [PrEP], HIV antiretroviral treatment [ART], STD treatment, services referrals). Collected network data will be used to inform models of transmission dynamics. Sites will also collect cost data to evaluate overall cost effectiveness and inform resource allocation decisions. b. Healthy People 2020 This project supports Healthy People 2020 objectives (which cohere closely with the National HIV/AIDS Strategy objectives) HIV-2, Reduce the number of new HIV infections among adolescents and adults, and HIV-3, Reduce the rate of HIV transmission among adolescents and adults. The project also supports HIV-13, Increase the proportion of persons living with HIV who know their serostatus, and HIV-14.2, Increase the proportion of men who have sex with men who report having been tested for HIV in the past 12 months. With respect to STD, this project supports HP 2020 objective STD 7.2, Reduce domestic transmission of primary and secondary syphilis among males. c. Other National Public Health Priorities and Strategies This project supports two of the goals of the National HIV/AIDS Strategy: (1) Reduce the number of people who become infected with HIV; and (2) Increase access to care and improve health outcomes for people living with HIV. The Secretary’s Minority AIDS Initiative Fund also derives goals from NHAS. The most clearly relevant highpriority goal is D(1): Innovative strategies to promote access to comprehensive PrEP services for high-risk racial/ethnic minorities for whom it is appropriate and desired, especially MSM and transgender persons. CDC Project Description a. Problem Statement: The overarching problem is that men who have sex with men (MSM) and transgender women form two subpopulations with high STD/HIV prevalence. More specifically, the United States is currently experiencing steep rises in syphilis rates, and the majority of syphilis cases are among MSM, many of whom are MSM of color. Secondly, syphilis and HIV are intertwined epidemics among MSM and transgender women – essentially part of the same constellation of sexual health needs. Thirdly, STD incidence (especially syphilis) among HIV-uninfected MSM is a marker for extremely high vulnerability to HIV infection among this population. Remediation of infectious diseases requires treatment or care for current disease and prevention for vulnerable persons. Case detection enables both treatment and prevention: the former because case detection identifies morbidity, and the latter because those exposed to cases are by definition at high risk and TX-DSHS-19-1309-A-000548 256 thus priority candidates for prevention. Network methods enable more productive and more efficient case detection. Because HIV and syphilis are intertwined and highly concentrated among MSM and transgender women, there is a good case for basing networks on members of these two groups. b. Purpose: Recipients will describe and use social, sexual and phylogenetic networks to improve management of STDs, particularly syphilis, and to identify MSM and transgender women who are either HIV-infected or at risk of HIV and STDs for high-impact prevention interventions. Discovery and use of networks allows for the connections among the target populations to be used to efficiently provide prevention and control interventions. The activities are based on expansion and extension of existing disease control activities enumerated in current guidance and program funding cooperative agreements. c. Outcomes: The three major outcomes expected from the approach are to: (1) Demonstrate that networks identify candidates for treatment and prevention by showing that networks seeded from individuals with a recent syphilis/HIV history lead to finding new cases and at-risk people. (2) Increase the number and proportion of members of networks linked to HIV care if infected with HIV and to high-quality prevention services – especially PrEP – if not infected with HIV and at risk, and (3) Reduce duration of infection for syphilis in these networks in order to reduce transmission of both syphilis and HIV infection. Funding Strategy: • Estimated total availability of funds: $1.4 million • Estimated number of awards given: 2 • Estimated average per award: $700,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1b: Enhance investigation and outbreak response Engage in formative assessment of MSM populations and transgender women with particular attention to local epidemiology and behaviors, social context, service availability, and disease. i. Conduct focus groups of target population and service providers (e.g., Disease Intervention Specialists) ☒Required b) ☐Optional Use network methodological techniques to describe networks seeded from STD clinic patients who are MSM or transgender women who have a recent history of HIV infection or syphilis, or who have a history of repeated syphilis infection. i. Network links should be based on sexual and social links (mandatory) and phylogenetic testing (optional) ☒Required ☐Optional TX-DSHS-19-1309-A-000549 257 I II. AREA B: PREVENTION AND INTERVENTION Strategy 2a: Implement public health interventions and tools a) Assure the provision of interventions to identify candidates for PrEP/ART and assure linkage to PrEP services, as well as interventions to assure treatment for syphilis. i. Recipient may provide interventions directly or assure provision through arrangements with third parties ii. Recipient should evaluate outcomes on an ongoing basis and adjust the intervention mix as needed with attention to maximizing synergies and efficiencies among interventions. iii. Recipient should include behavioral and social services assessments and link candidates to care as needed. ☒Required b) Measure all costs related to identification of networks and implementation of network-level interventions i. Collect time-motion data ☒Required I III. ☐Optional ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS Strategy 3a: Coordinate and engage with partners a) Participate in discussions about common protocols and common data elements across grantees b) ☒Required ☐Optional ☒Required ☐Optional Contribute data to inform models of transmission dynamics Collaborations: a. With CDC funded programs: Recipients will be expected to work with STD programs funded through the DSTDP Program NOFO (STD PCHD). b. With organizations external to CDC: Grantee STD programs will be expected to collaborate with external organizations as this facilitates provision of interventions to improve STD/HIV prevention and control for the target populations. These organizations might include: • clinical providers, health care organizations, • medical associations, • other local government entities, • social services organizations, • and other community-based organizations in the selected jurisdiction. Target Populations: TX-DSHS-19-1309-A-000550 258 Network seeds must be racial or ethnic minority MSM or transgender women who have evidence of early syphilis, a recent history of an early syphilis diagnosis, or recent HIV. Specifically, they will be STD clinic patients who meet at least one of the following criteria: • Current early syphilis diagnosis: this means P&S diagnosis or early latent diagnosis • A history of recent early syphilis infection: i.e., within the past 12 months • A history of more than one syphilis infection in the prior 24 months • A history of recent HIV infection Evaluation and Performance Measurement: I • • I • • • I • I • Measure #1: Develop adequate networks Awardee will enroll seeds from STD clinics o Number of seeds enrolled o Number of seeds interviewed and social/sexual contacts elicited Awardee will interview at least two waves of contacts based on seeds o Number of social and sexual contacts interviewed and social/sexual contacts elicited o Number of second generation social and sexual contacts interviewed Measure #2: Identify candidates for treatment and prevention Number of seeds and first and second generation contacts who are tested for HIV and syphilis o Number found to be infected with HIV (new positives and prior positives) • Number of those infected with HIV sequence data in health department • Number of those infected who are linked to care • Number of those retained in care • Number of those virally suppressed at follow-up Number found not to be infected with HIV (HIV-negative) o Number evaluated and referred for PrEP Number found to be infected with syphilis o Number staged and infections by stage o Number treated with evidence of cure (non-reactive/significant titer decrease) Measure #3: Provide services and linkage to services Awardee will evaluate seeds and first and second generation contacts for behavioral health and social service needs o Number evaluated for behavioral health or social services needs • Number eligible for behavioral health or social services • Number of those eligible who are directly provided or linked to behavioral health or social services • Number of those eligible who received behavioral health or social services Measure #4: Reduce duration of syphilis Awardee will show evidence that duration of syphilis in networks is decreased o Number of people in network diagnosed with syphilis o Time to estimated date of infection (median of range) among infected seeds and first and second generation contacts o Number of seeds and first and second generation contacts diagnosed at each stage of syphilis (P&S, secondary, latent) TX-DSHS-19-1309-A-000551 259 V: Human Papillomavirus Surveillance Among Men Program Activity Contact Information Elissa Meites, Medical Epidemiologist, dri9@cdc.gov, 404-639-6407 Funding Opportunity Description Background a. Overview Young men who have sex with men (MSM) are at high risk for developing HPV infection and associated diseases, including anal cancer, and would benefit from receiving HPV vaccine. Studies and monitoring data from the United States and other countries have demonstrated impact of HPV vaccination on outcomes in women (genital warts and cervical precancers) and data from some countries have shown indirect impact on heterosexual males from female vaccination programs. However, to date there are no impact data for HPV vaccine in MSM. Clinical trials of quadrivalent HPV vaccine in MSM showed high efficacy, but trials were limited to MSM with 5 or fewer lifetime sexual partners. Ongoing determinations of HPV prevalence in this population could monitor HPV vaccine impact among MSM as vaccine uptake continues to increase in the United States. b. Healthy People 2020 This project supports Healthy People 2020 objectives to increase the vaccination coverage level of human papillomavirus (HPV) vaccine for males (IID-11.5), and to increase the proportion of Tribal, State, and local public health agencies that provide or assure comprehensive epidemiology services to support essential public health services (PHI-13). In addition, herd effects could help reduce the proportion of females with HPV infections (STD-9, developmental). c. Other National Public Health Priorities and Strategies Since 2011, the Advisory Committee on Immunization Practices (ACIP) has recommended routine HPV vaccination for all U.S. males at age 11 or 12 years, through age 21 years for men not previously adequately vaccinated, and through age 26 years for MSM. ACIP recommendations to provide HPV vaccine are specifically included in the National Prevention Strategy. CDC Project Description a. Problem Statement: Infection with HPV in men can cause genital warts, and anal, penile, and oropharyngeal cancers. MSM are at particularly high risk for persistent HPV infection and related diseases. The majority of these diseases could be prevented by pre-exposure vaccination against the relevant HPV types. Surveillance activities for this vaccinepreventable infection among MSM are critical to gain information to monitor ongoing vaccination programs. b. Purpose: Ongoing assessment of HPV prevalence among MSM will identify HPV vaccine impact including anticipated reduced prevalence of vaccine-preventable HPV among MSM. Awardees will collect anal swab specimens from sexually active MSM (n>300 annually) and coordinate batch shipment of specimens to CDC laboratory for HPV testing. c. Outcomes: Intended outcomes include core area/strategy (1c): Improve surveillance and reporting • Short-term: conduct surveillance of HPV infections • Mid-term outcomes: Improve understanding of the epidemiology and incidence of infectious diseases 260 TX-DSHS-19-1309-A-000552 Long-term outcomes: Improve use of data to inform program and policy development for HPV, and develop and implement public health best practices and/or guidelines for HPV vaccination Funding Strategy: Continuing funding is open to jurisdictions who have identified at least one sexually transmitted disease (STD) care clinic or community organization providing anal STD testing to MSM in their jurisdiction. Grantee must demonstrate ongoing data management and epidemiologic capacity to review local data to inform public health action and prepare data for transmission to CDC. • Funds should be used for personnel, travel, supplies, equipment (e.g., specimen collection and shipping supplies) or contractual support for the proposed activities. • • • Estimated total availability of funds: $375K Estimated number of awards given: 3 (continuing) Estimated average per award: $125K Applicants must have the statutory authority to conduct state- or project-area-wide communicable disease or infectious disease surveillance and the organizational structure and capacity to execute the program approach and strategies and meet the project period outcomes, including the organizational capacity to support and/or operate an STD care clinic or community organization serving >300 MSM annually. The anticipated level of specific organizational capacity needed to execute the approach successfully includes capacity in: Surveillance, data management, and epidemiology to support the activities Organizational structure and management to support the activities • Clinic staffing structure and expertise to support the activities • Human resource management and financial management to support the activities Strategies and Activities: • AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1c: Improve surveillance and reporting of anal HPV prevalence among MSM Identify participating health center/s (STD clinics or community organizations providing anal STD testing to MSM) i. Identify health center/s with sufficient numbers of visits from target population ☒Required b) ☐Optional Obtain anal specimens from sexually active young adult MSM (N>300 annually) within the age range specified below (see “Target Population”). Anal specimen collection methodology should be consistent over time, and may be residual/remnant specimens collected for gonorrhea/chlamydia testing. Anal specimen collection should be in concordance with CDC HPV laboratory methodology. i. Identify specimen collection procedures used at participating site/s TX-DSHS-19-1309-A-000553 261 ☒Required Methodology and procedures for storage and shipping of specimens to CDC for HPV testing should occur in accordance with CDC HPV laboratory recommendations. c) ☒Required ☐Optional Obtain relevant surveillance information, including but not limited to: age, sex (e.g., current gender identity and sex assigned at birth), race/ethnicity, HPV vaccination status (e.g., number of doses administered, with dates and/or intervals), sexual orientation and/or sex of sex partners, number of lifetime sex partners, and HIV status. d) ☒Required ☐Optional Line-listed de-identified demographic and clinical data elements associated with each specimen will be collected by the awardee and electronically submitted to CDC following standardized protocols. e) ☒Required ☐Optional Coordinate submission of specimens and surveillance data to CDC for HPV testing and analysis. f) g) h) ☐Optional ☒Required ☐Optional ☒Required ☐Optional Collaborate with CDC to evaluate changes in HPV prevalence. OPTIONAL: Expand surveillance age range from 18-26 years (required) to 18-45 years. ☐Required ☒Optional Collaborations: a. With CDC funded programs: Close collaboration is expected with subject matter experts and staff from CDC HPV epidemiology (HPV Team, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases) and laboratory (HPV Laboratory, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Infectious Diseases) groups. b. With organizations external to CDC: Awardees are also expected to work with clinical providers in the participating health center(s) in their jurisdiction. Target Populations: Adult (i.e., ages 18-26 years, inclusive [required] with or without ages 27-45 years [optional]) men (i.e., born male, regardless of current gender identity or expression) who have sex with men (i.e., who identify as gay or TX-DSHS-19-1309-A-000554 262 bisexual, or have ever had any type of sexual contact with a male partner) with remnant anal specimens originally collected for clinical purposes (e.g., anal STD screening). Evaluation and Performance Measurement: Awardees are required to demonstrate that measurable progress is being made throughout the project period and share this progress in workgroup and partner conference calls. To indicate progress made toward program outcomes, data will be reported through: • Bimonthly (every two months) conference calls • Bimonthly (every two months) written updates to submitted via email prior to conference calls • Performance Measures for Tier 1 activities Measure #1) Name and number of participating health centers (i.e., health center partners that submit anal swab specimens for HPV testing). Measure #2) Number of anal swab specimens obtained and methodology, and percent of anal specimens available for HPV testing at CDC, from among all anal specimens submitted by target population of MSM within the target age range from each participating health center. Measure #3) Number of anal swab specimens submitted to the CDC laboratory for HPV testing (following standardized protocols). Measure #4) For each specimen submitted, line-list of associated surveillance data on age, sex (e.g., current gender identity and sex assigned at birth), race/ethnicity, HPV vaccination status (e.g., number of doses administered, with dates and/or intervals), sexual orientation and/or sex of sex partners, number of lifetime sex partners, and HIV status. TX-DSHS-19-1309-A-000555 263 W: Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats Program Activity Contact Information Nicole Fehrenbach eek5@cdc.gov Dana Meaney-Delman vmo0@cdc.gov Margaret Honein mrh7@cdc.gov Funding Opportunity Description Background a. Overview The program’s goals are to: 1) Support surveillance systems developed to address emerging threats to mothers and babies, including the US Zika Pregnancy and Infant Registry’s REDCap databases to improve the understanding of virus infection, including Zika and influenza, and other emerging threats on pregnant women and their children; 2) Work collaboratively with state, local, and territorial health departments to extend the follow up of babies born to mothers with evidence of infection and other emerging threats; 3) Work with clinical experts and clinical professional organizations to develop recommendations for enhanced follow up and targeted screening and evaluation of infants with congenital virus exposure and other emerging threats; and 4) Develop and disseminate clinical guidance and health communications materials and tools for mothers and babies and their providers when new evidence emerges. b. Healthy People 2020 This funding addresses the Healthy People 2020 goal of improving the health and well-being of women, infants, children, and families, including the following specific objectives: MICH-1: Reduce the rate of fetal and infant deaths MICH-1.6: Reduce the rate of infant deaths related to birth defects (all birth defects) MICH-3: Reduce the rate of child deaths MICH-6: Reduce maternal illness and complications due to pregnancy (complications during hospitalized labor and delivery) MICH-10: Increase the proportion of pregnant women who receive early and adequate prenatal and pediatric care MICH-16: Increase the proportion of women delivering a live birth who received preconception care services and practiced key recommended preconception health behaviors c. Other National Public Health Priorities and Strategies N/A CDC Project Description a. Problem Statement: The Zika virus outbreak reminded the world how vulnerable mothers and babies are to emerging congenital infections. CDC developed an innovative system to monitor the impact of Zika virus on mothers and babies. Jurisdictions were able to detect threats faster and arm healthcare providers with the information to protect these vulnerable populations. With help from our partners, this system could be leveraged against future threats on mothers and babies, including infections and natural disasters. This enhanced surveillance includes the collection of information about antenatal diagnostic testing, and clinical outcomes among pregnant women and their infants through the first two years of life. The critical TX-DSHS-19-1309-A-000556 264 information obtained will inform CDC clinical recommendations and public health guidance and messages. This information collection is authorized by Section 301 of the Public Health Service Act (42 U.S.C. 241). b. Purpose: The purpose of this NOFO is to provide jurisdictions financial and technical support for collaborative participation in surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry for completion of follow up on pregnant women and the exposed fetuses, infants, and children to expand the surveillance approach to monitor for other emerging infections and threats to the healthy development of fetuses and infants. Infections during pregnancy that potentially pose a risk of congenital infection or other adverse outcomes in the fetus or infant would be considered under this NOFO. CDC encourages all US jurisdictions to participate in order to have full monitoring of pregnant women and their infants with Zika virus infection and other emerging threats. All collaborating jurisdictions who request funding should confirm that they plan to submit all variables requested, with redaction only of variables that cannot be submitted due to specific state laws or regulations. The data forms and electronic databases will be distributed to ELC awardees and will be available upon request. Funding will provide jurisdictions support to obtain a jurisdictional-level Coordinator to conduct these activities and to perform data management. The jurisdictional-level Coordinator will serve as the primary contact and is expected to collaborate with CDC points of contact. In partnership with state, local, and territorial health departments, the US Zika Pregnancy and Infant Registry will continue to collect critical data to update recommendations for clinical guidance for infants with congenital Zika virus infections and other congenital infections, and to plan for services for pregnant women, infants and their families affected by emerging infections and threats. c. Outcomes 1. Improve epidemiological capacity to monitor pregnant women, infants, and children, who meet the required case definition. o This includes reporting to the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry, for the following:  Infants and children with laboratory evidence of possible congenital Zika virus infection or other congenital infections and their/mothers  As a surveillance activity, no additional tests or follow up visits are required for the sole purpose of the US Zika Pregnancy and Infant Registry. o This includes reporting emerging threats and infections for the monitoring of congenital infections through pregnancy and infant surveillance  Pregnant women and infants with laboratory evidence of infection  Description of case inclusion criteria, if novel infection is being monitored 2. Improve completeness and timeliness of reporting to surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry (including all data on the US Zika Pregnancy and Infant Registry surveillance forms where reporting is allowable by state laws/regulations) to state health departments and CDC in alignment with CDC established timelines. This includes the following: o Rapid and complete identification of women and infants who meet the stated case definition o Timely and accurate information on women and infants who meet the stated case definition o Improve follow up of pregnant women with laboratory evidence of possible Zika virus infection and their infants to assess fetal, birth, infant, and child outcomes 3. Improve monitoring of infants and children with laboratory evidence of possible congenital virus infection to assess long term health outcomes, with follow up to at least 24 months TX-DSHS-19-1309-A-000557 265 4. Translation of public health data into clinical and public health recommendations, particularly in the realm of early detection of developmental delays in infants Funding Strategy: Funds should be utilized for personnel, travel, supplies and equipment, or contractual support for proposed activities, specifically to support a jurisdictional-level Coordinator for surveillance activities. Awardees need to provide justification for using a percentage of current staff for this activity, hiring new full time staff, or using contractual mechanisms. This funding is dependent upon continued appropriations for related efforts. Funding decisions will be based on: 1) Quality of application 2) Number of births per year in the proposed area of surveillance 3) Estimates of exposure to emerging infections and other health threats among pregnant women in the jurisdiction 4) Public health importance of the emerging health threat proposed for monitoring by the applicant Jurisdictions, which have a high cost of living or which may otherwise experience difficulties hiring a Coordinator, may request additional funds above the base amount for this activity. We expect the funding for individual jurisdictions to range from $200,000 -- $425,000. Jurisdictions must provide strong justification for their requests to support the surveillance systems for emerging threats, such as US Zika Pregnancy and Infant Registry and the use of these funds. • Estimated total availability of funds: $3,000,000 • Estimated number of awards given: 4-9 • Estimated average per award: $320,000 Strategies and Activities: AREA A: SURVEILLANCE, DETECTION, AND RESPONSE I I. a) Strategy 1a: Enhance workforce capacity to address the impact of congenital Zika infection and other emerging infectious diseases that disproportionately impact pregnant women and their infants. Identify personnel or contractual staff to function as a jurisdictional-level Coordinator who will track and report all follow-up information for infants born to women enrolled in the US Zika Pregnancy and Infant Registry or other surveillance systems for emerging threats. ☒Required II. a) Strategy 1b: Enhance case investigation of reports of congenital infection during pregnancy and the impact on infants and children. Coordinate with birth defects surveillance efforts, the investigation and reporting of possible congenital Zika virus infection and other congenital infection cases with severe clinical manifestations. ☒Required b) ☐Optional ☐Optional Work with CDC to guide analytic direction and identify prenatal and pediatric care facilities for prioritized assessments/response TX-DSHS-19-1309-A-000558 266 ☒Required III. a) Strategy 1c: Improve surveillance of emerging threats to pregnant women and their infants by building on the surveillance capacity established as part of the Zika emergency response. Identify and report all eligible cases that meet required case definition within 30 days of case identification ☒Required b) a) ☐Optional Strategy 1g: Strengthen connections across the health department to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts. Coordinate connections between epidemiology and laboratory functions, at state and local levels ☒Required b) ☐Optional Analyze data, prepare summaries of data (e.g., reports, maps, manuscripts, and presentations), and distribute to medical providers, public health partners, policy makers, and the public ☒Required IV. ☐Optional For emerging infections, describe case inclusion criteria and preliminary case definitions for public health awareness and collaboration ☒Required e) ☐Optional Develop, maintain and/or enhance surveillance systems for emerging infections ☒Required d) ☐Optional Participate in the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry by collecting follow-up clinical data at designated time points for Registry-eligible pregnant women and infants. ☒Required c) ☐Optional ☐Optional Collaborate with the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry to leverage the existing infrastructure ☒Required ☐Optional TX-DSHS-19-1309-A-000559 267 V. Strategy 1g: Strengthen connections across the health department to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts. a) Identify and connect with national/local partners to raise awareness and increase provider support and collaboration. Examples include, but are not limited to: professional societies, health care systems, health plans, schools/universities, and community interest groups ☒Required ☐Optional b) Implement and maintain electronic mechanisms for exchange of public health information ☒Required VI. ☐Optional Strategy 1h: Advance innovative IT strategies to monitoring linked mother-child health information while minimizing burden a) Implement and maintain electronic mechanisms for exchange of public health information ☒Required ☐Optional b) Ensure surveillance systems are modernized and integrated when possible, and linked mother-child health information is used to assess the impact of congenital infection ☒Required I ☐Optional AREA C: COMMUNICATIONS, COORDINATION AND PARTNERSHIPS VII. Strategy 3a: Coordinate with key public health partners with expertise in protecting mothers and babies and promoting infant health a) Actively participate in the Data Use Working Group to communicate the public health message to protect mothers and babies ☒Required VIII. a) ☐Optional Strategy 3a: Coordinate and collaborate with key clinical partners that are committed to advancing the health of pregnant women, infants, and children Participate in the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry by collecting follow-up clinical data at designated time points for Registry-eligible pregnant women and infants ☒Required ☐Optional TX-DSHS-19-1309-A-000560 268 IX. a) Strategy 3b: Disseminate information on the importance of avoiding congenital virus infection, including Zika and influenza, and other emerging threats during pregnancy, and strategies to reduce risk Participate collaboratively to development of best practices for preparing and responding to emerging threats to pregnant women and their infants ☒Required X. a) ☐Optional Strategy 3b: Develop and disseminate information on protection of pregnant women and their infants from other emerging infectious diseases, and known health threats to pregnant women/infants such as CMV Participate collaboratively to disseminate information on protection of pregnant women and their infants from other emerging infectious diseases, and known health threats to pregnant women/infants such as CMV ☒Required ☐Optional XI. Strategy X: Work with cross-cutting health information systems team within your health department to develop core surveillance capacity within health departments to monitor and protect pregnant women, infants, and children Collaborations: a. With CDC funded programs: Collaboration is strongly encouraged with birth defects surveillance efforts in state health departments including awardees supported by the National Center on Birth Defects and Developmental Disabilities (NCBDDD). b. With organizations external to CDC: Awardees are encouraged to collaborate with national and local professional organizations such as American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Board of Obstetrics and Gynecology, Society for Maternal Fetal Medicine, American Nurses Association, Association of Clinical Nurse Midwives, and other professional groups as appropriate to increase provider support and collaboration with the Registry. Target Populations: Infant and children Evaluation and Performance Measurement: The Programmatic Team at CDC will support recipients by ensuring that the strategies and activities are implemented as expected and that performance outcomes are achieved in a timely manner. The program will monitor activities according to the Work Plan through monthly jurisdictional calls, emails, and progress reports. The program will provide technical assistance to awardees to overcome any barriers and to improve the effectiveness of the program. Outcome measures: TX-DSHS-19-1309-A-000561 269 1. Proportion of cases among infants reported to the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry with follow-up data reported for all time points: 2, 6, 12, 18 & 24 months. a. The Registry will use quarterly Jurisdictional Data Completeness reports to assess what proportion of cases have reported data for the applicable time points. These reports will take into account cases that have been lost to follow-up as reported by the jurisdiction. 2. Completeness of reporting of variables requested by the surveillance systems for emerging threats, such as the US Zika Pregnancy and Infant Registry. a. The Registry will use the quarterly Jurisdictional Data Completeness reports to assess the completeness of data submitted USZPR for a limited number of key variables. b. The report is also utilized to identify challenges in reporting and communicate these to the Registry so that we may continue to collaborate to improve data quality and completeness. TX-DSHS-19-1309-A-000562 270 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 14, 2019 2:11 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: FY19 ELC NOFO Kickoff Presentation Attachment(s): "FY19_New_NOFO Kickoff Webinar_3.13.19_FINAL_FINAL.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, Attaches it the presentation for the FY19 ELC NOFO Kickoff Webinar that will be held today at 3pm! We look forward to speaking to you at 3pm. Thank you, The ELC Team TX-DSHS-19-1309-A-000563 CK19-1904 ELCNoticeof Funding Opportunity (NOFO)Kickoff Meeting AngelicaO'Connor Thursday, March14,2019 3:00p.m.- 4:30p.m. ELG NATIONAL FUNDING STRATEGY ,i. ~sitW t:.;t, PREVENTING (JJJJP TX-DSHS-19-1309-A-000564 Agenda • Overviewof NOFO • Makinga "Program" ■ ■ ■ ■ Cross-cutting EpiandLab FoodandWaterborne HAI/AR Vector-borne • SubmittingyourApplication PREVENTING • REDCap • WorkPlanDevelopment Tips • Performance Measures • BudgetTemplate • ApplicationTimelinefor NOFO • QuestionsandAnswers TX-DSHS-19-1309-A-000565 Overviewof ELCFY19NOFO • NOFO was published on Grants.gov on February 28th , 2019. • All application resources and templates are located on REDCap Application and Monitoring Portal 2019-2020. • Longer application period - 70 days! • Completed applications are due on May 10th , 2019 at 11 :59 p.m. ET to Grants.gov and your ELC courtesy copy to be submitted to the REDCap Application and Monitoring Portal. PREVENTING TX-DSHS-19-1309-A-000566 Overviewof ELCFY19NOFO 2014 ELCNOFO CK14-1401: 2014 - 2018 2019 ELCNOFO CK19-1904:2019-2023 SECTIO N I: ,CROSS-CUTT IN G EPI DEIM IO ILOG1Y A NID l ABORA TO RY CAPA CITY PRO GRAM A Ep mde m io logy Capa cit y B Labo r a t ory Ca p•aci t y D Advanced F Pu b li'c Health !Labo r atory Su st a i'nab ml'ity Mo lle cula r Det e ·c t ion A Cross-Cutti ng Ep idem iology and Labo ira t o 1i-y Capacity Pr og r am SECTl 10 N II: ,CROSS-CUTT IN G P·ROJECTS 8 IELC Lea d ersh ip , M.an a gem ,ent. an d Ad m1in istr ation Pr o j,ect- N EW in 2019 C Hea lt h Inf o rma tio n Syst ,e m1s Capacity C Hea lth Informa t ion Sys t ems Capacity Project G En h anced Ev a lu at ion Ca p ac ity D llmpact a n d E.vallua t ion Pro j,ect E Cross-Cutti ng Eme rging Issues IProj,e,ct .: Enhanc e d Survei llanc e ., O ut b re a k Investiga t io n IR:espo n se ainid IRep ,orti n g,. Surge Eff orts and Intervent io ns Hl H2 Cross -Cutting Out b re ak Cap ac it y Cross --Cutting Out b reak Ca pa c'it y Program--- PREVENTING Project TX-DSHS-19-1309-A-000567 Overviewof ELCFY19NOFO 2014 ELC NOFO 2019 ELC NOFO CK 19-1904: 2019- 2023 CK 14-1401: 2014 - 2018 SECTION II: INFECTll OUS DISEASE!PROGRAMS I.I Outb11:ii:~1:1k N ET Natio n al Case Smve il lance/ lNORS Foodbo:me .• Waie ,rlbon1e,.Enteri:i::,amd Env:ironm,e;ntally 1:2 Natio n al An t imiuobia l Resist ance M o n ito ring Syste m Tra1111:srnitted Diseases Pr,ogram : Capadty Bui lding for 13 !Int egr at ed Food Safety Ce nte rs of IExcellen ,ce 141 PulseNe t USA 15 NprnSliAl" 16 Cali cit4ET z l~oEJ Su rve ill ance , Detect io n, Response , Reportin g, aindl Pre vention IF Caipiciity Bu il ding for W ate roorn e Di.se,a1se Detect io n, Ir.ves:l:igaiti o n, Reportin g, ai nd Pre'Ve nti o n K1A [)eted ion , Con taiinrn e mt, and IPrev e rnt ion KIH Extern ail Data Va Iidat ion K1C IHe mod ialysis BSI Hllealthca 1 re-associa 1 ted IUnfectim'l!s (HAil and Antibiotic Resistainoe· P11r ograrn (.AR): G1l. Health ca re -assodart ed I nfo dio ms, An ti biot i.c: G K1D !Inj ect ion Safety Resist an ce, and Alnt ib iot :ic Stew ar dlsh ip G2 . .Ant ib ioti c Resist a nee Labor a1to ry IN et wo rk K2 Coorcfirnated Preventio n and St ewa rds hip K.3 An ti m ·i,crn bi all Reslst an,ce Region al lab, Networ k Mt W est Ni le Virus, a nd Otlh er Arb ov ir al IDis,eases N1 Tid::bom e - Lym e Disease N2 Tid ::bome - Norn-ly rn e Disease ~ ,(AIR La bo rato rv Netwo r k), Iii-I Vecto'r-itim,r111e IDise;asesProgr;am:IBLIi Id i ng Com pre h ens~ve Programs t o Iden ti fy, Diagnose , Report, Pr eve nt , and Respond ~ Program PREVENTING Project TX-DSHS-19-1309-A-000568 Overviewof ELCFY19NOFO 2019 ELCNOFO CK 19-1904: 2019- 2023 2014 ELCNOFO CK 14-1401: 2014 - 2018 SECTION 1111:DISEASE-SPECIF IIC PR OJECili S X ~ -l rnprovi'1!$ Cctpd Li l y l o Dele<.:l c111Ll Respo nd to Pu b l ic Hea l th I ss u es Relate d t o Fu n ga l In fect ions I T B i na tio n a l Borde r nn f ect uous D isease Su 1r veilla ,n ce (B ID S) !Program J Binationa l Border (B IDS) Progra m u •G loba l M igrn t io 111 , Border M igra n t !Hea lth K G lob.al M igrat io n , Border Mii,:rant Hea h h s En h a n ced Pr io n Su rve i ll a n ce I ntervent ions, & ~ Detect L P ri on Surve ill ance Ra bues - Imp ro v in g Case M a n ageme n t f or Poten ti a,I Rabies Ex pos u 1re AND Rab ies - L a b Ca p acity fo r N at io n a,I Rabies Surveillance Ml Rab ie s Surveillance 0 Parnsitic N Parnisitic R1 En h a n ced Vacci n e Prev entio Su 1r veilla ,n ce 0 Enhanc W1 W2 Diseases n Di sease (V PD } in g a nd !Preventing !Funga l ln fect io rns. Diseases ed Vaccine l rnfect i ous Disease Surve ill ance lln terv e rnt io ns , a nd Surveillance -Pr even t able D isease y Legio nn a i r es' D isease p l,:.E;:gj_QJl Q.e..i.rg_~_.Q!.§..~~~£.. P rev e n t io n P1 l nfluenz:a Su11 -veilla ,n ce a n d D i agrno.st i c Test ung : AND llnfd u e n za O u1t lbre ak Res .po n se Q In flue n za S1t.1 r veillance Q1 Q2 Non -ll nflue n za !Resp i rato ry Diseases Diagnos ti cs , Reporting, a n d Survei ll a n ce AN D Non -llnfluenza Re s p i ratory Diseases Outb r ea k Respo ns e R No n-Infl uenza Resp ira tory Diseases: Reporting, arnd S u rveillai nc e Jl! Th r eat of Arnt ib 'io tic- Res ista nt Gono r r h ea : Ra pud De tect io n a n d Response Cap a c ity s Th reat of A n tib io t ic-Resistant Gono r rhea: Detec t iorn a nd Respo ns e Capacity J2 E11lid 11Leu 60 110 1.:: u<.:Ldl lsoldle P ro j ect T Gonococca J3 to Prev e n t Syphil'is a n d H IV Intervening th 1rough Socia l,. Sex u a l, Ph y logernet ic N et wo r ks u S.yphilus aind H IV Prev entio n t hrough Sex u al, a nd Phyloge n etic Networks R2 Su rve il lance for a n a l h u man am on g m ,en V Hum a n Pa p ill o m av i rus Suirvei ll a n ce ~ MZ U .S . ~ w In fa nts w it h Congen ita l Exposure : Surve ill a nc e a n d Mon itorin g of l:me r ging Inf ec t ious Ui seases a n d Ot h e r Health Threats P2 Pregnancy P r eve n tion Su1ve illld11ue pap i l lom aviru 1s Registry Program PREVENTING and D ia g nostic Test i n g D iagnostics, l !Iso l ate Surve i ll a nce Pr oject Rapid (G I SP) Socia l, Men Project TX-DSHS-19-1309-A-000569 NewELCNOFO(2019- 2023) Objective: Establisha strongerfocuson publichealthprograms whileretainingthe abilityfor recipients to workon discreteprojectsimportant to the healthandwellnessof theirpopulations. Thenewframework createsfourrobustpublichealthprograms(below)and19 emerginginfectious diseaseprojects: o o o o Cross-Cutting Epidemiology andLaboratory Capacity Foodborne, Waterborne, Enteric,andEnvironmentally Transmitted Diseases Healthcare-associated Infections andAntibioticResistance Vector-borne Diseases PREVENTING TX-DSHS-19-1309-A-000570 NewELCNOFO(2019- 2023) ThenewELCNOFOis designedto: ■ improvecoordination of thecooperative agreement andsupportgrowth,whilemaintaining valuedflexibility, ■ offeropportunities to implement prevention andintervention activitieswithinprograms, with an increased focuson integration, leadership, andflexibilityand ■ utilizea tieredfundingapproach thatwill allowfor varyinglevelsof activityandregional approaches. PREVENTING TX-DSHS-19-1309-A-000571 Makinga "Program" • Epidemiology andlaboratory activitiesin Programs arecombinedto reflectthe expectation of an integrated approachfor prevention, detection,andresponse • Includeactivitiesin eachof the'coreareas': ■ ■ ■ Surveillance, responseandcontrol Prevention andintervention strategies Communications, coordination, andpartnerships PREVENTING TX-DSHS-19-1309-A-000572 Makinga "Program" • Optionto "tier''activitieswithinprograms as necessary, to allowfor differentlevelsof activityor regional approaches ■ ■ ■ "Base"capacitybuildinglevelof activities Enhanced activities Advancedactivities,Centerof Excellence (orsimilar) • Programsprovidefundingsupportto majorityof jurisdictions; whereasproject fundingmaybe limitedin scopeandnumberof jurisdictions supported. PREVENTING TX-DSHS-19-1309-A-000573 NewCross-Cutting Leadership andManagement Project Recognizing the administrative challengesassociated withmanagingsucha largecooperative and agreement, the ELCnowhasa discreteprojectdedicatedto developingleadersllip_ management supportnecessary to adequately (andstrategically) managethe portfolioof ELC programsandproJects. Applicantsmayfind additionalinformation underthe ELCLeadership, Management and Administration Project[pages81-83;ELCNOFO]. Examplesmightinclude: ■ ■ ■ Liaison between epidemiology andlaboratory Program levelbudgetmanager ELGProgram manager/daily contact PREVENTING TX-DSHS-19-1309-A-000574 Overviewof ProgramF: Foodborne, Waterborne, Enteric, andEnvironmentally Transmitted Diseases • Purpose:Supportandenhancecapacityfor detection,investigation, control,andreportingof foodborne,waterborne, enteric,and environmentally transmitted diseasecasesandoutbreaks ■ ■ ■ Integratedandstreamlined Tieredapproach Aimto reduce o o Duplication Burdenof creatingseparateworkplans,budgets,evaluationplans PREVENTING TX-DSHS-19-1309-A-000575 TieredActivitiesandPrograms • • • • • • • Tier 1 Tier 2 (includes but is not limited to) (includes enhanced projects) CaliciNet CryptoNet NARMS National Case Surveillance NORS OutbreakNet PulseNet • CryptoNet, CryptoNet Regional Labs • Cyclospora genotyping • FoodCORE • FoodNet • NoroSTAT • NREVSS Enhanced • OHHABS • OutbreakNet Enhanced • PulseNet Area Labs • Envi ran menta I Microbiology PREVENTING Tier 3 • Integrated Food Safety Centers of Excellence TX-DSHS-19-1309-A-000576 Upcoming DFWEDNOFOcommunications ■ ELChosted: • ELCAnnual Meeting April 2-4 • DFWEDpresentations: • April 2nd from 4-Spm ET • April 4th from 1:30-2:30pm ET ■ DFWEDhosted: • DFWEDELCwebinar March 22nd 3-4pm ET • OutbreakNet/WASH Quarterly Webinar April 16th 3-4pm ET PREVENTING TX-DSHS-19-1309-A-000577 Overview of ProgramG: Healthcare-associated Infections/Antibiotic Resistance (HAI/AR) PREVENTING TX-DSHS-19-1309-A-000578 Epidemiologyand laboratory Capacity'for Infectious Diseases (ELC) Cooperative Agreement Overview of Program H: Vector-borne Diseases PREVENTING Submitting yourFY19NOFOApplication 1. Completed Applicationmustbesubmittedto www.grants.gov . 2. CompletedELCcourtesycopyto besubmittedto REDCap. PREVENTING TX-DSHS-19-1309-A-000580 Epidemiologyand laboratory Capacityfor Infamous Diseases (ELC) Coo perative Agreement Overview of Application Portal PREVENTING QuickStepsto CompleteFY19 NOFOApplication via REDCap 1. 2. 3. 4. 5. 6. 7. 8. Clickon RecordStatusDashboard to accessyourrecord. Selectthe projectsto includewithinyourapplication ontheOverviewofApplication page. Download Application Templates fromthe ELCApplication Templates page. Complete Application Templates offline. Complete at leastoneSuccessStoryusingthe SuccessStoryGuidance. CompletePeerto PeerMatchingSurvey. UploadCompleted Application Templates ontheCompleted Application Templates page. Consolidate all application templatesintoa singlePDFfor uploadto www.grants.gov . 9. Uploadcompleted application viawww.grants.gov . PREVENTING -IEDCap TX-DSHS-19-1309-A-000582 Important REDCapTips • Alwayssaveeachpage,to updatethe • If youwouldliketo includemorethanone colorcodedstatusindicators. successstoryclick"Save& AddNew Instance" whensavingeachsuccessstory. • Oncethetemplateshavebeen downloaded fromREDCap, yourstaff • If more than one individual in your candraftandcompletethetemplates jurisdiction wouldliketo submitthe peerto offline peermatchingsurvey,whensavingyour • Whenuploading yourcompleted survey,click"Save& AddNewInstance" template,indicatedateuploaded, status of thefile (Draftor Complete), andthe nameof the personwhouploadedit. This information updatestheApplication Template StatusTracker .EDCap PREVENTING TX-DSHS-19-1309-A-000583 ImportantREDCapTips • Whensubmitting yourapplication to www.grants.gov , pleasecompileyour application templatesintoa singlePDFfile.Completeinstructions areincludedin the Supplementary Information document, whichis locatedin theREDCapFile Repository. • Onlyonepersonperjurisdictioncanworkon anypagein REDCapat a time.Users canbe in the portalat thesametimeon differentpages. • ForhelpwithSAMS/REDCap access,pleasecontact: ■ CharNjoroge(wkv2@cdc.gov ) or MeganLight(wpa8@cdc.gov ) PREVENTING .EDCap TX-DSHS-19-1309-A-000584 Application Timelinefor ELCFY19NOFO I Awards ELC Budget Webinar NOFO Published ELCKiek-Off Webi nar Made Applications Due 2019 HAI/AR Performance Measures for 8/1 to 12/31 I All 2019 NOFO Performance data reported to REDCap 2014-2018 Closeout Report & 2018 Performance Measures Due ELCAnnual Meeting 20 18 El CNO FO BPS 2019 ELCNOF BP1 - Feb 28 Mar 14 Mar 19 Apr 2-4 PREVENTING May 10 Aug 1 Oct 31 Jan 31 Mar 31 TX-DSHS-19-1309-A-000585 CloseoutReportfor 2014- 2018ELCNOFO(CK14-1401) • A closeoutreport: ■ is lengthier thana typicalprogressreportcapturedin a continuation year ■ will includethe achievements andprogressmadeovertheentirepast projectperiod ■ will alsoincludereporting on specialfunding(i.e.Ebola,Zika) • ELCwill providetemplates, guidanceandsubmission information for the closeoutreportsbyAugust1, 2019. ■ will includeperformance measurereportingfor BP5 • Closeoutreportswill bedueOctober29,2019 PREVENTING TX-DSHS-19-1309-A-000586 Application Templates andResources for 2019ELCNOFO ForSubmission • ApplicationTemplates • ApplicationCompanion Tools • BudgetTemplate PREVENTING ApplicationResources • REDCapUserGuide • Supplementary Information for Applyingto 2019ELCNOFO • Webinarslides TX-DSHS-19-1309-A-000587 Application Template Changesin 2019 Newprojectperiodrequiresadditionalproblemstatement, justification, and capacitynarratives for eachprogramandproject ■ Enterthesenarrativeson "approach" tab in eachtemplate. Performance measures will NOTbecollectedwithapplication. ■ Toeasethe burdenonjurisdictions duringthe 2019competitive yearapplication, ELC hasdelayedthecollectionof activity-level Rrogress reportsandperformance measures untilthecloseoutreport,whichwill bedueOcfober29,2019. Activity-level progressreportswill NOTbecollectedwithapplication. ■ Majorachievements andprogressin priorprojectperiodscanbedescribedunder applicantcapacityon "approach" tab Ineachtemplate. PREVENTING TX-DSHS-19-1309-A-000588 I BudgetTemplate B [ ::: e eel NOTE: Provide all detail for Fringe and Indirect Rates Caleulation allocated at the bottom of the current worksheet ] ----------P_e_,s_o_n_n_e_1 .. 5 _n_e_p_o_1_t ______________________ Report 1•1: 2 A 1. C1oss-Cutting: Epidemiolog11 Capacit)I A2_Cross-Cuuing: Laborator!,I Capacit!,I B.ELC Leadership. Management 8: Administration C.Health Information 5',lstems Capaoit',I D.lmpact & Evaluation Tot.;il Indirect: Ill JU R.iilies Ezposure - Su1veill,mce necessar',I parameters in the rate calculation .11.L.ha L1....ba u and Monitor .ll.L.S.Ia .c.L.ha LL.ha E..2.....S..aa L.3.___ha .G.Lha .G.2....ba .IL1....ha H...2...ha .L1....ll..u 1J J..L.tu, .Ll .L.l M..1 Ll...ba 1..1....ha M.L.ha .fLJ .11.1....ha .o.J .D.L.S..u £..1...ba .u ~ B.J .l.LI :L.I with Congenit.al ll.L.l.u ~ L1 LZ L3 .G.J .LI Ll \I.Infants SUMMARY L:J JU 11..2: K.Global Migration. Border lnterv & Migrant Health L.Prion Surveillance M.Rabies Surveillance N.Parasitic Surveillance □.Enhanced Vaccine-Preventable Disease (VP□) P.Legionnaires• Disease Prevention Cl.Influenza Surveillance and Diagnostic T es:ting Resp Diseases: Diag. Replng, & Su,veill R.Non-lnfluenza TOTAL Ho•Picnroaacl A.I .6.2 .ILi .c.J tions GRAND Tot.;il □i,oi.-ct: _ G.2 C::,lnl,.tiea Approt,,:d llequesMd Pcr;:;01111,c;I TOP fi • BudgetWebinarwill be heldon Tuesday, March19,2019from3:00 p.m - 4:30p.m. O UI Jurisdiction Name out ol the '" ID ~,c,c-ess Prog ram/Proj e ct 3 in the space ow to REPORTS NonPersonnel • BudgetTemplate mustbesubmitted withyourapplication. FY 2019 c m :- RJ=A-·CK19- 19D4 MENU ~ .ll.1....1.u B.Lha .LL.ha LL.ha .IJ...Lha l!..1...J..u '.11'.Llla .f'G ID RrP(JIU!'S-lrPd ApprtHl Sent: Friday, March 15, 2019 5:27 PM EDT To: amy.stratton@adph.state.al.us ; Brenda.Ryals@adph.state.al.us ; grace.thomas@adph.state.al.us ; janice.smiley@adph.state.al.us ; Stevens, Kelly (CDC adph.state.al.us) ; McIntyre, Mary (CDC adph.state.al.us) ; mirwais.zhuben@adph.state.al.us ; Rachael.Montgomery@adph.state.al.us ; Davidson, Sherri (CDC adph.state.al.us) ; PRAMS Alabama (CDC adph.state.al.us) ; tobytha.powell@adph.state.al.us ; evelyn.geeter@adph.state.al.us ; Fearey, Donna (CDC alaska.gov) ; Castrodale, Louisa (CDC alaska.gov) ; a.tufa@doh.as ; Iugafono, Sunia (CDC doh.as) ; Dianna.contreras@azdhs.gov ; Hayley.Yaglom@azdhs.gov ; Venkat, Heather (CDC azdhs.gov) ; irene.ruberto@azdhs.gov ; Lora.Andrikopoulos@azdhs.gov ; Rigler, Jessica (CDC azdhs.gov) ; Joli.Weiss@azdhs.gov ; Joseph.Spadafino@azdhs.gov ; kara.tarter@azdhs.gov ; Villarroel, Lisa (CDC azdhs.gov) ; Timothy.Flood@azdhs.gov ; brandi.stricklin@arkansas.gov ; RangelCF@archildrens.org ; catherine.waters@arkansas.gov ; Haselow, Dirk (CDC arkansas.gov) ; SmithHL@archildrens.org ; Lori.Simmons@arkansas.gov ; Rupa.Sharma@arkansas.gov ; along@ph.lacounty.gov ; clyu@ph.lacounty.gov ; cvincent-jones@ph.lacounty.gov ; ccroker@ph.lacounty.gov ; Mascola, Laurene (CDC ph.lacounty.gov) ; MIbrahim@ph.lacounty.gov ; SReynaldo@ph.lacounty.gov ; Cchang@ph.lacounty.gov ; vngo@ph.lacounty.gov ; Aja.Griffin@cdph.ca.gov ; Barbara.Warmerdam@cdph.ca.gov ; Charsey.Porse@cdph.ca.gov ; harit.agroia@cdph.ca.gov ; Eileen.Yamada@cdph.ca.gov ; Watt, James (CDC cdph.ca.gov) ; Olga.Barer@cdph.ca.gov ; Richard.Olney@cdph.ca.gov ; Similoluwa.Sowunmi@cdph.ca.gov ; Valorie.Eckert@cdph.ca.gov ; House, Jennifer (CDC state.co.us) ; Natalie.Marzec@state.co.us ; brenda.espondamorrison@ct.gov ; Claudia.gutierrez@ct.gov ; tabitha.fox@ct.gov ; abdi.elmi@ct.gov ; karin.davis@ct.gov ; Cartter, Matthew (CDC ct.gov) ; zack.Fraser@ct.gov ; paula.eggers@state.de.us ; PRAMS District of Columbia (CDC dc.gov) ; Davies-Cole, John (CDC dc.gov) ; Iyengar, Preetha (CDC dc.gov) ; McGee, Sasha (CDC dc.gov) ; shreya.khuntia@dc.gov ; rewaguk@fsmhealth.fm ; EEdward@fsmhealth.fm ; lbarrow@fsmhealth.fm ; health@fsmhealth.fm ; jsarofalpiy@fsmhealth.fm ; cmasao@fsmhealth.fm ; ltaulung@fsmhealth.fm ; BTaoTao-Wini@fsmhealth.fm ; PVelasco@fsmhealth.fm ; Andrea.Morrison@flhealth.gov ; Blackmore, Carina (CDC flhealth.gov) ; Danielle.Stanek@flhealth.gov ; fdoh.grantsoffice@flhealth.gov ; heather.lake-burger@flhealth.gov ; Amanda.elmore@flhealth.gov ; Mary.Hilton@flhealth.gov ; Melissa.Jordan@flhealth.gov ; Drenzek, Cherie (CDC dph.ga.gov) ; Cragan, Janet D. (CDC/DDNID/NCBDDD/DCDD) ; michele.mindlin@dph.ga.gov ; jerusha.barton@dph.ga.gov ; julie.gabel@dph.ga.gov ; Michael.Bryan@dph.ga.gov ; skyler.brennan@dph.ga.gov ; ada, Estelle (CDC dphss.guam.gov) ; O'Mallan, Josephine (CDC dphss.guam.gov) ; Margaret.Bell@dphss.guam.gov ; tommy.taitague@dphss.guam.gov ; margarita.gay@dphss.guam.gov ; Jonathan.kimura@doh.hawaii.gov ; nianest.alersbarreto@doh.hawaii.gov ; William.Aakhus@doh.hawaii.gov ; sarah.park@doh.hawaii.gov ; sylvia@hawaiigenetics.org ; Hahn, Christine G. (CDC dhw.idaho.gov) ; Turner, Kathryn (CDC dhw.idaho.gov) ; Kris.Carter@dhw.idaho.gov ; tengelse@dhw.idaho.gov ; Marcia.Witte@dhw.idaho.gov ; Debbie.Freeman@illinois.gov ; tiefu.shen@illinois.gov ; jane.fornoff@illinois.gov ; Jonathan.popovitch@illinois.gov ; Kauerauf, Judy (CDC illinois.gov) ; theresa.sandidge@illinois.gov ; Toews, KarrieAnn (CDC cityofchicago.org) ; Jessica.Wilkerson@cityofchicago.org ; Black, Stephanie SB (CDC cityofchicago.org) ; aforkner@isdh.in.gov ; Brown, Jen (CDC isdh.in.gov) ; rchauhan1@isdh.in.gov ; MarAllen@isdh.IN.gov ; Pontones, Pamela (CDC isdh.in.gov) ; tastevens@isdh.in.gov ; Garvey, Ann (CDC idph.iowa.gov) ; carrie-fall@uiowa.edu ; nih@uiowa.edu ; florence-foo@uiowa.edu ; TX-DSHS-19-1309-A-000594 julie.coughlin@idph.iowa.gov ; oluwakemi.oni@idph.iowa.gov ; Kenneth.Sharp@idph.iowa.gov ; paulromitti@uiowa.edu ; Farah.Ahmed@ks.gov ; hsmith@kdheks.gov ; Jamie.Kim@ks.gov ; Kelly.Gillespie@ks.gov ; stubach@kdheks.gov ; Carrell.Rush@ky.gov ; katie.myatt@ky.gov ; martie.kupchinsky@ky.gov ; Monica.Clouse@ky.gov ; Tori.Amburgey@ky.gov ; Teresa.Fields@ky.gov ; Matthew.Johnson@ky.gov ; Rachel.Zinner@ky.gov ; dimple.patel@ky.gov ; Robeson, Sara (CDC ky.gov) ; christine.scott-waldron@la.gov ; Dionka.Pierce@la.gov ; jenna.ibergjohnson@la.gov ; Edward.Holmberg@la.gov ; julie.johnston@la.gov ; julius.tonzel@la.gov ; Ratard, Raoult (CDC la.gov) ; sean.simonson@la.gov ; Sokol, Theresa (CDC la.gov) ; tri.tran@la.gov ; Farmer, Ann (CDC maine.gov) ; catie.peranzi@maine.gov ; Robinson, Sara (CDC maine.gov) ; Blythe, David (CDC maryland.gov) ; judie.hyun@maryland.gov ; McLean, Sandra (CDC maryland.gov) ; monika.piccardi@maryland.gov ; Duwell, Monique MD (CDC maryland.gov) ; Brooks, Richard Benjamin (CDC/DDID/NCEZID/DHQP) ; alfred.demaria@state.ma.us ; Catherine.Brown@state.ma.us ; eileen.m.sullivan@state.ma.us ; cathleen.higgins@state.ma.us ; Julie.e.dunn@state.ma.us ; kayleigh.sandhu@state.ma.us ; mahsa.yazdy@MassMail.state.ma.us ; matthew.a.osborne@state.ma.us ; Sarah.Scotland@MassMail.State.MA.US ; susan.soliva@massMail.state.ma.us ; reikr@michigan.gov ; Fussman, Chris (CDC michigan.gov) ; alversonG@michigan.gov ; ehrhardtj@michigan.gov ; Signsk@michigan.gov ; simmonsl@michigan.gov ; Stobierski, Mary Grace (CDC michigan.gov) ; barbara.frohnert@state.mn.us ; david.neitzel@state.mn.us ; michele.hort@state.mn.us ; carolyn.hoel@state.mn.us ; elizabeth.schiffman@state.mn.us ; Danila, Richard (CDC state.mn.us) ; sook.ja.cho@state.mn.us ; erin.kough@state.mn.us ; Alyce.Stewart@msdh.state.ms.us ; Katherine.farrington@msdh.ms.gov ; gerri.cannon-smith@msdh.ms.gov ; LaShunda.Williams@msdh.ms.gov ; Beryl.polk@msdh.ms.gov ; Chana.Winder@msdh.ms.gov ; paul.byers@healthyms.com ; jennifer.hanson@msdh.ms.gov ; kathryn.taylor@msdh.ms.gov ; Alexandra.Berkley@health.mo.gov ; john.bos@health.mo.gov ; Molly.baker@health.mo.gov ; qian.liu@health.mo.gov ; Loise.Wambuguh@health.mo.gov ; rose.kowieski@health.mo.gov ; grants@health.mo.gov ; debgibson@mt.gov ; Milhon, Karl (CDC mt.gov) ; 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Blog, Debra (CDC health.ny.gov) ; jennifer.white@health.ny.gov ; deb.fox@health.ny.gov ; Amanda.Stolz@health.ny.gov ; laura.brady@health.ny.gov ; marilyn.browne@health.ny.gov ; Donna.DeLuca@healthresearch.org ; nicole.longcore@health.ny.gov ; nina.ahmad@health.ny.gov ; awinters@health.nyc.gov ; Fine, Annie (CDC health.nyc.gov) ; elee4@health.nyc.gov ; mcasali1@health.nyc.gov ; ccanary@health.nyc.gov ; swillis@health.nyc.gov ; fpoteat@health.nyc.gov ; tmcveigh@health.nyc.gov TX-DSHS-19-1309-A-000595 ; mvachon@health.nyc.gov ; Paladini, Marc (CDC health.nyc.gov) ; miwamoto@health.nyc.gov ; mlash@health.nyc.gov ; sslavins@health.nyc.gov ; ttseyang@health.nyc.gov ; Maillard, Jean-Marie (CDC dhhs.nc.gov) ; rick.brajer@dhhs.nc.gov ; nina.forestieri@dhhs.nc.gov ; kristin.bergman@dhhs.nc.gov ; ronna.chan@dhhs.nc.gov ; lcronquist@nd.gov ; Miller, Tracy (CDC nd.gov) ; educator.dph@gmail.com ; Muña, Esther (CDC dph.gov.mp) ; margarita.aldan@dph.gov.mp ; Luu, Ngoc Phuong NPL (CDC dph.gov.mp) ; rosita.waldron@dph.gov.mp ; 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Aldridge,Tiffany (DSHS) ; Owens,Kamesha (DSHS) ; Gamez,Monica (DSHS) ; Canfield,Mark (DSHS) ; Broussard,Kelly (DSHS) ; Langlois,Peter (DSHS) ; Folasuyi.Richardson@dallascounty.org ; idaresit.umoh@dallascounty.org ; wendy.chung@dallascounty.org ; Kyoo.Shim@dallascounty.org ; Amanda.Eckert@houstontx.gov ; Tolulope.Olumuyiwa@houstontx.gov ; Yang, Biru (CDC houstontx.gov) ; Kirstin.Short@houstontx.gov ; Tahani.Hamdan@houstontx.gov ; Salma.Khuwaja@houstontx.gov ; aenance@utah.gov ; ddpeterson@utah.gov ; janejohnson@utah.gov ; jeason@utah.gov ; Watkins, Shari A. (CDC utah.gov) ; melissastevens@utah.gov ; brennan.martin@vermont.gov ; paul.daley@vermont.gov ; Nicolai, Laura Ann (CDC vermont.gov) ; lucia.orantes@vermont.gov ; peggy.brozicevic@vermont.gov ; Cook, Sally (CDC vermont.gov) ; eleanor.johannes@doh.vi.gov ; Ellis, Esther (CDC doh.vi.gov) ; elena.mircoff@vdh.virginia.gov ; Jennifer.Macdonald@vdh.virginia.gov ; katherine.crawford@vdh.virginia.gov ; Kurkjian, Katie (CDC vdh.virginia.gov) ; shea.browne@vdh.virginia.gov ; elina.guralnik@vdh.virginia.gov ; Hanna.Oltean@doh.wa.gov ; mary.chan@doh.wa.gov ; kathy.g.cummons@wv.gov ; melissa.a.baker@wv.gov ; Tara.L.Buckner@wv.gov ; Ada.O.Okorie@wv.gov ; Rohan, Angela (CDC dhs.wisconsin.gov) ; TX-DSHS-19-1309-A-000596 christine.muganda@dhs.wisconsin.gov ; Kimberly.Meinholz@dhs.wisconsin.gov ; DHSGrantReview@wisconsin.gov ; rebecca.osborn@dhs.wisconsin.gov ; Sowmya.Adibhatla@dhs.wisconsin.gov ; DeSalvo, Traci (CDC dhs.wisconsin.gov) ; Wozniak, Ryan (CDC dhs.wisconsin.gov) ; Vanhouten, Clay (CDC wyo.gov) ; katie.bryan@wyo.gov CC: Honein, Margaret (Peggy) (CDC/DDNID/NCBDDD/DCDD) ; Reynolds, Megan (CDC/DDNID/NCBDDD/DCDD) ; Gilboa, Suzanne (CDC/DDNID/NCBDDD/DCDD) ; Tong, Van T. (CDC/DDNID/NCBDDD/DCDD) ; Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) Subject: Call Notes for Quarterly Zika Pregnancy and Infant Surveillance Data Use Working Group Call (3/5/19) Attachment(s): "image001.jpg","image003.jpg","Zika_Pregnancy_and_Infant_Surveillance_Data_Use_Working_Group_0305-19_Notes.docx","Zika Genetics Consortium Summary.docx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Dear Jurisdictional Partners, Attached are the notes from the last Quarterly Zika Pregnancy and Infant Surveillance Data Use Working Group call on March 5, 2019. The next quarterly call is scheduled for June 4, 2019 at 3:00 PM EST. A calendar invitation will be sent soon. Best regards, Amanda Amanda Akosa, MPH G2S Corporation Contractor Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities Phone: 404-718-3409 Email: kcq9@cdc.gov Note: I am not a government employee and have no legal authority to obligate any federal, state, or local government to perform any action or payment. TX-DSHS-19-1309-A-000597 Sun-9m 53"" Zika Genetics Consortium Summary Introduction: The Zika Genetics Consortium (investigators below) was formed to identify genetic risk and protective factors in Congenital Zika Syndrome. To perform this work, our goal is to recruit 10,000 mother-infant dyads affected by Congenital Zika Syndrome from all affected countries and regions. Study Design: Our study is composed of four phases. These phases include: Participant recruitment and study coordination (phase 1), receiving shipments, sample storage, DNA isolation and quality control testing (phase 2), whole genome sequencing at the National Human Genome Research Institute (NHGRI) (phase 3), and data analysis at Children’s National and NHGRI (phase 4). With support from the Zika In Infants and Pregnancy Study, we are enrolling patient from 13 different countries. Our analysis of genomic data includes testing for genetic variants that are acting as vulnerability/resilience factors in phenotypes associated with Congenital Zika Syndrome. This work is supported by statistical and gene regulatory models that will aid in data analysis and pathway discovery. Facility and Support: We have obtained support for this work, including start-up funding, laboratory space, research coordinators and a lab tech. These commitments were made with support from the Divisions of Neurology, Division of Fetal Medicine and the Clinical and Translational Science Institute at Children’s National. As a result, we currently have a pipeline that will support all phases of this research collaboration. Most importantly, our work is supported by a dedicated partnership with the Zika In Infants and Pregnancy Study with the National Institute of Health. Partners and Platforms: We have identified a broad-based platform and various partners to share our work, including the creation of a website dedicated to the Zika Genetics Consortium. Our partners also include the Neuroscience Research Center at the Children’s Research Institute, and the Global Health Initiative at Children’s National, in addition to 19 investigators representing 13 different institutions. Authorship: We are fully committed to academic partnerships on this project. All collaborators that are contributing or have contributed to our project will be offered authorship on publications, including local and international partners. Data Sharing: Genomic sequencing data will be available to all co-investigators by collaboration at any time before publication. Our current goal is to continue to partner with the Division of Congenital and Developmental TX-DSHS-19-1309-A-000600 Disorders and all CDC partnering sites to expand our participant enrollment in order to gain additional statistical power for the discovery of common genetic risk and protective variants contributing to Congenital Zika Syndrome and human development, both nationally and internationally. Our goal is a diverse participant population representing the scope of the pandemic. POC: Dr. Youssef Kousa Email: YKousa@childrensnational.org Biospecimens needed (in order of desirability): Blood - 2.5ml in a purple top tube is requested, but can extract sufficient DNA with 1ml if needed Tissue - can use 1cm x 1cm of tissue (e.g. placenta) Saliva - 3ml using an Oragene kit (other protocols can be used) Serum - 3ml in a red top tube (overall low DNA yield) Research Collaboration Agreement: Research Collaboration Agreements are available to be shared with partnering sites Shipments: Funds are available to support shipments within the US (using FedEx) or internationally (using Word Currier) Thank you, Youssef A. Kousa, on behalf of the Zika Genetics Consortium Steering Committee Dr. José Cordero (epidemiology, ZIP Governance Board) Dr. Jeff Murray (human genetics, craniofacial development) Dr. Roberta DeBiasi (infectious disease, congenital infections) Dr. Max Muenke (human genetics, development) Dr. Adre du Plessis (fetal medicine and neurology) Dr. Eric Vilain, (genomics, personalized medicine) Investigators Dr. Youssef A. Kousa (PI, child neurology, genetics) Dr. Elizabeth Leslie (Co-I, statistical genetics) Dr. Tamer Mansour (Co-I, bioinformatics) Dr. Miguel Del Campo (Co-I, dysmorphology) TX-DSHS-19-1309-A-000601 Site PIs Dr. Carlos Cure (Barranquilla, Colombia) Dr. Lavinia Schuler-Faccini (Porto Alegre, Brazil) Dr. Maribel Campos (San Juan, Puerto Rico) Dr. Denise Cavalcanti (Campinas, Brazil) Dr. Priscila Cascado (Rio de Janeiro, Brazil) Consultants Dr. Sarah Mulkey (Neurodevelopment) Dr. Dorthy Bulas (Ultrasound, Neuroimaging) Dr. Gilbert Vezina (fetal MRI, Neuroimaging) TX-DSHS-19-1309-A-000602 Zika Pregnancy and Infant Surveillance Data Use Working Group – Quarterly Call – Notes Call Notes: March 5, 2019, 3:00-4:00 pm EST Next Quarterly Call: June 4, 2019, 3:00-4:00 pm EST CDC Attendees: Peggy Honein, Van Tong, Megan Reynolds, Suzanne Gilboa, Stacey Martin, Sarah Reagan-Steiner, Kate Woodworth, Augustina Delaney, Kayla Anderson, Madelyn Baez-Santiago, Area Points of Contact and Emerging Threats Team (ETT) Staff State, Territory, and Freely Associated State Attendees: Alabama, Arizona, California, Colorado, DC, Florida, Georgia, Hawaii, Idaho, Illinois, Chicago, Iowa, Kansas, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, New York City, North Carolina, Ohio, Pennsylvania, Philadelphia, Republic of Marshall Islands, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, TX-Dallas County, TX-Houston, Utah, Virginia, Washington, West Virginia, Wisconsin ...............................................................................................................................!] Agenda 1) Welcome and introductions 2) Zika Genetics Consortium 3) Updates from CDC a. 2019 ELC NOFO publication and webinar b. Updated Zika travel guidance c. Zika Care Connect 4) Update on clinical review for USZPIR 5) On-going analytic projects a. Update on ZBDS MMWR b. International efforts to harmonize reporting of Zika cases c. Review of developmental data across all systems 6) Updates/questions from jurisdictions 7) Closing remarks Meeting Notes Zika Genetics Consortium - Dr. Kousa is a Clinical Fellow with the Children’s National Health System. He provided an overview of the Zika Genetics Consortium. Please see the attached document for details and contact Dr. Kousa at YKousa@childrensnational.org. Updates from CDC · 2019 ELC NOFO publication and webinar o A new ELC Notice of Funding Opportunity (NOFO) - CDC-RFA-CK19-1904: 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) was published on Grants.gov last Thursday, February 28th. TX-DSHS-19-1309-A-000603 This is a five-year cooperative agreement opportunity which is open to the 64 jurisdictions currently funded through the ELC. Our Center’s project can be found under, W: Infants with Congenital Exposures Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats. We anticipate awarding 4-9 jurisdictions to collaboratively participate in a surveillance system for emerging threats. The proposals can address Zika and/or a new emerging threat. o ELC held a NOFO kickoff webinar Thursday, March 14th at 3PM to 4:30PM ET. This webinar provided pertinent information regarding the application requirements. If you were unable to attend, the webinar was recorded and will be posted by ELC. Copies of the slides can be shared upon request. o The electronically submitted applications are due Friday, May 10th no later than 11:59PM ET. o The 2019 ELC Annual Meeting will be held April 2 - 4, 2019 in Atlanta, GA. § There will be networking opportunities for discussions to see if component W will work with anything being done in your jurisdiction. Let us know if you plan to attend. o Please feel free to reach out to us. We would like to hear about exposures that concern you locally and then have a conversation about how those would fit within this funding opportunity. Happy to set up a call to have a conversation about that. · Updated Zika travel guidance o Travel guidance was updated based on the changing epidemiology of Zika. The Centers for Disease Control and Prevention (CDC) collaborated with the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC) to review all scientific data available on the spread of Zika for every country of the world. Based on currently available data, the spread of Zika is no longer at the same high levels seen during the main outbreak period in the Americas during 2015 to 2017. o CDC released updated guidance on February 28th and distributed to all jurisdictions that day. CDC now recommends pregnant women and couples trying to become pregnant within the next 3 months and traveling to areas reporting past or current Zika transmission, but no current confirmed recent outbreak, work with their healthcare providers to carefully consider the risks and possible consequences of travel to areas with risk of Zika. Previous guidance recommended that pregnant women should not travel to areas with risk of Zika. CDC continues to recommend that pregnant women avoid travel to any area with a current Zika outbreak. o We have updated all our Zika and Pregnancy pages to reflect the new guidance, but please let us know if you have seen any issues. Thanks to those who noted the issues with the website and that the downloadable PDF of the world map was not correct. · Zika Care Connect (ZCC) o ZCC was created to help connect families affected by Zika to healthcare specialists and website was developed and has been maintained with Zika supplemental funding TX-DSHS-19-1309-A-000604 provided by the CDC, which will expire on March 31, 2019. The ZCC website will remain operational until December 31, 2019, at which time the website will shut down. Until then, we will continue to update the website with any new or changed clinical guidance from CDC. Though the website will remain operational, there might be a lag in response from ZCC staff after March 31, 2019. We hope the model has been helpful in the context of an emergency response, but we are unable to continue supporting beyond this year. Update on clinical review for USZPIR · We are making great progress on re-reviewing all cases using the approach from the Vital Signs, in which we evaluate all information available to inform classification. We are doing a comparison of any updated data that has been received since January 22nd to make the final classifications of birth defects. Once completed, we plan to share the classifications with each of the jurisdictions. · Once all birth defects reviews are completed, we will also begin the case review and analysis for the Infant follow-up report for the U.S. states. · Please speak with your Area Point of Contact about any barriers you might have for submitting timely data on these infants and we would be happy to work with you on that. On-going analytic projects · Update on ZBDS MMWR o The team has a draft of the ZBDS MMWR which will update the 2018 Delaney, et al., MMWR with data from 2016 through the first half of 2017. We are still discussing with a few jurisdictions analytic issues and updating clinical review for some cases. Once we resolve those issues, we will be sharing the draft with jurisdictions that will be included in the MMWR. Currently we do not have a set deadline for publication, but we will work with jurisdictions that also require local clearances, in addition to CDC Clearance. The project is still moving ahead, and we plan to have a new update on the next data use working group call. · Baseline ZBDS o There is growing evidence that neural tube defects (NTDs) are not associated with Zika virus infection. o Because of this, it is necessary to update the baseline prevalence of birth defects potentially associated with Zika virus infection during pregnancy prior to the Zika virus outbreak in the Americas. o We re-analyzed the data from the Cragan, et al., MMWR, which included statewide birth defects surveillance programs in Massachusetts and North Carolina in 2013 and three counties of metropolitan Atlanta, GA, from 2013-2014. o We excluded NTD cases, in light of the growing evidence that NTD do not seem to be associated with Zika virus infection, and for any NTD cases with a co-occurring eye TX-DSHS-19-1309-A-000605 abnormality, expert clinicians reviewed the cases to determine if the eye finding was related to the NTD or another cause. o This analysis will provide a refined baseline prevalence estimate. o Status: 1. We aim to publish a research letter in Birth Defects Research. 2. We currently have a draft and aim to clear it over the next few months. · International efforts to harmonize reporting of Zika cases o Thomas Jaenisch from the University of Heidelberg reached out to Peggy Honein. He is the coordinator and PI of ZikaAlliance, one of the European Community’s Zika pregnancy cohorts. He is interested in harmonizing case definitions for Zika associated abnormalities across Zika pregnancy cohorts and is leading an effort to reconcile the divergent published risk estimates of ZIKV associated abnormalities. He is proposing that the cohorts that are willing participate in this effort reabstract data on the abnormalities they are seeing according to a specific set of criteria – and the same way across all of the cohorts. The hope is that this would lead to greater clarity on why some of the effect estimates have been so divergent. The expectation is that the outcome data would be completely de-identified. o For potential participation of USZPIR, we would need permission from the jurisdictions. CDC would facilitate the completion the reabstraction, so we do not expect additional work from jurisdictions. Depending on what cases are included, we may reach out to the areas to get permission and support for the collaboration. Would this group be interested in pursuing this, if so we can follow-up with individual states to see if there are any questions and if your data can be included? o Question about which data variables would be shared: information on birth defects such as head circumferences, etc. The request is focused at the defect level. However, a variable that we would not provide is state of residence. · Review of developmental data across all systems o Dr. Kayla Anderson is an epidemiologist working in the Birth Defects Branch in DCDD, and her PhD is in the developmental and family sciences. She has been closely working on the internal Zika projects, serving as the developmental SME for activities including design, implementation, and monitoring of child developmental testing. She is undertaking a review to inventory the developmental data across all the internal CDC Zika surveillance systems/studies in CDC, within our division. o Infant developmental data collection are completed or underway across several surveillance and research Zika datasets at CDC. This includes USZPIR and international surveillance projects in Colombia, Brazil, and Honduras. o Most surveillance systems and studies of which CDC is a part follow women during pregnancy and then their infants to between 18–36 months of age. o Substantial capacity across the systems to examine early childhood development after possible or confirmed Zika virus exposure during pregnancy, but capacity of the systems TX-DSHS-19-1309-A-000606 to collect detailed developmental information differs. In some cases, we are only able to capture diagnosis of any delay; in others, capturing detailed information from standardized evaluations or screeners at multiple time points. o Potential for substantial variation across jurisdictions and within jurisdictions about quality of infant developmental data available as well as data abstracted. o We are working here to examine the data available across all DCDD-engaged sources. Considering: · How can we best partner to help to strengthen capacity and quality of data collected? Detailed screening/evaluation data by domain is most useful, as well as diagnosis/date of diagnosis if a clinical diagnosis has been made would be most ideal. Information about ‘any developmental delay’ is not as useful (without indication of what kind of delay (in what domain), or when or how diagnosed/screened), but is sometimes all that is available. · What common analytic questions can we address with our partners across data sources? What unique public health practice questions can be addressed by each source? § Question about how to record data for the Registry and what to do without standardized assessment of development. Response: Considering how to utilize screening test results relative to formal indications or evaluations for diagnosis. We will need to consider how to consider data from screens vs. diagnoses, as well as consider how to use changes in developmental screening data over time (this could be due to inadequate testing, poor mood, or true changes in the child’s developmental capacity). In some systems (e.g., surveillance data), we might have to use the least detailed data because it is what is commonly available. In other analyses (e.g., in a prospective cohort data), we might be able to dive more in depth into specific domains if data are available. § If your jurisdiction is particularly interested in developmental outcomes, and you are interested in discussing possible ways to improve completeness and quality abstraction of developmental data reported in the Registry, please let your area POC know. Reminders: · · Next DUWG call is scheduled for June 4 at 3pm EST ELC NOFO CDC-RFA-CK19-1904 ELC 2019 Notice of Funding Opportunity (NOFO) “W: Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats” due Friday, May 10th no later than 11:59PM ET. TX-DSHS-19-1309-A-000607 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, March 19, 2019 11:47 AM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Program H: Vector-borne Diseases Webinar: Wednesday, March 20 at 3 p.m. - 4 p.m. (Eastern Time) WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Morning, Please use the call-in information below to attend the ELC Program H: Vector-borne Diseases Webinar scheduled for Wednesday, March 20, 2019 at 3 p.m. – 4 p.m. (Eastern Time) Adobe Connect Seminar Link: https://adobeconnect.cdc.gov/r825u9k7zvot/ Conference number:: Participant code:: 866-617-3597 76857551 Questions related to this webinar can be sent to elc@cdc.gov. Thank You, The ELC Team TX-DSHS-19-1309-A-000608 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, March 19, 2019 1:48 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: DFWED ELC Webinar: 3/22/19 3p-4p ET WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Afternoon, Please add to your calendar the DFWED ELC Webinar scheduled for Friday, March 22. 2019 from 3:00 p.m. to 4:00 p.m. ET. Thank you, Char ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 5497494 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... TX-DSHS-19-1309-A-000609 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, March 19, 2019 7:53 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: *********NEW CALL-IN INFORMATION FOR VECTOR-BORNE DISEASES WEBINAR: MARCH 20, 2019 3PM ET************ WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, The call-in information for the Vector-borne Disease Webinar has been updated to the following: New call in information below Date: March 20, 2019 Time: 3:00-4:00 pm (Eastern Time) Link: https://adobeconnect.cdc.gov/r825u9k7zvot/ Conference number:: 888-324-0238 Leader passcode: 56428 Participant passcode: 1354608 Thank You, The ELC- Team TX-DSHS-19-1309-A-000610 From: Vector-Borne ELC (CDC) Sent: Wednesday, March 20, 2019 1:32 PM EDT To: Vector-Borne ELC (CDC) Subject: SLIDES ATTACHED: ELC Program H: Vector-borne Diseases Webinar Attachment(s): "VBD ELC Webinar 3-20-19.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Attached are the slides for today’s webinar. We look forward to speaking with you all shortly. Thank you, The VBD Extramural Program Management Team vbdelc@cdc.gov From: Vector-Borne ELC (CDC) Sent: Tuesday, March 19, 2019 3:03 PM Cc: Vector-Borne ELC (CDC) Subject: NEW CALL IN INFORMATION: ELC Program H: Vector-borne Diseases Webinar *PLEASE USE THE UPDATED CALL IN INFORMATION BELOW AND FORWARD TO APPROPRIATE PARTIES. ELC Program H: Vector-borne Diseases Webinar Date: March 20, 2019 Time: 3:00-4:00 pm (Eastern Time) Adobe Connect Seminar Link: https://adobeconnect.cdc.gov/r825u9k7zvot/ Conference number: Participant code: 888-324-0238 1354608 DVBD would like to take this time to discuss content and changes related to the new comprehensive vector-borne program, now known as Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond. Please review the guidance and budget template prior to the webinar. When possible, we encourage participants from the same location to take the call from the same room. There will be time dedicated for your questions. Sincerely, The VBD Extramural Program Management Team vbdelc@cdc.gov TX-DSHS-19-1309-A-000611 ELC2019- Program H Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond March 20, 2019 Division of Vector-Borne Diseases National Center for Emerging Zoonotic and Infectious Diseases TX-DSHS-19-1309-A-000612 Agenda • Welcome and Introductions • Overview of current vector-borne disease (VBD) issues in the US • Overview of NEW VBD Guidance • Tiered approach • CDC Priorities • Points of Contact • Questions TX-DSHS-19-1309-A-000613 Current State of VBDs in the U.S. - Increasing Cases (2004-2016) • Between 2004 and 2016, more than 640,000 cases of VBDs were reported in the US • The reported data substantially underestimates actual disease occurrence (8 to 70 fold depending on the disease) • The number of reported cases of disease spread by fleas, ticks and mosquitos has more than tripled • Tickborne diseases accounted for over 75% of reported VBD cases • Mosquito-borne disease epidemics happen more frequently Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. TX-DSHS-19-1309-A-000614 MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. Reported Nationally Notifiable Mosquito-borne*, Tickborne, and Fleaborne+ Disease Cases - US States and Territories, 2004-2016 60000 50000 40000 30000 20000 10000 0 2.004 2.005 2.006 2.007 2.008 2.009 2012 2.011 2.010 Reported mosqLiito-borne dis.ease cases in US st ates ■ Reported mos,quito -bome disease cases.in US territories 2013 2014 2016 2015 Reported tick -borne disease cas.esin US states ■ "Mosquito-borne case counts include both locally transmitted and travel-associated cases. + A total of 89 flea borne disease cases (plague) were reported during 2004-2016, ranging from two cases in 2010 to 16 cases in 2015. The cases are not depicted on the figure. Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. TX-DSHS-19-1309-A-000615 Division of Vector-Borne Diseases VISION: Create a future where vector-borne diseases no longer threaten public health MISSION: Reduce illness and death due to VBDs GOAL 1: Identify and detect vector-borne pathogens that cause disease in people GOAL 2: Understand when, where, how often and how people are exposed to vector-borne pathogens GOAL 3: Prevent exposure to vector-borne pathogens and mitigate consequences of infection GOAL 4: Implement vector-borne disease diagnostics, surveillance, control and prevention programs TX-DSHS-19-1309-A-000616 A Call to Action for a National Strategy/National Action Plan Am. J. 1~ . Me/Jt . f-00_, i ~) . 20 19 . A] •. 242 - 2-4$ oo :10.4 269/a:_nim.iS-0841 Oopyligliit e 2'019 by-TheAmerican SocieWofTrq:iicalMed.ldne aoo HygieM P erspec1 1-.1v:e p·iece r C,omba11ing t he ~ncr,easing Thr,eat ,of V,ec:t ,or-lBorne Dis,ease in the Unit,ed States with a National Vee:1 :or---B,orne Disease Prev,en1ion and Control Syst em 1 1 1 1 1 ly l'e R. Pietierse n , Charl:es 8. Beam, .al1ldSusanin.aN. Viss,er* Division of Vee10.r -Bome Diseases1 Natiarisl ce ,uer tot EmetgituJ tJJ1d Z oon01.icl11fecrious,Ds~e,s, 1 1 Ce.i1:te.r:s for DisaeiSe a,mro-l Md Prevention, Fen Collins, CcJlot8do • Highlightsthe importance of sustaining states health departments in their role of combating VBDs and the need for a common national strategy to protect the US from VBD threats TX-DSHS-19-1309-A-000617 ELCVBD Funding 2012-2019 Arbo $72,307,103 Total $74,108,830 $30 $25 $20 V, C: ,Q $15 ~ $10 $5 $0 2012 2013 2014 ■ M1 -Arbo 2015 ■ N1 - Lyme 2016 ■ 2017 N2 - Non-Lyme Tickborne 2018 2019 TX-DSHS-19-1309-A-000618 DVBDApproach to Prevention and Control of VBDs Goal • Sustained, national capacity to detect, prevent, investigate, report, and control new and emerging vector-borne threats ELCVBD Goal • Support Jurisdictions to build sustainable, locally relevant programs to identify, prevent and respond to vector-borne diseases TX-DSHS-19-1309-A-000619 VBD ELC2019 - Overview • Vector-Borne Diseases moving from Project to Program • Combined VBD guidance • No longer Ml, Nl and N2 • New tiered approach • Core activities - Tier 1 • Enhanced activities - Tiers 2 and 3 • Focus on priority VBDs of the jurisdiction • FY2019 Funding - ~$16 million TX-DSHS-19-1309-A-000620 VBD ELC2019 - Overview • Average award range: $150,000-260,000 • Opportunity to fund a limited of jurisdictions for Tier 3 • 5-7 jurisdictions at $500,000-750,000 total • Communicate your current capacity • Baseline for comparison to future year capacity • Please include jurisdiction • • • • POCs: Arbovirus Lyme Disease, plague, tularemia Rickettsial diseases Parasitic vector-borne diseases (non-malaria) TX-DSHS-19-1309-A-000621 Tier 1 • Core activities for VBD programs - Summary • Epidemiology • Surveillance of nationally notifiable VBDs: data collection, reporting and evaluation • Limited educational outreach • Capacity to investigate and respond to VBD cases as necessary • Laboratory • Testing for VBDs of public health importance to the jurisdiction • Participation in VBD proficiency panels • Ecology • Report passively collected vector, sentinel animal, or veterinary cases • Ability to advise local agencies on vector control TX-DSHS-19-1309-A-000622 Tier 2 • Enhanced activities for VBD programs - Summary • Epidemiology • Surveillance and reporting of NON-nationally notifiable VBDs • Develop and maintain surveillance and response plan for VBDs • Laboratory • Enhanced laboratory capacity • Ecology • Actively conduct or coordinate ecologic/vector surveillance and reporting (e.g. ArboNET, MosquitoNET) • Pathogen testing in ticks, in collaboration with CDC • Pathogen testing in mosquitos • Insecticide resistance testing for mosquitos • Tick surveillance - Guidance released*, Tick module in ArboNET ~ https://www.cdc.gov/ticks/resources/TickSu rve i Ila nee lsca pu la ris-P.pdf TX-DSHS-19-1309-A-000623 Tier 3 • Regional focus, local reach/resource sharing • Collaboration with public health and academic partners • Epidemiology • Enhanced surveillance • Capacity to lead complex investigations; assisting other jurisdictions • Novel surveillance and interventions • Laboratory • Regional reference laboratory support for other jurisdictions • Advanced diagnostics TX-DSHS-19-1309-A-000624 Tier 3 - Continued • Ecology • Vector-control implementation/coordination • Develop and implement a comprehensive integrated vector surveillance and control plans • Pathogen testing in ticks (at jurisdiction) • Enhanced communication activities • Advanced message dissemination and reporting • VBD communication plans • Multi-faceted outreach to diverse audiences TX-DSHS-19-1309-A-000625 2019 Priorities • • • • Jurisdiction's priority VBDs and vectors Communicating your current capacity If you don't ask for it, we can't fund it Assuring Core (Tier 1) capabilities in every jurisdiction • Inclusion of one FTE (or% FTE)to support activities • Travel to ELCGrantee meeting AND 4 day VBD meeting ("'Feb 2020) • Supplies/shipping • Education materia Is TX-DSHS-19-1309-A-000626 2019 Priorities - Enhanced • Enhanced (Tier 2) • Demonstrated Tier 1 capacity • Enhanced ecology activities • Tick surveillance - reporting in Tick Module in ArboNET • Mosquito surveillance/ insecticide resistance MosquitoNET • Additional FTEs(or% FTE) • Travel for staff to VBD meeting in Feb 2020 • Supplies/shipping to support enhanced lab activities • Education materials TX-DSHS-19-1309-A-000627 2019 Priorities - Enhanced • Enhanced (Tier 3) • Demonstrated Tier 1 and 2 capacity • Supporting comprehensive programs that develop and maintain capacity to: • Use surveillance data for decision making and coordinate complex investigations and responses, including vector control and communications planning • Collaborate between stakeholders and lower level health and vector control jurisdictions • Demonstrate linkage of surveillance to prevention and control ofVBD TX-DSHS-19-1309-A-000628 Points of Contact • VBD ELC Guidance - Jeff Borchert gqxl@cdc.gov • Technical POCs • • • • Arbovirus diseases: Stacey Martin, zmt0@cdc.gov Lyme disease, plague, tularemia: Kiersten Kugeler, bio1@cdc.gov Rickettsial diseases: Kristen Nichols Heitman, wwd7@cdc.gov ; Parasitic vector-borne diseases (non-malaria): Elizabeth Gray, din8@cdc.gov • Tick surveil la nee guidelines - ticksu rvei Ila nce@cdc.gov TX-DSHS-19-1309-A-000629 New Vector-Borne Disease Program Inbox VBDELC@cdc.gov Questions? 60000 50000 40000 30000 20000 10000 0 2004 2005 2006 2007 2008 2009 2010 Reported mosquito-borne disease cases in US states ■ Reported 2011 2012 ■ Reported mosquito-borne disease cases in US territories 2013 2014 2015 2016 tick-borne disease cases in US states Chartl TX-DSHS-19-1309-A-000632 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A B C D E F G H I J K L M TABLE 1. Vector-borne disease cases reported to National Notifiable Disease Surveillance System U.S. and territories, 2004-2016* N Disease 2004 Tickborne Diseases Lyme Disease 19,804 Anaplasmosis/Ehrlichiosis† 875 Spotted Fever Rickettsioses§ 1,713 Babesiosis N Tularemia 134 Powassan virus 1 Subtotal Tickborne Diseases 22,527 2005 2006 2007 2008 2009 Year 2010 2011 2012 2013 2014 2015 2016 23,305 1,404 1,936 N 154 1 26,800 19,931 1,455 2,288 N 95 1 23,770 27,444 1,999 2,221 N 137 7 31,808 35,198 2,107 2,563 N 123 2 39,993 38,468 2,267 1,815 N 93 6 42,649 30,158 2,615 1,985 N 124 8 34,890 33,097 3,586 2,802 1,128 166 16 40,795 30,831 3,725 4,470 937 149 7 40,119 36,307 4,551 3,359 1,796 203 15 46,231 33,461 4,488 3,757 1,760 180 8 43,654 38,069 5,137 4,198 2,100 314 7 49,825 36,429 5,750 4,269 1,910 230 22 48,610 Mosquito-Borne Diseases** Dengue viruses¶ 721 Zika virus N West Nile virus 2,539 Malaria 1,458 Chikungunya virus N California serogroup viruses†† 118 St. Louis encephalitis virus 15 Eastern equine encephalitis virus 7 Yellow fever virus 0 Subtotal Mosquito-Borne Diseases 4,858 2,462 N 3,000 1,498 N 80 13 21 0 7,074 882 N 4,269 1,476 N 69 10 8 0 6,714 4,484 N 3,630 1,411 N 55 9 4 0 9,593 1,118 N 1,356 1,257 N 62 13 4 0 3,810 2,759 N 720 1,456 N 55 12 4 0 5,006 11,611 N 1,021 1,778 N 75 10 10 0 14,505 1,795 N 712 1,726 N 137 6 4 0 4,380 6,714 N 5,674 1,504 N 81 3 15 0 13,991 10,727 N 2,469 1,594 N 112 1 8 0 14,911 1,226 N 2,205 1,654 7,521 96 10 8 0 12,720 1,015 N 2,175 1,397 1,133 70 23 6 0 5,819 1,178 41,680 2,149 1,958 427 53 8 7 1 47,461 8 17 7 3 8 2 3 4 4 10 16 4 Total Vector-Borne Diseases 27,388 33,882 30,501 41,408 43,806 47,663 49,397 45,178 Abbreviations: N = not notifiable * Unless stated otherwise, all cases reported from continental U.S., Hawaii, and Alaska † Anaplasmosis and ehrlichiosis were reported separately after 2008 but are combined here for the entire period. § Includes R. 54,114 61,146 56,384 55,660 96,075 Fleaborne Disease Plague 3 rickettsii, R. parkeri, R. 32 philippi ¶ Dengue became reportable to NNDSS from 2010. Data 2004-2009 from Dengue Branch, Division of Vector-Borne Diseases, 33 CDC. ** Cases reported from U.S. states, District of Columbia, 34 and territories 35 †† Includes Jamestown Canyon, La Crosse, and unspecified California serogroup viruses §§ For babesiosis and malaria, surveillance data are reported independently to different CDC programs. For this reason, surveillance data reported elsewhere might vary slightly from data 36 reported in this summary TX-DSHS-19-1309-A-000633 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 O Total 402,502 39,959 37,376 9,631 2,102 101 491,671 46,692 41,680 31,919 20,167 9,081 1,063 133 106 1 150,842 89 642,602 32 33 34 35 slightly from data 36 TX-DSHS-19-1309-A-000634 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah B MBDs C TBDs 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 699 6648 498 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 5950 2140 198 D E Plague F Total VBD: 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 2859 204 2737 7458 10666 3004 37272 8610 1024 5670 2848 414 1583 6268 2233 2577 1823 1363 1635 12977 24091 51443 2553 28344 1676 7196 577 2159 574 13883 53482 599 76480 10043 1376 2717 5523 950 75005 7389 1455 1537 6649 8789 699 TX-DSHS-19-1309-A-000635 Map Data 47 48 49 50 51 52 53 54 55 56 57 A Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B C 93 1319 781 238 640 383 171 80534 1755 6161 16454 300 1964 33255 140 D E F 0 0 0 0 0 0 0 0 0 6254 17773 1081 2202 33895 523 171 80534 1755 Total: 642602 TX-DSHS-19-1309-A-000636 Map Data A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 B C D E Reported mosquito-borne disease Reported mosquito-borne cases in Reported tick- and flea-borne Reported tick- and flea-borne cases in US states US territories disease cases in US states disease cases in US territories 4147 711 22527 4712 2362 26800 5935 779 23770 5453 4140 31,808 2891 919 39993 2442 2564 42649 3589 10916 34890 2837 1543 40795 7822 6169 40119 5027 9884 46231 7463 5257 43654 5514 305 49825 10550 36911 48610 Reported mosquito-borne disease cases in US states 2004 4147 Reported mosquito-borne disease cases in US territories 0 0 0 0 0 0 0 0 0 0 0 0 0 Reported tick-borne disease cases in US states 711 22527 2005 4712 2362 26800 2006 5935 779 23770 2007 5453 4140 31808 2008 2891 919 39993 2009 2442 2564 42649 2010 3589 10916 34890 2011 2837 1543 40795 2012 7822 6169 40119 2013 5027 9884 46231 Histogram TX-DSHS-19-1309-A-000637 49 50 51 52 53 54 55 56 57 A B 2014 C 7463 D E 5257 43654 2015 5514 305 49825 2016 10550 36911 48610 TX-DSHS-19-1309-A-000638 Histogram 1 2 3 4 5 6 7 8 A Year Total Mosquito-Borne Diseases B J K L 2005 7074 2006 6714 2007 9593 2008 3810 G 2009 5006 H 2004 4858 C D E F 2010 14505 I 2011 4380 2012 13991 2013 14911 2014 12720 M 2015 5819 Year Total Tickborne Diseases 2004 22527 2005 26800 2006 23770 2007 31808 2008 39993 2009 42649 2010 34890 2011 40795 2012 40119 2013 46231 2014 43654 2015 49825 Year Total Vector-Borne Diseases 2004 27388 2005 33882 2006 30501 2007 41408 2008 43806 2009 47663 2010 49397 2011 45178 2012 54114 2013 61146 2014 56384 2015 55660 TX-DSHS-19-1309-A-000639 Line Summaries Line Summaries 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 A B C D E F G Tickborne Diseases H Reporting Area Lyme disease Anaplasmosis/Ehrlichiosis* Spotted fever rickettsioses† Babesiosis Tularemia Powassan Subtotal Tickborne Diseases: United States (excluding territories) 36429 5750 4269 1910 230 22 Alabama 38 21 453 — 1 — Alaska 15 N N N 1 Arizona 13 2 27 N Arkansas 2 218 821 California 134 6 Colorado — Connecticut I J K L Mosquito-borne Diseases Dengue Zika West Nile Virus Malaria 48610 961 5168 2149 1955 513 5 37 19 13 — 16 5 — — 2 3 — 45 13 54 78 38 1 32 — 1074 3 13 9 5 14 3 2 — 159 197 421 442 125 N 4 N 14 — 18 21 55 149 25 1748 104 6 322 — 1 2181 6 118 1 13 Delaware 506 20 17 2 — — 545 2 17 — 16 District of Columbia 103 6 4 2 — — 115 9 41 1 23 Florida 216 34 12 N — — 262 68 1107 8 62 Georgia 4 14 74 N — — 92 20 107 6 57 Hawaii N N N N — — 0 56 11 — — Idaho 17 N 7 N 3 — 27 4 5 9 — Illinois 237 40 68 2 5 — 352 35 105 154 62 Indiana 152 24 40 — — — 216 9 49 18 17 Iowa 232 14 11 1 3 — 261 11 26 37 22 Kansas 39 57 130 N 25 — 251 4 20 37 11 Kentucky 33 46 167 1 2 — 249 1 31 8 13 Louisiana 7 3 17 2 — — 29 6 38 59 12 Maine 1487 383 4 82 — 1 1957 2 12 — 10 Maryland 1866 44 1 6 — — 1917 13 130 6 180 Massachusetts 198 848 8 518 5 5 1582 8 119 17 93 Michigan 221 14 13 2 1 — 251 16 67 43 43 Minnesota 2126 773 6 50 3 5 2963 29 66 83 67 Mississippi 1 9 111 N — — 121 — 23 43 7 Missouri 10 252 350 1 34 — 647 13 37 11 20 Montana 17 2 9 1 3 — 32 2 9 6 4 Nebraska 14 9 31 1 10 — 65 3 13 95 7 Nevada 15 — 4 N — — 19 6 22 16 7 New Hampshire 891 60 2 13 1 1 968 3 11 — 14 New Jersey New Mexico 4350 1 193 N 64 — 174 N 5 7 — — 4786 8 51 5 180 10 11 6 84 2 New York 3882 964 37 481 — 2 5366 136 1002 22 319 North Carolina 272 77 482 N 1 1 833 13 100 2 46 North Dakota 32 15 1 1 — — 49 2 3 85 5 Ohio 160 14 24 — — — 198 6 83 17 60 Oklahoma — 66 124 N 26 — 216 5 29 35 7 Oregon 61 4 6 2 4 — 77 9 47 4 20 Pennsylvania 11443 81 22 N 4 — 11550 21 175 16 77 Rhode Island 903 183 4 155 — 1 1246 5 55 2 9 South Carolina 51 1 54 2 — — 108 11 61 8 14 South Dakota 11 1 6 — 14 — 32 2 3 152 4 Tennessee 25 107 595 1 2 — 730 12 61 7 24 TX-DSHS-19-1309-A-000641 2016 Table MMWR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 M N O P Q R Chikungunya California Serogroup Viruses§ St. Louis encephalitis EEE Yellow fever Subtotal Mosquito-Borne Diseases: 248 53 8 7 1 1 — — — — — — — — 3 — — 1 — 57 S Fleaborne Diseases T Plague Total Vector-Borne Diseases: 10550 4 59164 75 — 588 — 7 — 23 — — 186 — 231 — — — 31 — 1105 — 3 — — 1245 — 1404 — — — — — 250 — 268 2 — — — — 140 — 2321 1 — — — — 36 — 581 — — — — — 74 — 189 8 — — — — 1253 — 1515 1 — — 1 — 192 — 284 3 — — — — 70 — 70 — — — — — 18 — 45 13 — 1 — — 370 — 722 2 — — — — 95 — 311 2 — — — — 98 — 359 1 — — — — 73 — 324 3 — — — — 56 — 305 1 — — — — 116 — 145 — — — — — 24 — 1981 4 — — — — 333 — 2250 6 2 — — — 245 — 1827 4 — — 2 — 175 — 426 16 9 — — — 270 — 3233 — — — — — 73 — 194 1 — — — — 82 — 729 1 — — 1 — 23 — 55 1 — — — — 119 — 184 — — 3 — — 54 — 73 1 — — — — 29 — 997 11 3 — — — — 1 — — — 338 26 38 — — — 1 3 8 — 2 — 1 — — — 4 9 — — — — — 4 5124 38 1518 — 6884 174 — 1007 — 96 — 145 — — 179 — 377 — — — 76 — 292 — — — — 80 — 157 5 — — — — 294 — 11844 3 — — — — 74 — 1320 4 — — — — 98 — 206 — — — — — 161 — 193 4 4 — — — 112 — 842 U V W TX-DSHS-19-1309-A-000642 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F Texas 71 17 87 1 3 — Utah 19 — 4 — 5 G H I J K L 179 45 312 370 159 — 28 6 21 13 8 — 985 3 11 2 6 Vermont 761 207 2 15 — Virginia 1350 115 312 N 2 — 1779 28 108 8 74 Washington 31 — — — 1 — 32 24 69 9 44 West Virginia 368 6 14 — — — 388 — 11 1 1 Wisconsin 2295 695 19 68 1 5 3083 7 60 13 20 Wyoming 1 1 1 — 7 — 10 — 3 11 4 Territories 0 0 0 0 0 0 — 217 36512 — 3 U — — — 2 131 — — — — 3 American Samoa N N N Puerto Rico N N N N — 204 35395 — U.S. Virgin Islands — — — — — — — 11 986 — — Total: 36429 5750 4269 1910 230 22 48610 1178 41680 2149 1958 TX-DSHS-19-1309-A-000643 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 M N — O 20 — — 1 — 1 — — — — — 6 — — 10 — — P — Q R S T 906 — — 50 — 78 — 22 — 1007 — — 224 — 2003 — — — 156 — 188 8 — — — 21 — 409 2 13 — — — 115 — 3198 — — — — — 18 — 28 179 0 — — — 36911 — 36911 — — — — — 133 — 133 179 — — — — 35781 — 35781 — — — — — 997 — 997 427 53 8 7 1 47461 4 96075 U V W 1085 TX-DSHS-19-1309-A-000644 2016 Table MMWR A 1 2 3 Reporting Area B California Serogroup Viruses C D E F G H I J Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 53 427 1178 7 1958 8 2149 1 41680 53 248 961 7 1955 8 2149 1 5168 5 — 11 — 19 — 37 2 — — — — 4 Total: United States (excluding territories) 5 Alabama — 1 6 Alaska — — 5 — 7 Arizona — 3 13 — 38 — 78 — 54 8 Arkansas — 1 3 — 5 — 9 — 13 California — 57 197 — 125 3 442 — 421 10 Colorado — — 21 — 25 — 149 — 55 11 Connecticut — 2 6 — 13 — 1 — 118 12 Delaware — 1 2 — 16 — — — 17 13 District of Columbia — — 9 — 23 — 1 — 41 14 Florida — 8 68 — 62 — 8 — 1107 15 Georgia — 1 20 1 57 — 6 — 107 16 Hawaii — 3 56 — — — — — 11 17 Idaho — — 4 — — — 9 — 5 18 Illinois — 13 35 — 62 1 154 — 105 19 Indiana — 2 9 — 17 — 18 — 49 20 Iowa — 2 11 — 22 — 37 — 26 21 Kansas — 1 4 — 11 — 37 — 20 22 Kentucky — 3 1 — 13 — 8 — 31 23 Louisiana — 1 6 — 12 — 59 — 38 24 Maine — — 2 — 10 — — — 12 25 Maryland — 4 13 — 180 — 6 — 130 26 Massachusetts 2 6 8 — 93 — 17 — 119 27 Michigan — 4 16 2 43 — 43 — 67 28 Minnesota 9 16 29 — 67 — 83 — 66 29 Mississippi — — — — 7 — 43 — 23 9 TX-DSHS-19-1309-A-000645 2016 K Total MosquitoAnaplasmosis/Eh Borne Disease Cases: rlichiosis Babesiosis Lyme disease Powassan Spotted fever rickettsiosis Tularemia R Total TickBorne Diseases: 47461 5750 1910 36429 22 4269 230 48610 4 96075 4 10550 5750 1910 36429 22 4269 230 48610 4 59164 5 73 21 — 38 — 453 1 513 — 586 15 — 16 — 23 27 3 45 — 231 821 32 1074 — 1105 159 — 1404 268 1 2 3 6 7 L N M N N O P N Q 1 S Plague T Total VectorBorne Diseases: 7 186 2 N 13 — 8 31 218 1 2 — 3 134 — — 4 14 18 — 6 — 2181 — 2321 545 — 581 9 1245 6 14 2 10 250 N N — 11 140 104 322 1748 1 17 — 12 36 20 2 506 — 13 74 6 2 103 — 4 — 115 — 189 14 1253 34 N 216 — 12 — 262 — 1515 74 — 92 — 284 15 192 14 N 4 — 16 70 N N N — N — 0 — 70 17 18 N N 17 — 7 3 27 — 45 68 5 352 — 722 18 370 40 2 237 — 19 95 24 — 152 — 40 — 216 — 311 20 98 14 1 232 — 11 3 261 — 359 130 25 251 — 324 21 73 57 N 39 — 22 56 46 1 33 — 167 2 249 — 305 23 116 3 2 7 — 17 — 29 — 145 1957 — 1981 24 24 383 82 1487 1 4 — 25 333 44 6 1866 — 1 — 1917 — 2250 26 245 848 518 198 5 8 5 1582 — 1827 13 1 251 — 426 6 3 2963 — 3233 111 — 121 — 194 27 175 14 2 221 — 28 270 773 50 2126 5 1 — 29 73 9 N TX-DSHS-19-1309-A-000646 2016 A B C 30 Missouri — 1 31 Montana — 32 Nebraska D E 13 — 1 2 — 1 33 Nevada — 34 New Hampshire F G 20 — 1 4 3 — 7 — 6 — 7 — 1 3 — 35 New Jersey — 11 51 1 36 New Mexico — 3 37 New York — 38 North Carolina 8 39 North Dakota — 40 Ohio H I J 11 — 37 — 6 — 9 — 95 — 13 3 16 — 22 14 — — — 11 84 — 11 — 180 5 — 2 — 6 — 10 38 136 — 319 — 22 1 1002 3 13 2 46 — 2 — 100 1 2 — 7 — 85 — 3 9 4 6 — 60 — 17 — 83 41 Oklahoma — — 5 — 7 — 35 — 29 42 Oregon — — 9 — 20 — 4 — 47 43 Pennsylvania — 5 21 — 77 — 16 — 175 44 Rhode Island — 3 5 — 9 — 2 — 55 45 South Carolina — 4 11 — 14 — 8 — 61 46 South Dakota — — 2 — 4 — 152 — 3 12 — 24 — 7 — 61 159 — 370 — 312 8 1 13 — 21 11 47 Tennessee 4 48 Texas — 20 45 — 49 Utah — 1 6 — 50 Vermont — — 3 — 6 — 2 — 51 Virginia — 6 28 — 74 — 8 — 108 52 Washington — 10 24 — 44 — 9 — 69 53 West Virginia 8 — — — 1 — 1 — 11 54 Wisconsin 13 2 7 — 20 — 13 — 60 55 Wyoming — — — — 4 — 11 — 3 57 Territories 0 179 217 — 3 — — — 36512 58 American Samoa — — 2 — — — — — 131 4 56 2016 TX-DSHS-19-1309-A-000647 K L M N O P Q R S T 30 82 252 1 10 — 31 23 2 1 17 — 9 3 32 — 55 32 119 9 1 14 — 31 10 65 — 184 33 54 — N 15 — 4 — 19 — 73 34 29 60 13 891 1 2 1 968 — 997 35 338 193 174 4350 — 64 5 4786 — 5124 — 7 8 4 38 350 34 647 — 729 36 26 N N 1 — 37 1518 964 481 3882 2 37 — 5366 — 6884 38 174 77 N 272 1 482 1 833 — 1007 1 — 49 — 147 39 98 15 1 32 — 40 179 14 — 160 — 24 — 198 — 377 41 76 66 N — — 124 26 216 — 292 6 4 77 — 157 42 80 4 2 61 — 43 294 81 N 11443 — 22 4 11550 — 11844 44 74 183 155 903 1 4 — 1246 — 1320 54 — 108 — 206 6 14 32 — 193 730 — 842 1085 45 98 1 2 51 — 46 161 1 — 11 — 25 — 87 3 179 — 4 5 28 — 78 2 — 985 — 1007 2003 47 112 107 1 595 2 48 906 17 1 71 — 49 50 — — 19 — 761 — 312 2 1779 — — 1 32 — 188 388 — 409 50 22 207 15 51 224 115 N 1350 — 52 156 — — 31 — 53 21 6 — 368 — 14 — 54 115 695 68 2295 5 19 1 3083 — 3198 55 18 1 — 1 — 1 7 10 — 28 57 36911 0 0 0 0 0 0 — — 36911 58 133 N U N — N — — — 56 2016 133 TX-DSHS-19-1309-A-000648 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E — 179 204 — — — I I 11 — F 3 I — G H I — — — I — — — J 35395 I 986 I TX-DSHS-19-1309-A-000649 2016 K 59 35781 60 997 11 L M N O N N N — — — — — P N — Q — I — R — I — S — I — T 35781 I 997 TX-DSHS-19-1309-A-000650 2016 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 70 1133 1015 6 1397 23 2175 0 0 70 0 0 0 0 0 0 896 1 1 24 4 276 8 16 0 0 73 9 7 5 20 7 4 11 8 7 2 19 34 9 15 1 5 1 4 1 1 31 0 99 19 2 10 4 3 8 5 3 0 954 3 1 17 1 138 13 5 1 11 82 8 219 3 29 6 1390 11 3 14 9 97 21 12 3 17 40 56 1 6 50 9 17 6 4 11 7 122 51 20 43 1 19 1 4 6 6 86 3 258 27 5 37 12 20 37 16 3 4 23 2175 9 0 0 23 103 18 783 101 10 6 5 13 15 0 0 0 2 0 0 1 1 0 1 0 1 7 0 0 0 0 0 1 0 11 0 25 0 0 1 0 4 4 1 4 4 13 8 16 21 2 3 4 2 1 1 60 3 112 9 1 11 2 5 23 3 4 2 E 1 1 3 1 2015 F G H I J 13 77 21 14 34 2 51 1 45 10 18 9 38 29 3 68 7 26 14 57 4 23 35 89 1 30 40 TX-DSHS-19-1309-A-000651 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5819 5137 2100 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 5137 18 n 3 209 4 n 120 18 1 24 34 n n 41 20 n 54 53 4 192 34 779 11 638 13 262 1 5 2100 2 n 123 192 n 910 93 5 19 63 4 35 160 4 5 n 328 1 n n n n n 3 n n 1 55 4 443 3 45 n n n 53 297 n 592 n 3 2 n 2 n 190 2 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4198 314 49825 16 55660 4198 288 n 17 889 10 7 5 19 314 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 16 55355 357 16 219 1154 1414 206 3037 483 155 419 247 227 41 569 228 366 313 252 98 1465 1969 5570 228 2593 159 676 31 144 24 714 5613 34 6386 854 83 306 500 80 9200 1280 106 78 Powassan Spotted fever rickettsiosis 38069 7 38069 25 9 12 7 98 2541 435 121 166 8 n 9 287 138 318 23 49 3 1201 1728 4224 148 1805 4 5 5 11 7 529 4855 4314 230 33 154 31 9048 904 42 5 1 3 1 1 Q 2 4 24 2 52 21 114 n 3 52 30 8 146 134 15 1 4 13 2 10 100 324 9 25 2 2 10 3 34 1 4 29 7 25 1 1 8 63 2 40 459 6 12 307 6 16 2 47 2 1 5 1 23 6 3 25 2015 R S 2 1 4 1 1 4 2 TX-DSHS-19-1309-A-000652 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 4 0 0 Territories American Samoa Puerto Rico 60 U.S. Virgin Islands C D 0 0 4 10 1 9 55 3 1 24 39 0 8 0 13 32 1 3 24 19 1 7 0 0 0 237 0 216 61 0 21 3 E 0 58 F G H 15 99 6 8 275 8 66 21 2 5 1 21 24 7 I J 9 8 0 0 0 0 7 TX-DSHS-19-1309-A-000653 2015 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N 49 461 18 4 135 103 7 39 10 82 11 2 145 116 1 6 628 1 1 305 0 281 0 N N 0 U N 0 N N — — — 60 24 9 n 2 56 26 54 7 710 1539 24 289 1894 1 O P Q R S T 605 61 7 3 1 5 296 4 9 5 1 4 4 1 2 21 717 128 21 864 1955 35 305 2586 23 0 — — 0 N N 0 — — 0 — — 0 — — 305 0 281 — — — — — 24 1 1 766 589 40 868 2090 138 312 2625 33 TX-DSHS-19-1309-A-000654 2015 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 96 7521 1226 8 1654 10 2205 0 0 96 0 0 0 0 0 0 0 0 0 1 2 0 0 1 2 0 0 0 0 0 0 2 0 8 1 0 0 0 0 0 0 0 0 23 0 31 0 0 0 0 0 0 2811 19 680 3 4 97 4 130 10 3 1 2 84 4 10 1 7 5 4 1 1 3 1 8 17 5 3 2 2 2 — 8 1 — — — — — — — — — — — — — — — — — — 1653 14 4 25 7 95 30 15 2 18 52 82 4 3 55 20 17 9 11 20 7 146 61 17 51 1 15 2 9 11 11 79 3 263 36 9 38 10 17 85 22 6 5 10 1 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2205 2 0 107 11 801 118 6 0 3 17 13 1 19 44 10 15 54 1 125 0 6 6 1 21 43 13 5 142 3 0 19 24 15 0 23 11 18 8 13 0 3 57 0 0 19 7 137 15 35 7 15 487 36 21 1 29 34 4 15 24 15 6 61 191 21 28 8 18 2 3 25 182 2 803 50 3 5 84 — 42 14 5 97 54 19 2 9 — — 70 8 — 6 5 2 — E 1 — — 1 — — — — — — 3 — — 2 — — — — — — — — — 2014 F G H I J TX-DSHS-19-1309-A-000655 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 12720 4488 1760 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 4488 19 n 1 252 7 n 75 24 1 36 16 n n 65 49 n 55 62 5 205 41 642 7 471 5 380 7 140 133 n 582 85 7 6 81 35 121 8 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3757 180 43654 10 56384 3757 220 N 16 824 11 5 6 24 — 180 — — — 10 29 37 N 1 89 36 10 110 53 18 3 6 8 — 1 — — — 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 51127 344 16 287 1147 1257 202 2712 476 79 864 194 36 34 531 268 245 291 197 189 1666 1643 6775 183 2054 114 723 23 184 27 951 4013 38 5966 868 60 270 359 85 7730 1278 110 75 Powassan Spotted fever rickettsiosis 33461 8 1760 1 N — — 33461 64 8 21 — 3 N 212 1 N N N N N 1 — 73 — 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 N N N — 42 2 537 2 49 N N — — N 41 169 N 471 N — 1 N 1 N 172 3 1 2360 417 40 155 4 N 9 233 110 194 20 44 2 1401 1373 5304 127 1416 2 10 7 7 6 724 3286 — 3736 170 14 119 — 45 7487 904 37 2 Q 42 — 16 — — — 7 2 1 27 1 1 — — 3 2 — — 7 50 265 4 13 1 2 58 2 21 496 3 12 219 5 7 — 20 1 6 — — 1 5 3 — 4 1 17 4 — — — 32 3 5 2014 R S 8 2 TX-DSHS-19-1309-A-000656 47 48 49 50 51 52 53 54 55 56 57 58 59 A B C D — — — — — — — — — E F Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 12 0 0 0 2 0 2 9 0 45 116 2 3 59 14 2 17 2 34 — Territories American Samoa Puerto Rico 0 4710 37 4274 546 — 527 1 399 19 — 60 U.S. Virgin Islands 4 16 9 1 8 — 0 G H 20 106 5 4 77 41 2 11 — 0 4 0 0 0 0 0 0 0 16 379 2 0 7 12 0 6 5 1 — 0 0 I 0 J 0 TX-DSHS-19-1309-A-000657 2014 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 95 639 9 11 161 76 7 51 5 101 15 5257 37 4802 60 418 — M N O P 0 0 0 0 0 0 0 2 0 558 94 8 — 43 — 17 40 13 599 1346 15 136 1361 3 0 N N 0 U N 0 N N 0 — — — N N — 69 137 5 538 1 — 3 N 4 — Q 2 — R S T 1 678 150 22 672 1856 25 147 1955 4 0 N N 0 — — 0 — — 0 — — 5257 37 4802 N — — — 418 1 1 — 373 2 5 11 — 4 1 — 773 789 31 683 2017 101 154 2006 9 TX-DSHS-19-1309-A-000658 2014 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 112 0 10727 8 1594 1 2469 0 0 4 Total: United States (excluding territories) 112 0 843 8 1594 1 2469 0 0 5 Alabama 2 5 — 2 — 9 6 Alaska 0 1 — 4 — 0 33 — 62 1 2 3 Reporting Area B E F G H 7 Arizona 0 1 — 8 Arkansas 0 2 1 2 — 18 9 California 0 119 — 103 — 379 32 — 322 10 Colorado 0 0 — 11 Connecticut 0 18 1 20 — 4 12 Delaware 0 2 — 9 — 3 13 — 1 13 District of Columbia 0 0 — 14 Florida 0 151 3 54 — 7 15 Georgia 2 9 1 67 — 10 1 — 0 5 — 40 117 16 Hawaii 0 10 — 17 Idaho 1 1 — 26 — 64 — 20 — 23 12 — 44 91 18 Illinois 0 19 Indiana 1 6 — 20 Iowa 0 2 — 8 — 8 — 9 — 3 9 — 54 0 21 Kansas 0 22 Kentucky 0 0 — 23 Louisiana 0 6 — 10 — 24 Maine 0 1 — 25 Maryland 0 11 — 147 — 16 26 Massachusetts 1 0 1 71 — 8 21 — 36 27 Michigan 0 16 — 28 Minnesota 6 22 — 67 — 79 29 Mississippi 3 1 — 3 — 45 2013 I J TX-DSHS-19-1309-A-000659 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3359 203 46231 4 61146 15 3359 203 46231 4 51262 24 0 255 — 294 312 14 0 N 1 15 20 97 193 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14911 4551 1796 4 5027 4551 5 18 6 5 1 2 3 O P Powassan Spotted fever rickettsiosis 36307 15 1796 36307 15 — 0 N Q R S 7 96 2 N 32 0 63 — 8 23 172 N — 0 480 38 690 713 9 601 9 3 112 0 15 2 141 742 0 6 1 7 361 10 354 0 N — 11 43 125 289 2925 0 — — 3339 3382 12 14 16 2 509 0 11 — 538 552 41 55 13 14 0 N 35 0 6 — 14 215 23 N 138 0 24 1 186 401 15 89 20 N 8 0 81 — 109 198 0 11 16 11 0 N N 0 N — 17 47 0 N 19 0 1 3 23 70 18 207 53 4 337 0 102 4 500 707 19 50 48 1 110 0 32 5 196 246 20 58 0 N 247 0 8 4 259 317 28 158 265 21 107 96 N 34 0 — 22 12 67 N 40 0 72 3 182 194 23 69 3 2 — 0 5 — 10 79 1512 1523 24 11 100 36 1373 1 2 — 25 174 38 9 1197 0 8 2 1254 1428 26 81 338 425 5290 1 1 8 6063 6144 179 252 3273 27 73 6 2 168 0 3 — 28 174 679 64 2340 1 15 — 3099 29 52 5 N — 0 39 — 44 2013 96 TX-DSHS-19-1309-A-000660 A B C D E F G H 30 Missouri 0 5 — 6 — 29 31 Montana 0 5 — — — 38 32 Nebraska 0 0 — 6 — 226 8 — 11 33 Nevada 1 4 — 34 New Hampshire 1 4 — 10 — 1 35 New Jersey 0 0 — 93 — 12 1 — 38 36 New Mexico 0 0 — 37 New York 3 184 0 254 0 32 38 North Carolina 13 13 1 27 — 3 3 — 125 39 North Dakota 0 1 — 40 Ohio 16 9 — 33 — 24 41 Oklahoma 0 4 — 14 — 89 13 — 16 42 Oregon 1 0 — 43 Pennsylvania 1 24 — 71 — 11 44 Rhode Island 1 9 — 14 — 1 9 — 7 7 — 149 24 45 South Carolina 1 7 — 46 South Dakota 0 3 — 10 — 19 — 90 1 183 7 — 7 2 47 Tennessee 23 48 Texas 0 95 — 49 Utah 0 0 — 2 — 5 — 75 — 6 30 — 1 1 50 Vermont 0 51 Virginia 2 22 — 52 Washington 0 13 — 2 — 53 West Virginia 11 2 — 54 Wisconsin 22 8 — 11 — 21 55 Wyoming 0 1 — — — 41 56 57 Territories 0 9884 0 0 0 0 58 American Samoa 0 0 I 0 J 0 0 TX-DSHS-19-1309-A-000661 2013 K L M N O P Q R S T 30 40 398 N 3 0 245 36 682 722 31 43 1 — 18 0 2 5 26 69 32 232 8 1 10 0 15 17 51 283 18 42 33 24 1 N 16 0 1 — 34 16 97 22 1687 1 4 — 1811 1827 35 105 132 171 3766 1 42 2 4114 4219 36 39 0 N 6 0 4 4 14 37 473 602 534 4615 5 28 — 5784 6257 38 57 93 N 180 0 426 2 701 758 43 172 4 57 39 129 11 1 29 0 2 — 40 82 16 N 93 0 23 2 134 216 41 107 116 N 3 0 241 10 370 477 42 30 1 — 43 0 2 3 49 79 43 107 61 N 5758 0 16 — 5835 5942 44 25 118 142 724 0 2 — 986 1011 110 134 45 24 7 1 42 0 60 — 46 159 1 1 4 0 7 7 20 179 47 76 96 — 25 0 549 4 674 750 48 369 8 1 82 0 83 1 175 544 49 14 1 — 15 0 7 2 25 39 — 949 958 50 9 50 6 893 0 — 51 105 143 N 1307 0 350 2 1802 1907 52 44 2 1 18 0 2 5 28 72 53 16 9 — 143 0 6 — 158 174 54 62 764 78 1872 5 11 1 2731 2793 55 42 0 — 3 0 2 — 5 47 56 57 9884 0 0 0 0 0 0 0 0 9884 58 0 0 U N — N — — — 0 TX-DSHS-19-1309-A-000662 2013 A B C D E F 59 Puerto Rico 9710 0 60 U.S. Virgin Islands 61 62 Total: 174 0 112 0 10727 8 1594 G 1 H 2469 I 0 J 0 TX-DSHS-19-1309-A-000663 2013 K L M N O P Q R S T 59 9710 0 N N — N — — — 9710 60 174 61 62 14911 0 N N — N — — — 174 4551 1796 36307 15 3359 203 46231 4 61146 TX-DSHS-19-1309-A-000664 2013 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 81 0 6714 15 1504 3 5674 0 0 4 Total: United States (excluding territories) 81 0 547 15 1503 3 5673 0 0 5 Alabama 0 4 — 10 62 6 Alaska 0 1 — 8 0 19 133 1 2 3 Reporting Area B E F G H 7 Arizona 0 8 — 8 Arkansas 0 0 — 4 64 9 California 0 64 — 108 479 24 131 10 Colorado 0 0 — 11 Connecticut 0 16 — 21 21 12 Delaware 0 0 — 2 9 6 10 13 District of Columbia 0 0 — 14 Florida 0 139 2 59 73 15 Georgia 0 11 1 66 99 4 0 16 Hawaii 0 8 — 17 Idaho 0 1 — 8 17 21 — 43 290 22 77 18 Illinois 0 19 Indiana 3 9 — 20 Iowa 0 2 — 6 31 1 — 7 56 10 23 21 Kansas 0 22 Kentucky 0 1 — 23 Louisiana 0 6 — 13 335 5 1 24 Maine 0 0 — 25 Maryland 0 9 — 112 47 26 Massachusetts 0 0 7 48 33 26 202 27 Michigan 0 9 — 28 Minnesota 4 9 — 58 70 29 Mississippi 1 1 — 4 247 2012 I J TX-DSHS-19-1309-A-000665 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4470 149 40119 4 54114 7 4470 149 40119 4 47945 25 — 167 — 218 294 10 — N 12 21 50 64 224 837 952 1020 103 754 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 13991 3725 937 4 7822 3725 5 76 6 9 1 2 3 O P Powassan Spotted fever rickettsiosis 30831 7 937 30831 26 — 0 N 7 160 1 N 13 — 8 68 93 N — — 4 70 — — 6 9 651 6 Q 2 — 22 2 21 R S 10 155 0 N — 11 58 142 123 2657 — — — 2922 2980 12 11 18 — 669 — 30 — 717 728 2 — 2 18 1 7 1 163 13 16 0 N N — 14 273 28 N 118 — 31 — 177 450 15 177 31 N 31 — 92 — 154 331 N — 0 12 4 10 36 411 765 147 258 174 213 90 154 110 144 16 12 0 N N — 17 26 0 N 5 — 204 — 33 18 354 50 2 1 4 151 19 111 35 1 74 — 20 39 0 N 165 — 8 19 — — 62 9 — 18 372 — 1179 1185 1707 1875 21 64 49 N 22 34 30 N 14 — 23 354 2 N 7 — 3 24 6 55 10 1111 — 25 168 42 3 1651 — 9 26 88 343 261 5138 — 7 27 237 8 — 98 — 28 141 529 40 1515 29 253 3 N 1 4 1 22 4 2 8 5757 5845 3 — 109 346 4 15 — 2103 2244 — 25 — 29 2012 282 TX-DSHS-19-1309-A-000666 A B C D E F G H 30 Missouri 0 6 — 31 Montana 0 2 — — 6 32 Nebraska 0 0 — 4 193 8 9 19 20 33 Nevada 0 2 — 34 New Hampshire 0 0 — 9 1 35 New Jersey 0 0 — 67 48 2 47 36 New Mexico 0 0 — 37 New York 1 111 0 267 107 38 North Carolina 26 7 2 34 7 2 89 39 North Dakota 0 0 — 40 Ohio 13 6 — 41 121 41 Oklahoma 0 1 — 24 191 12 11 42 Oregon 0 0 — 43 Pennsylvania 0 21 — 52 60 44 Rhode Island 0 0 — 17 4 9 29 45 South Carolina 2 2 — 46 South Dakota 0 2 — 5 203 6 — 12 33 102 47 Tennessee 9 48 Texas 3 16 — 49 Utah 0 0 — 14 5 50 Vermont 0 1 2 4 3 51 Virginia 2 17 1 65 30 52 Washington 0 16 — 26 4 2 10 3 53 West Virginia 14 0 54 Wisconsin 3 11 — 13 57 55 Wyoming 0 0 — — 7 56 57 Territories 0 6167 0 1 58 American Samoa — 0 0 J 1868 — 0 I 1 0 0 0 TX-DSHS-19-1309-A-000667 2012 K L M N O P Q 30 45 228 N 2 — 31 8 0 — 6 — 3 32 197 2 1 15 — 9 — 1 315 27 3 6 R S T 572 617 12 20 33 230 11 30 33 19 0 N 10 — 34 10 55 19 1450 — 2 — 1526 1536 35 115 198 92 3576 — 128 — 3994 4109 4 35 36 49 0 N 1 — 37 486 407 254 2998 1 122 — 1 23 38 76 132 N 39 91 3 — 15 — 40 181 5 N 67 — 4 — 41 216 145 N 42 23 0 — 48 — 43 133 31 N 5033 44 21 107 56 — 17 1 56 3695 4181 846 922 22 113 95 276 575 791 1 49 — 41 — 5105 5238 217 — 13 — 393 414 61 — 107 149 1 11 221 811 871 157 2149 14 33 534 544 1721 1836 N 44 46 210 1 N 4 — 83 — 30 — 77 6 48 1992 5 N 75 49 19 1 N 5 — 522 — 461 1 51 115 148 N 1110 — 52 46 0 — 15 — 5 2 696 — 2 3 6 — 2 9 1 409 45 42 50 10 — 591 — 47 60 1 — 2 — 1 2 5 2 74 21 67 2 — 101 127 — 2529 2613 7 14 53 26 2 N 97 — 54 84 670 69 1766 2 22 55 7 0 — 4 — 2 56 57 6169 0 0 0 0 0 0 0 0 6169 58 0 0 U N — N — — — 0 1 TX-DSHS-19-1309-A-000668 2012 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E 6025 142 F G 1 I — I H I J 1 I 0 I TX-DSHS-19-1309-A-000669 2012 I K 59 6027 60 142 11 L M 0 — 0 — N O N — N — P Q R N — — N — — S — I — T 6027 I 142 I TX-DSHS-19-1309-A-000670 2012 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 137 0 1795 4 1726 6 712 0 0 137 1 0 1 0 0 0 0 0 0 1 2 0 0 1 2 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 26 0 50 0 0 0 0 1 0 0 254 4 0 2 0 5 0 1 2 0 66 6 11 0 8 2 5 1 4 3 0 6 0 6 6 0 0 0 0 1 0 0 2 53 4 1 2 0 0 16 0 1 0 4 — — — — — — — — — — — — — — — — — — — — — 1724 9 5 21 7 129 24 20 7 18 99 91 7 2 66 14 22 10 10 2 6 128 68 34 46 1 21 2 8 8 3 97 5 280 49 — 6 1 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 712 5 0 69 1 158 7 9 1 15 24 22 0 3 34 9 9 4 5 10 0 19 6 34 2 52 10 1 29 16 0 7 4 44 2 4 21 1 0 6 1 0 2 0 0 1 — — — 1 — — — — — — 1 — — — — — — — — — 2011 F 41 10 22 61 6 7 2 G H I J TX-DSHS-19-1309-A-000671 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4380 3586 1128 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 3586 9 0 4 61 2 0 152 18 0 26 38 0 0 36 18 0 25 16 2 27 42 172 9 788 4 194 0 3 0 33 193 0 406 105 3 16 119 6 16 75 3 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2802 166 40795 3 45178 2802 79 N 77 558 8 3 — 166 — — — 3 20 4 12 88 N 2 51 33 7 — 1 — — — — 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 43635 133 16 189 667 404 37 3295 923 37 343 279 18 13 395 173 146 68 44 29 1049 1580 2943 192 3062 87 526 18 65 33 1351 4864 26 5716 601 40 205 482 74 5482 316 85 21 Powassan Spotted fever rickettsiosis 33097 16 1128 1 — — — 33097 24 11 15 — 4 — 92 — 74 1 — — — — 3039 873 N 115 32 N 4 194 94 100 17 3 2 1006 1351 2476 104 2124 5 8 11 11 5 1299 4262 6 4490 88 27 53 2 38 5362 159 37 4 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 N — — — N N — 9 4 208 — 73 — N — — N 13 166 — 418 N 1 N N 1 N 73 — N Q 37 6 3 — 2 5 1 3 11 1 — — — 4 10 1 29 4 4 11 24 270 1 10 2 3 136 — 8 — — — 21 3 4 1 — 3 7 — — 24 327 2 21 335 1 19 2 36 1 2 1 15 5 1 — — 8 2011 R S 2 1 TX-DSHS-19-1309-A-000672 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 12 0 0 0 1 0 26 9 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 3 7 1 3 8 9 0 5 0 0 — — — — — — — E F G H 1 — 21 102 5 6 78 24 1 19 — 0 0 0 0 0 0 0 0 0 18 27 3 1 9 0 2 3 3 1541 0 1541 0 — — 2 1 1 0 0 0 0 0 0 0 — — 0 0 I 0 J 0 TX-DSHS-19-1309-A-000673 2011 47 48 49 50 51 52 53 54 55 56 K 54 136 9 10 96 33 29 37 3 L M 79 6 1 8 131 1 3 731 1 1 N N 1 N — — 57 1543 58 1 59 1542 0 0 0 — 60 0 0 N O 37 74 9 623 1023 19 118 3649 2 0 0 0 0 0 0 0 4 0 N N N 0 0 0 N N 0 80 — P Q 263 52 8 — 3 — 231 4 4 11 10 6 5 — R S T 1 1 383 132 19 632 1391 29 125 4476 14 N N — — — — — — — — 1543 1 1542 N — — — 0 1 — 437 268 28 642 1487 62 154 4513 17 TX-DSHS-19-1309-A-000674 2011 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 75 0 11611 10 1778 10 1021 0 0 75 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 1 0 0 2 0 2 1 0 0 0 0 0 0 0 0 1 22 0 24 0 0 0 0 0 0 0 700 4 1 12 1 36 0 0 0 0 191 12 0 3 23 14 2 4 2 4 6 0 0 9 14 0 6 4 7 4 0 29 1 178 8 1 16 5 0 22 1 13 1 10 ------------------4 ----------------------1 3 ------------------1 ------------1 ----- 1773 9 5 28 4 126 21 22 2 13 139 71 4 5 60 15 14 13 8 5 6 99 73 31 48 2 21 3 15 6 5 106 1 352 52 1 43 6 14 61 15 6 3 10 0 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1021 3 0 167 7 111 81 11 0 6 12 13 0 1 61 13 9 19 3 27 0 23 7 29 8 8 3 0 39 2 1 30 25 128 0 9 5 1 0 28 0 1 20 0 0 2010 F G H I J TX-DSHS-19-1309-A-000675 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14505 2615 0 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 2615 19 N 0 24 4 N 43 22 0 13 22 N N 28 15 N 7 17 1 21 39 0 6 743 6 142 N 2 N 25 130 N 266 127 N 9 106 0 6 41 6 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1985 124 34890 2 49397 1985 83 N 17 162 7 2 --22 1 14 57 N 5 37 27 5 --6 3 2 49 --2 2 26 278 3 5 --1 61 1 30 286 1 15 236 1 15 2 20 --- 124 ----1 19 8 3 --------------1 3 --16 2 ------3 ------18 1 5 1 1 1 1 --3 1 --8 3 1 ----11 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 2 38481 120 13 227 219 421 110 3144 702 64 457 187 4 23 345 165 115 69 44 43 786 1829 3347 179 2779 42 473 15 81 15 1372 4069 34 4382 580 46 156 362 59 3938 241 75 36 Powassan Spotted fever rickettsiosis 30158 8 30158 2 7 2 --129 3 3068 656 42 84 10 N 9 135 78 85 10 5 3 751 1617 3263 95 1960 --4 4 8 2 1339 3712 5 3425 82 33 44 --39 3805 181 29 1 8 ----------------------------------------------3 ----------------1 ------------------- 2010 Q R S 2 TX-DSHS-19-1309-A-000676 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 11 1 0 0 0 0 8 0 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 C 0 D 1 19 0 3 14 19 2 8 0 ------------------- 10911 0 10911 0 ----- 0 --- E F G H 12 98 3 3 67 39 3 15 --- 0 3 0 0 0 0 0 0 0 4 89 2 0 5 2 0 2 6 5 --5 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000677 2010 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 28 210 5 6 86 60 13 25 6 76 7 0 2 93 0 3 544 0 10916 0 10916 0 N N 0 60 0 M N O P Q R S T 36 142 3 356 1245 16 145 3488 --- --------------4 --- 310 34 3 --145 1 --7 1 3 1 2 --1 3 ----3 425 184 8 358 1484 20 148 4043 4 453 394 13 364 1570 80 161 4068 10 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 10916 0 10916 — --- --- --- — — 0 TX-DSHS-19-1309-A-000678 2010 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 2759 4 1456 12 720 0 0 55 1 0 0 0 0 0 0 0 0 0 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 3 16 0 5 0 0 0 0 0 0 0 200 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1451 9 2 10 5 126 26 7 5 17 93 68 1 3 70 25 10 8 13 8 2 80 40 31 43 4 13 5 8 --4 103 --257 32 1 37 2 12 53 5 7 1 12 0 0 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 720 0 0 20 6 112 103 0 0 2 3 4 0 38 5 4 5 13 3 21 0 1 0 1 4 53 5 5 52 12 0 3 8 7 0 1 2 10 11 0 0 3 21 0 0 3 57 5 3 3 6 9 1 5 2 1 2 57 1 3 4 2 2 E 2009 F G H I J TX-DSHS-19-1309-A-000679 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5006 2267 0 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 2267 10 0 1 44 6 0 22 24 0 14 19 0 0 42 21 0 7 12 0 16 34 108 6 363 6 167 0 2 0 24 172 0 339 56 0 14 146 0 34 43 3 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1815 93 42649 8 47663 1815 68 N 23 184 1 1 --19 1 10 52 N 1 49 13 5 1 1 2 5 40 7 5 5 9 253 10 12 1 1 63 1 24 255 --18 342 --23 --19 --- 93 --2 --17 1 3 1 ----1 ------3 1 1 4 1 ----1 4 --1 --13 2 5 ----2 1 1 1 --1 7 1 1 ----5 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 8 N 45099 92 11 64 260 363 134 4186 1032 81 288 190 1 58 307 152 129 51 31 32 996 2180 5415 152 1970 75 460 28 85 28 1445 5316 21 6343 458 17 138 509 62 5837 285 76 28 Powassan Spotted fever rickettsiosis 38468 6 38468 3 7 7 --117 1 4156 984 61 110 40 N 16 136 83 108 18 1 --970 2024 5256 103 1543 --3 3 5 13 1415 4973 5 5651 96 15 58 2 38 5722 235 42 1 6 ----------------------------------------------2 ----------------3 ------------------- 2009 Q R S 1 6 TX-DSHS-19-1309-A-000680 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 8 0 0 0 1 0 14 1 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 61 0 C D 4 14 11 4 0 2559 2559 E F G H 0 0 0 0 0 0 0 0 0 9 87 4 4 61 26 4 10 --- 0 4 0 0 0 1 0 0 0 9 115 2 0 5 38 0 1 12 0 0 0 5 --5 0 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000681 2009 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 30 220 6 4 67 76 18 16 12 90 7 0 1 72 0 2 340 0 2564 0 2564 0 0 0 0 60 0 61 M N O P Q R S T 37 276 9 408 908 16 201 2589 3 --------1 --------- 190 36 1 1 53 --2 5 3 4 ----1 --5 ----2 321 319 10 411 1034 21 205 2934 8 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 2564 0 2564 — --- --- ----- --- — — 0 1 351 539 17 415 1101 97 223 2950 20 TX-DSHS-19-1309-A-000682 2009 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 62 0 1118 4 1257 13 1356 0 0 62 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 1 1 0 0 0 0 1 4 0 0 0 0 0 0 0 6 9 0 9 0 0 0 0 0 0 0 201 2 4 1 ----------------1 ----------------------1 ----------------------1 ----------------- 1255 5 6 15 1 125 5 14 3 7 65 57 3 3 77 5 12 9 6 4 1 80 33 18 29 1 14 --8 5 5 65 3 230 31 --31 5 4 42 3 9 --- 13 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 0 0 1 1 0 0 0 1356 18 0 114 9 445 71 8 1 8 3 8 0 39 20 4 6 31 3 49 0 14 1 17 10 65 15 5 47 16 0 10 8 46 3 37 15 9 16 14 1 1 39 0 0 25 2 5 2 20 3 3 1 1 71 6 7 2 3 E 2008 F G H I J TX-DSHS-19-1309-A-000683 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 3810 2107 0 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 2107 9 0 2 87 0 0 47 24 0 12 20 0 0 34 4 0 0 13 1 18 66 106 3 336 0 227 0 4 0 21 102 0 326 40 0 12 121 0 9 48 1 1 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2563 123 39993 3 43806 2563 93 N 17 129 --1 --33 6 19 78 N 1 110 6 8 --1 6 1 92 2 3 --11 407 3 20 3 1 85 4 54 511 1 31 268 3 15 3 57 3 123 ------11 2 2 ------------2 1 ----2 2 ----1 19 --2 --21 --7 2 --2 1 1 3 3 --7 4 ------10 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 3 42887 137 12 157 241 646 82 3966 833 95 214 202 3 54 350 61 140 58 31 67 930 2471 4744 133 1681 82 694 25 98 41 1629 3749 26 8529 654 51 150 414 66 3902 265 97 56 Powassan Spotted fever rickettsiosis 35198 2 35198 9 6 8 --74 3 3896 772 74 88 35 N 9 108 42 109 16 5 3 908 2218 4582 92 1282 1 6 17 12 12 1601 3485 8 7794 47 10 45 2 38 3818 210 29 3 2 ----------------------------------------------1 ----------------1 ------------------- 2008 Q R S 1 1 1 TX-DSHS-19-1309-A-000684 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 6 0 0 0 2 0 14 6 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 22 8 14 1 3 0 917 917 E F G H ------------------- 15 87 5 5 49 32 2 21 --- 0 0 0 0 0 0 0 0 0 19 64 26 0 1 3 1 8 8 0 ----- 2 --2 0 0 0 0 0 0 --- --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000685 2008 47 48 49 50 51 52 53 54 55 56 K 40 173 31 5 60 49 18 38 8 57 919 58 0 59 919 60 0 L M 78 29 0 0 65 0 0 241 0 N 31 153 5 404 933 23 135 2034 3 O ------------------- P 233 62 7 --155 --10 --10 Q R S T 2 --8 --1 4 --1 2 344 244 20 404 1154 27 145 2276 15 — — — 919 0 919 — 0 0 0 0 U N N N ----- N N ----- — — — 0 — N --- N --- — 384 417 51 409 1214 76 163 2314 23 TX-DSHS-19-1309-A-000686 2008 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 4484 4 1411 9 3630 0 0 55 0 347 5 4 1 1408 7 2 12 2 130 23 30 4 3 56 39 2 6 63 11 3 4 9 14 8 76 34 20 29 2 8 3 7 3 9 72 5 287 22 5 28 10 18 44 8 7 1 9 3630 24 0 0 8 2 53 10 1 1 1 6 9 5 4 1 2 10 140 9 10 3 3 15 3 2007 F G 2 H I J 97 20 380 576 4 1 3 50 3 2 1 1 132 101 24 30 40 4 40 10 6 17 101 136 77 202 163 12 1 1 60 22 8 369 23 107 26 10 5 208 TX-DSHS-19-1309-A-000687 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 9593 1999 0 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 1999 15 0 82 9 31 14 21 14 50 1 1 4 12 39 80 364 222 3 108 316 60 3 106 1 6 22 5 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2221 137 31808 7 41408 2221 96 137 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 7 37268 161 13 134 244 596 605 3123 751 122 182 186 2 151 404 98 180 69 29 63 549 2765 3124 92 1749 161 673 210 204 35 912 3348 82 4974 819 386 116 431 56 4087 207 112 224 Powassan Spotted fever rickettsiosis 27444 7 27444 13 10 2 1 75 7 9 149 55 123 8 6 2 529 2576 2988 51 1238 1 10 4 7 15 896 3134 5 4165 53 12 33 1 6 3994 177 31 1 3 15 1 3 10 122 1 3 3058 715 116 30 11 Q 17 3 19 60 4 39 6 17 12 5 4 6 1 1 4 1 63 9 4 6 20 315 1 14 1 7 1 32 6 35 665 1 1 1 1 1 10 186 2 18 18 3 1 35 10 64 5 7 2007 R S 2 5 TX-DSHS-19-1309-A-000688 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D E 14 32 22 10 1 10 11 4 0 0 4137 F G 21 130 13 5 65 30 1 17 0 3 H I J 11 260 70 5 13 181 0 0 0 0 58 American Samoa 59 Puerto Rico 4137 3 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000689 2007 47 48 49 50 51 52 53 54 55 56 K 46 422 83 5 92 40 13 44 181 L M 38 32 N 31 87 7 138 959 12 84 1814 3 1 39 1 299 O 1 P Q 155 49 2 1 9 123 3 1 R 6 1 13 4 226 169 16 139 1124 13 91 2115 20 S T 272 591 99 144 1216 53 104 2159 201 57 4140 0 0 0 0 0 0 — — 4140 58 0 0 U N — N — — — 0 N — — — 4140 — — — — 0 59 4140 0 N N — 60 0 0 — — — TX-DSHS-19-1309-A-000690 2007 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 69 0 882 8 1476 10 4269 0 0 69 0 105 1 8 1474 9 23 23 4 157 24 13 5 5 61 88 8 1 83 13 2 8 4 9 4 79 29 21 50 6 6 2 4 4 10 90 5 223 32 2 29 10 13 49 4 10 1 10 4269 8 0 0 2 150 29 278 345 9 8 2 1 1 21 1 1 6 3 1 1 3 1 5 2 1 1 15 3 2 1 17 11 1 11 1 9 3 1 1 2006 F G H I J 2 3 8 1 1 2 1 996 215 80 37 30 6 180 11 3 55 65 183 62 34 264 124 1 1 5 8 24 1 137 48 48 69 9 1 113 TX-DSHS-19-1309-A-000691 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 6714 1455 0 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 1455 4 0 40 1 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2288 95 23770 17 30501 2288 94 95 17 11 104 1 6 5 3 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 29722 127 26 205 183 528 377 1847 532 70 147 176 8 1024 473 132 144 50 25 204 356 1506 1529 142 1246 202 353 43 315 135 633 2684 40 5120 993 148 173 247 96 3331 345 82 120 Powassan Spotted fever rickettsiosis 19931 1 19931 11 3 10 1 85 5 37 21 6 16 32 4 4 2 14 75 37 3 196 99 4 1 2 116 377 58 6 47 1 1 23 6 1788 482 62 34 8 7 110 26 97 4 7 1 338 1248 1432 55 914 3 5 1 11 4 617 2432 3 4460 31 7 43 7 3242 308 20 1 Q 22 1 21 53 14 26 6 5 1 3 5 1 1 1 7 1 93 12 6 5 9 163 2 25 11 14 4 7 1 1 41 8 23 852 7 1 1 2 26 139 2 26 10 43 3 4 1 5 2006 R S 2 4 1 8 TX-DSHS-19-1309-A-000692 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories 58 American Samoa 59 Puerto Rico B C D E 7 8 4 16 3 0 8 0 777 F 6 106 18 1 55 43 3 19 0 777 2 G 1 H I J 22 354 158 5 3 1 21 65 0 0 0 0 2 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000693 2006 47 48 49 50 51 52 53 54 55 56 K 35 469 176 1 60 50 20 51 65 L M 35 7 N 15 29 5 105 357 8 28 1466 1 8 171 1 O P Q 265 40 3 3 114 1 1 1 4 1 7 R 315 76 8 105 479 9 33 1639 12 S 1 1 T 350 546 185 106 539 59 53 1690 77 57 779 58 0 59 779 0 0 0 0 U N 0 N N 0 — — 0 N N 0 — — — — — — — — 779 0 779 60 0 0 — — — — — — — 0 TX-DSHS-19-1309-A-000694 2006 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 80 0 2462 21 1498 13 3000 0 0 80 1 0 104 21 2 1494 6 7 21 6 177 24 24 3 11 68 50 18 13 3000 10 0 0 1 113 28 880 106 6 2 5 21 20 5 1 1 1 18 5 5 1 1 1 1 1 4 2 1 F 74 10 9 7 10 5 5 99 39 24 41 2 9 18 2 7 1 15 32 15 G 11 1 1 2005 3 4 6 79 3 251 40 1 30 12 12 37 10 11 H I J 13 252 23 37 25 5 171 5 6 62 45 70 30 25 188 31 6 33 38 4 86 61 31 7 25 1 5 229 TX-DSHS-19-1309-A-000695 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Ehr lichiosis Babesiosis Lyme disease 7074 1404 0 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 1404 3 0 1 42 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1936 154 26800 8 33882 1936 72 154 1 1 2 19 3 5 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 8 31520 98 12 178 232 1160 142 1872 665 28 179 180 18 18 474 70 143 45 31 189 258 1487 2484 158 1218 98 272 28 207 40 282 3584 51 6189 787 91 200 365 26 4399 77 117 245 Powassan Spotted fever rickettsiosis 23305 1 23305 3 4 10 1 25 137 95 4 32 7 5 11 1810 646 10 47 6 6 73 81 2 211 2 127 33 89 3 5 3 247 1235 2336 62 917 54 15 3 106 1 308 37 2 3 265 3363 3 5565 49 3 58 7 5 3 96 16 24 14 3 4287 39 15 2 7 2 14 86 1 3 11 1 7 5 3 6 1 2 5 3 75 6 6 2 18 128 1 6 1 Q 12 2 27 2 8 1 30 4 9 625 1 21 206 2 32 3 70 5 2 2 1 20 2 2 1 8 2005 R S 1 3 4 TX-DSHS-19-1309-A-000696 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 2 Territories American Samoa Puerto Rico 0 C D E 32 4 3 3 15 4 5 1 0 2358 0 2358 F G 14 130 7 2 44 21 3 16 2 1 4 N 4 0 H I J 18 195 52 1 17 12 0 0 0 — 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000697 2005 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N O 35 357 59 2 52 24 18 42 15 24 8 2362 0 2362 0 0 0 0 U N 0 N N 0 — — 0 — — — 60 0 8 69 2 54 274 13 61 1459 3 13 2 205 P 136 30 Q 9 1 1 T 0 — — 0 — — 0 — — 2362 0 2362 — — — 0 9 0 S 2 121 10 2 3 R 177 108 3 54 408 22 73 1666 8 212 465 62 56 460 46 91 1708 23 TX-DSHS-19-1309-A-000698 2005 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 118 0 721 7 1458 15 2539 0 0 118 0 10 7 1458 12 2 17 8 146 16 22 5 13 93 65 4 2 47 17 4 9 5 6 7 81 53 21 30 5 20 1 4 6 5 74 5 268 23 3 30 10 18 44 11 15 2539 16 0 0 4 391 28 779 291 1 2 5 9 2 2 3 4 1 2 1 13 26 1 4 2004 F G H I J 2 41 21 2 3 60 13 23 43 7 109 16 3 1 1 16 34 51 36 6 53 44 1 88 10 3 20 12 22 3 15 TX-DSHS-19-1309-A-000699 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4858 875 0 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 875 5 0 O 2 1 226 2698 1 5100 122 49 83 27388 1713 54 134 3 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 3 26677 96 5 429 273 977 317 1407 352 31 211 194 4 16 226 71 80 66 36 125 233 1108 1696 70 1242 84 278 12 79 51 234 2790 96 5553 742 24 134 294 36 4075 350 4 188 2 4 3 6 1348 339 16 46 12 1 151 45 3 1 25 2 2 22527 19804 6 3 13 63 45 81 134 1 149 1 1713 19804 6 87 32 49 3 15 2 225 891 1532 27 1023 4 Plague Powassan 48 7 13 Tularemia Total TickBorne Diseases: T Total VectorBorne Diseases: Spotted fever rickettsiosis 29 33 2 P 50 3 11 3985 249 Q 20 2 3 22 78 4 14 6 2 1 5 1 9 5 3 5 1 75 15 2 4 28 106 3 16 11 28 2 2 14 2 24 535 1 1 1 19 2 1 11 190 2 30 7 2004 R S 3 TX-DSHS-19-1309-A-000700 45 46 47 48 49 50 51 52 53 54 55 56 A South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D 1 E 1 13 3 2 30 8 0 2 0 711 0 F 10 1 12 111 8 4 59 24 2 14 1 0 G 4 H I J 2 51 14 176 11 5 12 10 0 0 0 0 58 American Samoa 59 Puerto Rico 711 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000701 2004 45 46 47 48 49 50 51 52 53 54 55 56 K L M N 14 52 39 294 19 4 66 24 32 36 11 6 57 711 0 0 0 58 0 0 U 59 711 0 0 60 0 O 22 1 20 98 1 50 216 14 38 1144 4 P Q R S T 7 2 5 1 1 92 9 149 119 4 54 267 18 45 1222 10 0 0 0 — — 711 N — N — — — 0 N N — N — — — 711 — — — — — — — 0 20 3 6 75 64 4 105 20 1 1 45 4 4 1 2 4 106 61 188 413 23 58 333 42 77 1258 21 TX-DSHS-19-1309-A-000702 2004 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area A B 2004 C 2005 D 2006 E 2007 F 2008 G 2009 Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota 4858 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 14 52 7074 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 6714 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 9593 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 3810 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 5006 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 14505 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 4380 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 13991 7822 76 9 160 68 651 155 58 11 16 273 177 12 26 354 111 39 64 34 354 6 168 88 237 141 253 45 8 197 19 10 115 49 486 76 91 181 216 23 133 21 42 210 14911 5027 18 5 96 23 601 354 43 14 14 215 89 11 47 207 50 58 107 12 69 11 174 81 73 174 52 40 43 232 24 16 105 39 473 57 129 82 107 30 107 25 24 159 12720 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 5819 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 TX-DSHS-19-1309-A-000703 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 47461 10550 75 7 186 31 1245 250 140 36 74 1253 192 70 18 370 95 98 73 56 116 24 333 245 175 270 73 82 23 119 54 29 338 26 1518 174 96 179 76 80 294 74 98 161 150842 68382 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 TX-DSHS-19-1309-A-000704 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F G H I J K L M Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 39 294 19 4 66 24 32 36 11 35 357 59 2 52 24 18 42 15 35 469 176 1 60 50 20 51 65 46 422 83 5 92 40 13 44 181 40 173 31 5 60 49 18 38 8 30 220 6 4 67 76 18 16 12 28 210 5 6 86 60 13 25 6 54 136 9 10 96 33 29 37 3 60 1992 19 10 115 46 26 84 7 76 369 14 9 105 44 16 62 42 95 639 9 11 161 76 7 51 5 49 461 18 4 135 103 7 39 10 Territories American Samoa Puerto Rico U.S. Virgin Islands 711 0 711 0 2362 0 2362 0 779 0 779 0 4140 0 4140 0 919 0 919 0 2564 0 2564 0 10916 0 10916 0 1543 1 1542 0 6169 0 6027 142 9884 0 9710 174 5257 37 4802 418 305 0 281 24 14911 TX-DSHS-19-1309-A-000705 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 112 906 50 22 224 156 21 115 18 699 6648 498 93 1319 781 238 640 383 36911 133 35781 997 82460 171 80534 1755 TX-DSHS-19-1309-A-000706 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B 2005 2006 2007 2008 G 2009 H 2004 C D E F 2010 I 2011 J 2012 K 2013 L 2014 M 2015 22527 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 92 9 26800 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 23770 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 31808 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 39993 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 42649 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 34890 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 40795 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 40119 40119 218 12 64 952 103 7 2922 717 2 177 154 0 10 411 147 174 90 110 18 1179 1707 5757 109 2103 29 572 12 33 11 1526 3994 6 3695 846 22 95 575 49 5105 393 107 11 46231 46231 294 15 97 690 141 7 3339 538 41 186 109 0 23 500 196 259 158 182 10 1512 1254 6063 179 3099 44 682 26 51 18 1811 4114 14 5784 701 43 134 370 49 5835 986 110 20 43654 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 49825 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 TX-DSHS-19-1309-A-000707 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 48610 48610 513 16 45 1074 159 18 2181 545 115 262 92 0 27 352 216 261 251 249 29 1957 1917 1582 251 2963 121 647 32 65 19 968 4786 8 5366 833 49 198 216 77 11550 1246 108 32 491671 491671 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 TX-DSHS-19-1309-A-000708 TBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Territories American Samoa Puerto Rico U.S. Virgin Islands C 149 119 4 54 267 18 45 1222 10 — — — — D 177 108 3 54 408 22 73 1666 8 — — — 0 E 315 76 8 105 479 9 33 1639 12 — — — — F 226 169 16 139 1124 13 91 2115 20 — — — — G 344 244 20 404 1154 27 145 2276 15 — — — — H 321 319 10 411 1034 21 205 2934 8 — — — 0 I 425 184 8 358 1484 20 148 4043 4 — — — 0 J 383 132 19 632 1391 29 125 4476 14 — — — — K 811 157 14 534 1721 21 101 2529 7 — — — 0 L 674 175 25 949 1802 28 158 2731 5 — — — 0 M 678 150 22 672 1856 25 147 1955 4 — — — 0 717 128 21 864 1955 35 305 2586 23 — — — 46231 TX-DSHS-19-1309-A-000709 TBDs 0 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 730 179 28 985 1779 32 388 3083 10 5950 2140 198 6161 16454 300 1964 33255 140 — — — — TX-DSHS-19-1309-A-000710 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington B 2004 3 C 2005 1 3 D 2006 E F 2007 2008 2 1 G 2009 N H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 2 2 1 8 1 4 1 1 4 1 1 1 4 8 5 1 6 2 1 1 1 2 1 1 2 4 2 4 2 1 TX-DSHS-19-1309-A-000711 Plague N 2016 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — O 1 Total: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 0 0 0 TX-DSHS-19-1309-A-000712 Plague 50 51 52 53 54 55 56 57 A West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B — — — C — — — D — — — E — — — F — — — G — — — H — — — I — — — J — — — K — — — L — — — M — — — #N/A TX-DSHS-19-1309-A-000713 Plague — — — — — — N Plague 120,000 100,000 80,000 60,000 40,000 20,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Sheet 23 TX-DSHS-19-1309-A-000715 60000 - 50000 40000 - 30000 20000 10000 0 2004 2005 2006 2007 ■ 2008 2009 2010 2011 2012 2013 2014 2015 2016 Reported tick-borne disease cases in US states ■ Reported mosquito-borne disease cases in US territories ■ Reported mosquito-borne disease cases in US states Sheet 24 TX-DSHS-19-1309-A-000716 Reported Cases of NationallyNotifiable Vector-BorneDiseases, 2004-2016 100000 80000 60000 40000 20000 0 -----,----- ---,----- ---,----- -----,--- -----,--- -----,--- 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - Total Vector-Borne Diseases Sheet 25 TX-DSHS-19-1309-A-000717 Reported Cases of NationallyNotifiable Tick-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 -- 2016 Total Tickborne Diseases Sheet 26 TX-DSHS-19-1309-A-000718 Reported Cases of NationallyNotifiable Mosquito-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,------ -----,----------,----------,----------,----------,----------,----------,----------,----------,----------,----------,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - 4842 6970 6610 9247 3609 4806 14505 4363 13990 14911 12719 5808 47500 Sheet 27 TX-DSHS-19-1309-A-000719 ReportedCases of NationallyNotifiableMosquito -Borne and TickborneDiseases by Vector, 2004-2016 60000 50000 40000 30000 20000 10000 0 2004 2005 -- 2006 2007 2008 2009 2010 2011 2012 Total Mosquito-Borne Diseases Sheet 28 -- 2013 2014 2015 2016 Total Tickborne Diseases TX-DSHS-19-1309-A-000720 From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) Sent: Wednesday, March 20, 2019 5:08 PM EDT To: Aldridge,Tiffany (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Sidwa,Tom (DSHS) ; Qualls,Whitney (DSHS Contractor) ; Bolling,Bethany (DSHS) ; Thompson,Martha (DSHS) ; Fonken,Eric (DSHS) ; VanCleave,Crystal (DSHS) ; Sidwa,Tom (DSHS) ; Aldridge,Tiffany (DSHS) ; Broussard,Kelly (DSHS) CC: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: ELC M1 Quarter 2 Call - TX; Action Items/Summary Attachment(s): "VBD ELC Webinar 3-20-19.pdf","ELCPONotes_DVBDM1_Q2 Updates Call Summary-TX.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, team – Thanks again for joining me on the call yesterday to talk about your Q2 updates. The action items can be found on PG. 3 and below: Follow up items: 1. Update Quarter 2 status progress for activities/milestones. Nga will follow up with specific questions on high-level notes from TX team on progress status. 2. Nga will follow up with Roxanne and EET for further questions about the VI (Dallas or HCPH). 3. Nga will follow up with Jeff for ELC guidance questions. TX will follow up with vbdelc@cdc.gov to choose a date/time for the ELC Grantees Meeting "Office Hours" technical discussion with DVBD staff. ---> ELC Guidance Questions 1. With every activity, if you have capacity to do it, should TX put this info down? 2. There's a list of measures that Program H wants to provide. Where's the supplemental performance measures? 3. TX is so diverse in the state itself, they have 11 PH regions. Will this be considered at all as regional capacity? How does someone define "regional"? Once again, please send ALL questions on the ELC guidance to vbdelc@cdc.gov and cc: Nga (ypg2@cdc.gov). Thanks. Have a great rest of your day, everyone. Nga Vuong, MAT Public Health Advisor CDC/NCEZID/DVBD/ADB 3156 Rampart Road, MS P-02, Fort Collins, CO 80521 Cubicle Location: 2-305.30 Phone: 970-494-6682 ypg2@cdc.gov TX-DSHS-19-1309-A-000721 Confidential DVBD (M1) Monitoring Portal 2018-2019 Grantee: Texas Page 1 of 4 ELC Project Officer Notes Grantee: 0 Quarter 1 Texas Quarter 2 Date of call or request 0 Quarter 3 0 Quarter 4 03-19-2019 TX-DSHS-19-1309-A-000722 03/20/2019 5:07pm projectredcap.org EDCap Confidential Grantee: Texas Page 2 of 4 Questions Funds: -Need status on progress of spending down funds. On track? Any delays? ---> TX Call: 95% on track to spending down the funds. 60k left in the STAR requests may use in supplies. Tiffany may assess RD of contingency funds (< 20% threshold). Strategy 1 PVD cases a. Who communicates West Nile- or Zika-reactive blood donations to the health department? ---> TX Call: Kelly does the arbo case reporting - comes from the blood centers. If the LHDs receive, they'll share with the SHD. b. What does the health department do to investigate a West Nile- or Zika-reactive blood donation? ---> TX Call: LHDs does the investigation. c. If your health department does not routinely perform its own confirmatory testing, how do you get these results from blood collection agencies? ---> TX Call: Case by case. All initial testing by the blood collection agency is meaningful, but SPHL may ask for the locals to investigate and will assess if a follow up test is needed. d. If a blood collection agency does not perform confirmatory testing or reports inconclusive results, how does the health department handle this situation? ---> TX Call: As related to reporting, if it doesn't meet the lab criteria, then it won't be reported as a case. If there's concern of local transmission, they will encourage follow up for samples or additional testing and will assess past travel history, S/S, risk factors. 1.9 - Currently checking with all states to confirm their current reporting mechanism for human case data to ArboNET and their current status of onboarding to transmit Arboviral v1.3 Messages to CDC via HL7 messages. We currently have you listed as having NEDSS 1.3 in production and with post-production work ongoing. Is this correct? ---> TX Call: Sounds good as stated above. Currently working to upgrade NEDSS. Will be at 5.3 by June. Strategy 2 1. Are you incorporating the Vector Index (as found in the CDC WNV surveillance guidelines) as part of your mosquito surveillance program? ---> TX Call: TX doesn't have a centralized mosquito control program - Dept Ag. is main entity. TX has many counties that submit mosq surv data to the lab or will have the pos mosq pools are submitted over. Majority of programs do mosq adulticiding without conducting any surv activities. This means that the local entities can't look at the historical data to use for VI activities. Dallas may possibly use VI but they have years of data. Harris County as well - TX can see this in the reports HCPH provides to the states. There are 286 entities that do some sort of mosquito control but 161 don't do surv accordingly. This is unclear for the remainder of these programs (what type of data theyre using to drive intervention?). 2. Top priority for activities in the next mosquito season? Any pending needs from the vector team? ---> TX Call: NCE for Zika pregnancy. Top priorities: Arbo/Ento program - Maintaining, enhancing current capacity to do mosq arbo testing. Need staff and reagents. Will provide 10 jurs with mosquito kits that have not submitted mosq samples to the state yet. Would like to build capacity through the state by building up the Arbo/ento program. IR testing collaboration. ---> TX Call: Epi: Fully funded for VBDs, but have two positions funded through Zika supplemental - would like to keep these positions in the next cycle. Communication and outreach for the DIN conference - proposed to apply differently in this next cycle - lower the registration fee from $350 to $250 instead. 2.2 - What barriers are you facing for IR testing? Is it testing itself, inputting data, or something else? How would you feel about mosquito districts inputting their IR testing data directly to MosquitoNET? ---> TX Call: Bethany is submitting for MNet surv data monthly during the mosquito season. Last season's data has been updated for the IR side through collab with ELC funds. TX capacity will decrease if ELC funds decrease as well. Working with Texas Tech and RGV for aedes population. 161 tests done by RGV and 50 by TX tech. ---> TX Call: IR side - There used to be a yearly report with the contractors. This has been changed for monthly data. There were lots of glitches with uploading that becomes problematic for the state and partners. Quarterly would be easier, esp. during the mosquito season. ---> TX Call: HCPH may be the only jurisdiction that does their own IR testing - some others contract with VDCI, Clarke, etc. Most other programs have not been doing. Sometimes, the state is asked to do IR testing for locals, but funding is limited to Culex and not Aedes. There is limited capacity to provide the testing. TX wouldn't have an issue with local entering IR testing data directly into MNet, but they would want to have access to the data. This would ensure that there is situational awareness between Whitney and Bethany and the locals. Strategy 3 - Top priority for activities in the next mosquito season? Any pending needs from the lab team? - Keep us updated on if TX runs into issues with this year's proficiency panel. We can link you back to the diagnostics and reference team to troubleshoot. TX-DSHS-19-1309-A-000723 ---> TX Call: Staff top priority - addn FTE for testing (arbo/human). Reagents, maintenance contracts. 03/20/2019 5:07pm projectredcap.org EDCap Strategy 4 4.2- Upcoming events or trainings that they will be attending or hosting? State-wide or national? - ELC meeting? Tom, Martha, Susan, Tiffany - Will need the phone line. - NAVCO attendee? Whitney ELC Guidance Questions 1. With every activity, if you have capacity to do it, should TX put this info down? 2. There's a list of measures that Program H wants to provide. Where's the supplemental performance measures? 3. TX is so diverse in the state itself, they have 11 PH regions. Will this be considered at all as regional capacity? How does someone define "regional"? Notes Call attendees: CDC - Nga TX - Tiffany, Whitney, Tom, Monica, Kelly, Martha, Bethany, Crystal - missing a few other names from TX team (low volume) Strategy 1 Strategy 2 Strategy 3 Strategy 4 Action Items CDC Update: 1. ArboNET was modified to accept a new diagnostic test type. It is called 'Arboviral antigen, Specimen Unspecified'. This would include diagnostic tests that detect dengue non-structural proteins (NS1), which you may already be familiar with. If you have any questions, please reach back to us and we'll connect you with our technical advisors. 2. Vector Week has been tentatively moved to early 2020. Funding for travel to two CDC national meetings should be included: 2020 Vector Week - CDC National Conference; Fort Collins, CO or Denver, CO (1-3 representatives; 3 days and travel) and 2020 ELC Grantees Meeting (1 representative, 1 day pre-conference meeting). 3. Looking for success stories to share with technical staff and leadership teams. ---> TX Call: TX has 5 they're working on. 4. DVBD will provide programmatic guidance for the new application following the general ELC DPEI webinars (March 14/19). DVBD will host a webinar on March 20 3pm-4pm ET - Invite has been sent out. Send ALL questions on the ELC guidance to vbdelc@cdc.gov and cc: Nga (ypg2@cdc.gov). 5. New team member to the DVBD/ADB project officer group - Chris Duggar, Senior PHA - Chris will be the back-up to Kat, Kristine, and Nga (ELC M1 Program Consultants). His contact information is cnd8@cdc.gov/cduggar@cdc.gov. Follow up items: 1. Update Quarter 2 status progress for activities/milestones. Nga will follow up with specific questions on high-level notes from TX team on progress status. 2. Nga will follow up with Roxanne and EET for further questions about the VI (Dallas or HCPH). 3. Nga will follow up with Jeff for ELC guidance questions. TX will follow up with vbdelc@cdc.gov to choose a date/time for the ELC Grantees Meeting "Office Hours" technical discussion with DVBD staff. ---> ELC Guidance Questions 1. With every activity, if you have capacity to do it, should TX put this info down? 2. There's a list of measures that Program H wants to provide. Where's the supplemental performance measures? 3. TX is so diverse in the state itself, they have 11 PH regions. Will this be considered at all as regional capacity? How does someone define "regional"? Quarterly Call Supporting Document TX-DSHS-19-1309-A-000724 Confidential Grantee: Texas Page 4 of 4 Quarterly Call Supporting Document TX-DSHS-19-1309-A-000725 03/20/2019 5:07pm projectredcap.org EDCap ELC2019- Program H Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond March 20, 2019 Division of Vector-Borne Diseases National Center for Emerging Zoonotic and Infectious Diseases TX-DSHS-19-1309-A-000726 Agenda • Welcome and Introductions • Overview of current vector-borne disease (VBD) issues in the US • Overview of NEW VBD Guidance • Tiered approach • CDC Priorities • Points of Contact • Questions TX-DSHS-19-1309-A-000727 Current State of VBDs in the U.S. - Increasing Cases (2004-2016) • Between 2004 and 2016, more than 640,000 cases of VBDs were reported in the US • The reported data substantially underestimates actual disease occurrence (8 to 70 fold depending on the disease) • The number of reported cases of disease spread by fleas, ticks and mosquitos has more than tripled • Tickborne diseases accounted for over 75% of reported VBD cases • Mosquito-borne disease epidemics happen more frequently Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. TX-DSHS-19-1309-A-000728 MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. Reported Nationally Notifiable Mosquito-borne*, Tickborne, and Fleaborne+ Disease Cases - US States and Territories, 2004-2016 60000 50000 40000 30000 20000 10000 0 2.004 2.005 2.006 2.007 2.008 2.009 2012 2.011 2.010 Reported mosqLiito-borne dis.ease cases in US st ates ■ Reported mos,quito -bome disease cases.in US territories 2013 2014 2016 2015 Reported tick -borne disease cas.esin US states ■ "Mosquito-borne case counts include both locally transmitted and travel-associated cases. + A total of 89 flea borne disease cases (plague) were reported during 2004-2016, ranging from two cases in 2010 to 16 cases in 2015. The cases are not depicted on the figure. Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. TX-DSHS-19-1309-A-000729 Division of Vector-Borne Diseases VISION: Create a future where vector-borne diseases no longer threaten public health MISSION: Reduce illness and death due to VBDs GOAL 1: Identify and detect vector-borne pathogens that cause disease in people GOAL 2: Understand when, where, how often and how people are exposed to vector-borne pathogens GOAL 3: Prevent exposure to vector-borne pathogens and mitigate consequences of infection GOAL 4: Implement vector-borne disease diagnostics, surveillance, control and prevention programs TX-DSHS-19-1309-A-000730 A Call to Action for a National Strategy/National Action Plan Am. J. 1~ . Me/Jt . f-00_, i ~) . 20 19 . A] •. 242 - 2-4$ oo :10.4 269/a:_nim.iS-0841 Oopyligliit e 2'019 by-TheAmerican SocieWofTrq:iicalMed.ldne aoo HygieM P erspec1 1-.1v:e p·iece r C,omba11ing t he ~ncr,easing Thr,eat ,of V,ec:t ,or-lBorne Dis,ease in the Unit,ed States with a National Vee:1 :or---B,orne Disease Prev,en1ion and Control Syst em 1 1 1 1 1 ly l'e R. Pietierse n , Charl:es 8. Beam, .al1ldSusanin.aN. Viss,er* Division of Vee10.r -Bome Diseases1 Natiarisl ce ,uer tot EmetgituJ tJJ1d Z oon01.icl11fecrious,Ds~e,s, 1 1 Ce.i1:te.r:s for DisaeiSe a,mro-l Md Prevention, Fen Collins, CcJlot8do • Highlightsthe importance of sustaining states health departments in their role of combating VBDs and the need for a common national strategy to protect the US from VBD threats TX-DSHS-19-1309-A-000731 ELCVBD Funding 2012-2019 Arbo $72,307,103 Total $74,108,830 $30 $25 $20 V, C: ,Q $15 ~ $10 $5 $0 2012 2013 2014 ■ M1 -Arbo 2015 ■ N1 - Lyme 2016 ■ 2017 N2 - Non-Lyme Tickborne 2018 2019 TX-DSHS-19-1309-A-000732 DVBDApproach to Prevention and Control of VBDs Goal • Sustained, national capacity to detect, prevent, investigate, report, and control new and emerging vector-borne threats ELCVBD Goal • Support Jurisdictions to build sustainable, locally relevant programs to identify, prevent and respond to vector-borne diseases TX-DSHS-19-1309-A-000733 VBD ELC2019 - Overview • Vector-Borne Diseases moving from Project to Program • Combined VBD guidance • No longer Ml, Nl and N2 • New tiered approach • Core activities - Tier 1 • Enhanced activities - Tiers 2 and 3 • Focus on priority VBDs of the jurisdiction • FY2019 Funding - ~$16 million TX-DSHS-19-1309-A-000734 VBD ELC2019 - Overview • Average award range: $150,000-260,000 • Opportunity to fund a limited of jurisdictions for Tier 3 • 5-7 jurisdictions at $500,000-750,000 total • Communicate your current capacity • Baseline for comparison to future year capacity • Please include jurisdiction • • • • POCs: Arbovirus Lyme Disease, plague, tularemia Rickettsial diseases Parasitic vector-borne diseases (non-malaria) TX-DSHS-19-1309-A-000735 Tier 1 • Core activities for VBD programs - Summary • Epidemiology • Surveillance of nationally notifiable VBDs: data collection, reporting and evaluation • Limited educational outreach • Capacity to investigate and respond to VBD cases as necessary • Laboratory • Testing for VBDs of public health importance to the jurisdiction • Participation in VBD proficiency panels • Ecology • Report passively collected vector, sentinel animal, or veterinary cases • Ability to advise local agencies on vector control TX-DSHS-19-1309-A-000736 Tier 2 • Enhanced activities for VBD programs - Summary • Epidemiology • Surveillance and reporting of NON-nationally notifiable VBDs • Develop and maintain surveillance and response plan for VBDs • Laboratory • Enhanced laboratory capacity • Ecology • Actively conduct or coordinate ecologic/vector surveillance and reporting (e.g. ArboNET, MosquitoNET) • Pathogen testing in ticks, in collaboration with CDC • Pathogen testing in mosquitos • Insecticide resistance testing for mosquitos • Tick surveillance - Guidance released*, Tick module in ArboNET ~ https://www.cdc.gov/ticks/resources/TickSu rve i Ila nee lsca pu la ris-P.pdf TX-DSHS-19-1309-A-000737 Tier 3 • Regional focus, local reach/resource sharing • Collaboration with public health and academic partners • Epidemiology • Enhanced surveillance • Capacity to lead complex investigations; assisting other jurisdictions • Novel surveillance and interventions • Laboratory • Regional reference laboratory support for other jurisdictions • Advanced diagnostics TX-DSHS-19-1309-A-000738 Tier 3 - Continued • Ecology • Vector-control implementation/coordination • Develop and implement a comprehensive integrated vector surveillance and control plans • Pathogen testing in ticks (at jurisdiction) • Enhanced communication activities • Advanced message dissemination and reporting • VBD communication plans • Multi-faceted outreach to diverse audiences TX-DSHS-19-1309-A-000739 2019 Priorities • • • • Jurisdiction's priority VBDs and vectors Communicating your current capacity If you don't ask for it, we can't fund it Assuring Core (Tier 1) capabilities in every jurisdiction • Inclusion of one FTE (or% FTE)to support activities • Travel to ELCGrantee meeting AND 4 day VBD meeting ("'Feb 2020) • Supplies/shipping • Education materia Is TX-DSHS-19-1309-A-000740 2019 Priorities - Enhanced • Enhanced (Tier 2) • Demonstrated Tier 1 capacity • Enhanced ecology activities • Tick surveillance - reporting in Tick Module in ArboNET • Mosquito surveillance/ insecticide resistance MosquitoNET • Additional FTEs(or% FTE) • Travel for staff to VBD meeting in Feb 2020 • Supplies/shipping to support enhanced lab activities • Education materials TX-DSHS-19-1309-A-000741 2019 Priorities - Enhanced • Enhanced (Tier 3) • Demonstrated Tier 1 and 2 capacity • Supporting comprehensive programs that develop and maintain capacity to: • Use surveillance data for decision making and coordinate complex investigations and responses, including vector control and communications planning • Collaborate between stakeholders and lower level health and vector control jurisdictions • Demonstrate linkage of surveillance to prevention and control ofVBD TX-DSHS-19-1309-A-000742 Points of Contact • VBD ELC Guidance - Jeff Borchert gqxl@cdc.gov • Technical POCs • • • • Arbovirus diseases: Stacey Martin, zmt0@cdc.gov Lyme disease, plague, tularemia: Kiersten Kugeler, bio1@cdc.gov Rickettsial diseases: Kristen Nichols Heitman, wwd7@cdc.gov ; Parasitic vector-borne diseases (non-malaria): Elizabeth Gray, din8@cdc.gov • Tick surveil la nee guidelines - ticksu rvei Ila nce@cdc.gov TX-DSHS-19-1309-A-000743 New Vector-Borne Disease Program Inbox VBDELC@cdc.gov Questions? 60000 50000 40000 30000 20000 10000 0 2004 2005 2006 2007 2008 2009 2010 Reported mosquito-borne disease cases in US states ■ Reported 2011 2012 ■ Reported mosquito-borne disease cases in US territories 2013 2014 2015 2016 tick-borne disease cases in US states Chartl TX-DSHS-19-1309-A-000746 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A B C D E F G H I J K L M TABLE 1. Vector-borne disease cases reported to National Notifiable Disease Surveillance System U.S. and territories, 2004-2016* N Disease 2004 Tickborne Diseases Lyme Disease 19,804 Anaplasmosis/Ehrlichiosis† 875 Spotted Fever Rickettsioses§ 1,713 Babesiosis N Tularemia 134 Powassan virus 1 Subtotal Tickborne Diseases 22,527 2005 2006 2007 2008 2009 Year 2010 2011 2012 2013 2014 2015 2016 23,305 1,404 1,936 N 154 1 26,800 19,931 1,455 2,288 N 95 1 23,770 27,444 1,999 2,221 N 137 7 31,808 35,198 2,107 2,563 N 123 2 39,993 38,468 2,267 1,815 N 93 6 42,649 30,158 2,615 1,985 N 124 8 34,890 33,097 3,586 2,802 1,128 166 16 40,795 30,831 3,725 4,470 937 149 7 40,119 36,307 4,551 3,359 1,796 203 15 46,231 33,461 4,488 3,757 1,760 180 8 43,654 38,069 5,137 4,198 2,100 314 7 49,825 36,429 5,750 4,269 1,910 230 22 48,610 Mosquito-Borne Diseases** Dengue viruses¶ 721 Zika virus N West Nile virus 2,539 Malaria 1,458 Chikungunya virus N California serogroup viruses†† 118 St. Louis encephalitis virus 15 Eastern equine encephalitis virus 7 Yellow fever virus 0 Subtotal Mosquito-Borne Diseases 4,858 2,462 N 3,000 1,498 N 80 13 21 0 7,074 882 N 4,269 1,476 N 69 10 8 0 6,714 4,484 N 3,630 1,411 N 55 9 4 0 9,593 1,118 N 1,356 1,257 N 62 13 4 0 3,810 2,759 N 720 1,456 N 55 12 4 0 5,006 11,611 N 1,021 1,778 N 75 10 10 0 14,505 1,795 N 712 1,726 N 137 6 4 0 4,380 6,714 N 5,674 1,504 N 81 3 15 0 13,991 10,727 N 2,469 1,594 N 112 1 8 0 14,911 1,226 N 2,205 1,654 7,521 96 10 8 0 12,720 1,015 N 2,175 1,397 1,133 70 23 6 0 5,819 1,178 41,680 2,149 1,958 427 53 8 7 1 47,461 8 17 7 3 8 2 3 4 4 10 16 4 Total Vector-Borne Diseases 27,388 33,882 30,501 41,408 43,806 47,663 49,397 45,178 Abbreviations: N = not notifiable * Unless stated otherwise, all cases reported from continental U.S., Hawaii, and Alaska † Anaplasmosis and ehrlichiosis were reported separately after 2008 but are combined here for the entire period. § Includes R. 54,114 61,146 56,384 55,660 96,075 Fleaborne Disease Plague 3 rickettsii, R. parkeri, R. 32 philippi ¶ Dengue became reportable to NNDSS from 2010. Data 2004-2009 from Dengue Branch, Division of Vector-Borne Diseases, 33 CDC. ** Cases reported from U.S. states, District of Columbia, 34 and territories 35 †† Includes Jamestown Canyon, La Crosse, and unspecified California serogroup viruses §§ For babesiosis and malaria, surveillance data are reported independently to different CDC programs. For this reason, surveillance data reported elsewhere might vary slightly from data 36 reported in this summary TX-DSHS-19-1309-A-000747 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 O Total 402,502 39,959 37,376 9,631 2,102 101 491,671 46,692 41,680 31,919 20,167 9,081 1,063 133 106 1 150,842 89 642,602 32 33 34 35 slightly from data 36 TX-DSHS-19-1309-A-000748 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah B MBDs C TBDs 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 699 6648 498 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 5950 2140 198 D E Plague F Total VBD: 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 2859 204 2737 7458 10666 3004 37272 8610 1024 5670 2848 414 1583 6268 2233 2577 1823 1363 1635 12977 24091 51443 2553 28344 1676 7196 577 2159 574 13883 53482 599 76480 10043 1376 2717 5523 950 75005 7389 1455 1537 6649 8789 699 TX-DSHS-19-1309-A-000749 Map Data 47 48 49 50 51 52 53 54 55 56 57 A Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B C 93 1319 781 238 640 383 171 80534 1755 6161 16454 300 1964 33255 140 D E F 0 0 0 0 0 0 0 0 0 6254 17773 1081 2202 33895 523 171 80534 1755 Total: 642602 TX-DSHS-19-1309-A-000750 Map Data A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 B C D E Reported mosquito-borne disease Reported mosquito-borne cases in Reported tick- and flea-borne Reported tick- and flea-borne cases in US states US territories disease cases in US states disease cases in US territories 4147 711 22527 4712 2362 26800 5935 779 23770 5453 4140 31,808 2891 919 39993 2442 2564 42649 3589 10916 34890 2837 1543 40795 7822 6169 40119 5027 9884 46231 7463 5257 43654 5514 305 49825 10550 36911 48610 Reported mosquito-borne disease cases in US states 2004 4147 Reported mosquito-borne disease cases in US territories 0 0 0 0 0 0 0 0 0 0 0 0 0 Reported tick-borne disease cases in US states 711 22527 2005 4712 2362 26800 2006 5935 779 23770 2007 5453 4140 31808 2008 2891 919 39993 2009 2442 2564 42649 2010 3589 10916 34890 2011 2837 1543 40795 2012 7822 6169 40119 2013 5027 9884 46231 Histogram TX-DSHS-19-1309-A-000751 49 50 51 52 53 54 55 56 57 A B 2014 C 7463 D E 5257 43654 2015 5514 305 49825 2016 10550 36911 48610 TX-DSHS-19-1309-A-000752 Histogram 1 2 3 4 5 6 7 8 A Year Total Mosquito-Borne Diseases B J K L 2005 7074 2006 6714 2007 9593 2008 3810 G 2009 5006 H 2004 4858 C D E F 2010 14505 I 2011 4380 2012 13991 2013 14911 2014 12720 M 2015 5819 Year Total Tickborne Diseases 2004 22527 2005 26800 2006 23770 2007 31808 2008 39993 2009 42649 2010 34890 2011 40795 2012 40119 2013 46231 2014 43654 2015 49825 Year Total Vector-Borne Diseases 2004 27388 2005 33882 2006 30501 2007 41408 2008 43806 2009 47663 2010 49397 2011 45178 2012 54114 2013 61146 2014 56384 2015 55660 TX-DSHS-19-1309-A-000753 Line Summaries Line Summaries 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 A B C D E F G Tickborne Diseases H Reporting Area Lyme disease Anaplasmosis/Ehrlichiosis* Spotted fever rickettsioses† Babesiosis Tularemia Powassan Subtotal Tickborne Diseases: United States (excluding territories) 36429 5750 4269 1910 230 22 Alabama 38 21 453 — 1 — Alaska 15 N N N 1 Arizona 13 2 27 N Arkansas 2 218 821 California 134 6 Colorado — Connecticut I J K L Mosquito-borne Diseases Dengue Zika West Nile Virus Malaria 48610 961 5168 2149 1955 513 5 37 19 13 — 16 5 — — 2 3 — 45 13 54 78 38 1 32 — 1074 3 13 9 5 14 3 2 — 159 197 421 442 125 N 4 N 14 — 18 21 55 149 25 1748 104 6 322 — 1 2181 6 118 1 13 Delaware 506 20 17 2 — — 545 2 17 — 16 District of Columbia 103 6 4 2 — — 115 9 41 1 23 Florida 216 34 12 N — — 262 68 1107 8 62 Georgia 4 14 74 N — — 92 20 107 6 57 Hawaii N N N N — — 0 56 11 — — Idaho 17 N 7 N 3 — 27 4 5 9 — Illinois 237 40 68 2 5 — 352 35 105 154 62 Indiana 152 24 40 — — — 216 9 49 18 17 Iowa 232 14 11 1 3 — 261 11 26 37 22 Kansas 39 57 130 N 25 — 251 4 20 37 11 Kentucky 33 46 167 1 2 — 249 1 31 8 13 Louisiana 7 3 17 2 — — 29 6 38 59 12 Maine 1487 383 4 82 — 1 1957 2 12 — 10 Maryland 1866 44 1 6 — — 1917 13 130 6 180 Massachusetts 198 848 8 518 5 5 1582 8 119 17 93 Michigan 221 14 13 2 1 — 251 16 67 43 43 Minnesota 2126 773 6 50 3 5 2963 29 66 83 67 Mississippi 1 9 111 N — — 121 — 23 43 7 Missouri 10 252 350 1 34 — 647 13 37 11 20 Montana 17 2 9 1 3 — 32 2 9 6 4 Nebraska 14 9 31 1 10 — 65 3 13 95 7 Nevada 15 — 4 N — — 19 6 22 16 7 New Hampshire 891 60 2 13 1 1 968 3 11 — 14 New Jersey New Mexico 4350 1 193 N 64 — 174 N 5 7 — — 4786 8 51 5 180 10 11 6 84 2 New York 3882 964 37 481 — 2 5366 136 1002 22 319 North Carolina 272 77 482 N 1 1 833 13 100 2 46 North Dakota 32 15 1 1 — — 49 2 3 85 5 Ohio 160 14 24 — — — 198 6 83 17 60 Oklahoma — 66 124 N 26 — 216 5 29 35 7 Oregon 61 4 6 2 4 — 77 9 47 4 20 Pennsylvania 11443 81 22 N 4 — 11550 21 175 16 77 Rhode Island 903 183 4 155 — 1 1246 5 55 2 9 South Carolina 51 1 54 2 — — 108 11 61 8 14 South Dakota 11 1 6 — 14 — 32 2 3 152 4 Tennessee 25 107 595 1 2 — 730 12 61 7 24 TX-DSHS-19-1309-A-000755 2016 Table MMWR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 M N O P Q R Chikungunya California Serogroup Viruses§ St. Louis encephalitis EEE Yellow fever Subtotal Mosquito-Borne Diseases: 248 53 8 7 1 1 — — — — — — — — 3 — — 1 — 57 S Fleaborne Diseases T Plague Total Vector-Borne Diseases: 10550 4 59164 75 — 588 — 7 — 23 — — 186 — 231 — — — 31 — 1105 — 3 — — 1245 — 1404 — — — — — 250 — 268 2 — — — — 140 — 2321 1 — — — — 36 — 581 — — — — — 74 — 189 8 — — — — 1253 — 1515 1 — — 1 — 192 — 284 3 — — — — 70 — 70 — — — — — 18 — 45 13 — 1 — — 370 — 722 2 — — — — 95 — 311 2 — — — — 98 — 359 1 — — — — 73 — 324 3 — — — — 56 — 305 1 — — — — 116 — 145 — — — — — 24 — 1981 4 — — — — 333 — 2250 6 2 — — — 245 — 1827 4 — — 2 — 175 — 426 16 9 — — — 270 — 3233 — — — — — 73 — 194 1 — — — — 82 — 729 1 — — 1 — 23 — 55 1 — — — — 119 — 184 — — 3 — — 54 — 73 1 — — — — 29 — 997 11 3 — — — — 1 — — — 338 26 38 — — — 1 3 8 — 2 — 1 — — — 4 9 — — — — — 4 5124 38 1518 — 6884 174 — 1007 — 96 — 145 — — 179 — 377 — — — 76 — 292 — — — — 80 — 157 5 — — — — 294 — 11844 3 — — — — 74 — 1320 4 — — — — 98 — 206 — — — — — 161 — 193 4 4 — — — 112 — 842 U V W TX-DSHS-19-1309-A-000756 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F Texas 71 17 87 1 3 — Utah 19 — 4 — 5 G H I J K L 179 45 312 370 159 — 28 6 21 13 8 — 985 3 11 2 6 Vermont 761 207 2 15 — Virginia 1350 115 312 N 2 — 1779 28 108 8 74 Washington 31 — — — 1 — 32 24 69 9 44 West Virginia 368 6 14 — — — 388 — 11 1 1 Wisconsin 2295 695 19 68 1 5 3083 7 60 13 20 Wyoming 1 1 1 — 7 — 10 — 3 11 4 Territories 0 0 0 0 0 0 — 217 36512 — 3 U — — — 2 131 — — — — 3 American Samoa N N N Puerto Rico N N N N — 204 35395 — U.S. Virgin Islands — — — — — — — 11 986 — — Total: 36429 5750 4269 1910 230 22 48610 1178 41680 2149 1958 TX-DSHS-19-1309-A-000757 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 M N — O 20 — — 1 — 1 — — — — — 6 — — 10 — — P — Q R S T 906 — — 50 — 78 — 22 — 1007 — — 224 — 2003 — — — 156 — 188 8 — — — 21 — 409 2 13 — — — 115 — 3198 — — — — — 18 — 28 179 0 — — — 36911 — 36911 — — — — — 133 — 133 179 — — — — 35781 — 35781 — — — — — 997 — 997 427 53 8 7 1 47461 4 96075 U V W 1085 TX-DSHS-19-1309-A-000758 2016 Table MMWR A 1 2 3 Reporting Area B California Serogroup Viruses C D E F G H I J Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 53 427 1178 7 1958 8 2149 1 41680 53 248 961 7 1955 8 2149 1 5168 5 — 11 — 19 — 37 2 — — — — 4 Total: United States (excluding territories) 5 Alabama — 1 6 Alaska — — 5 — 7 Arizona — 3 13 — 38 — 78 — 54 8 Arkansas — 1 3 — 5 — 9 — 13 California — 57 197 — 125 3 442 — 421 10 Colorado — — 21 — 25 — 149 — 55 11 Connecticut — 2 6 — 13 — 1 — 118 12 Delaware — 1 2 — 16 — — — 17 13 District of Columbia — — 9 — 23 — 1 — 41 14 Florida — 8 68 — 62 — 8 — 1107 15 Georgia — 1 20 1 57 — 6 — 107 16 Hawaii — 3 56 — — — — — 11 17 Idaho — — 4 — — — 9 — 5 18 Illinois — 13 35 — 62 1 154 — 105 19 Indiana — 2 9 — 17 — 18 — 49 20 Iowa — 2 11 — 22 — 37 — 26 21 Kansas — 1 4 — 11 — 37 — 20 22 Kentucky — 3 1 — 13 — 8 — 31 23 Louisiana — 1 6 — 12 — 59 — 38 24 Maine — — 2 — 10 — — — 12 25 Maryland — 4 13 — 180 — 6 — 130 26 Massachusetts 2 6 8 — 93 — 17 — 119 27 Michigan — 4 16 2 43 — 43 — 67 28 Minnesota 9 16 29 — 67 — 83 — 66 29 Mississippi — — — — 7 — 43 — 23 9 TX-DSHS-19-1309-A-000759 2016 K Total MosquitoAnaplasmosis/Eh Borne Disease Cases: rlichiosis Babesiosis Lyme disease Powassan Spotted fever rickettsiosis Tularemia R Total TickBorne Diseases: 47461 5750 1910 36429 22 4269 230 48610 4 96075 4 10550 5750 1910 36429 22 4269 230 48610 4 59164 5 73 21 — 38 — 453 1 513 — 586 15 — 16 — 23 27 3 45 — 231 821 32 1074 — 1105 159 — 1404 268 1 2 3 6 7 L N M N N O P N Q 1 S Plague T Total VectorBorne Diseases: 7 186 2 N 13 — 8 31 218 1 2 — 3 134 — — 4 14 18 — 6 — 2181 — 2321 545 — 581 9 1245 6 14 2 10 250 N N — 11 140 104 322 1748 1 17 — 12 36 20 2 506 — 13 74 6 2 103 — 4 — 115 — 189 14 1253 34 N 216 — 12 — 262 — 1515 74 — 92 — 284 15 192 14 N 4 — 16 70 N N N — N — 0 — 70 17 18 N N 17 — 7 3 27 — 45 68 5 352 — 722 18 370 40 2 237 — 19 95 24 — 152 — 40 — 216 — 311 20 98 14 1 232 — 11 3 261 — 359 130 25 251 — 324 21 73 57 N 39 — 22 56 46 1 33 — 167 2 249 — 305 23 116 3 2 7 — 17 — 29 — 145 1957 — 1981 24 24 383 82 1487 1 4 — 25 333 44 6 1866 — 1 — 1917 — 2250 26 245 848 518 198 5 8 5 1582 — 1827 13 1 251 — 426 6 3 2963 — 3233 111 — 121 — 194 27 175 14 2 221 — 28 270 773 50 2126 5 1 — 29 73 9 N TX-DSHS-19-1309-A-000760 2016 A B C 30 Missouri — 1 31 Montana — 32 Nebraska D E 13 — 1 2 — 1 33 Nevada — 34 New Hampshire F G 20 — 1 4 3 — 7 — 6 — 7 — 1 3 — 35 New Jersey — 11 51 1 36 New Mexico — 3 37 New York — 38 North Carolina 8 39 North Dakota — 40 Ohio H I J 11 — 37 — 6 — 9 — 95 — 13 3 16 — 22 14 — — — 11 84 — 11 — 180 5 — 2 — 6 — 10 38 136 — 319 — 22 1 1002 3 13 2 46 — 2 — 100 1 2 — 7 — 85 — 3 9 4 6 — 60 — 17 — 83 41 Oklahoma — — 5 — 7 — 35 — 29 42 Oregon — — 9 — 20 — 4 — 47 43 Pennsylvania — 5 21 — 77 — 16 — 175 44 Rhode Island — 3 5 — 9 — 2 — 55 45 South Carolina — 4 11 — 14 — 8 — 61 46 South Dakota — — 2 — 4 — 152 — 3 12 — 24 — 7 — 61 159 — 370 — 312 8 1 13 — 21 11 47 Tennessee 4 48 Texas — 20 45 — 49 Utah — 1 6 — 50 Vermont — — 3 — 6 — 2 — 51 Virginia — 6 28 — 74 — 8 — 108 52 Washington — 10 24 — 44 — 9 — 69 53 West Virginia 8 — — — 1 — 1 — 11 54 Wisconsin 13 2 7 — 20 — 13 — 60 55 Wyoming — — — — 4 — 11 — 3 57 Territories 0 179 217 — 3 — — — 36512 58 American Samoa — — 2 — — — — — 131 4 56 2016 TX-DSHS-19-1309-A-000761 K L M N O P Q R S T 30 82 252 1 10 — 31 23 2 1 17 — 9 3 32 — 55 32 119 9 1 14 — 31 10 65 — 184 33 54 — N 15 — 4 — 19 — 73 34 29 60 13 891 1 2 1 968 — 997 35 338 193 174 4350 — 64 5 4786 — 5124 — 7 8 4 38 350 34 647 — 729 36 26 N N 1 — 37 1518 964 481 3882 2 37 — 5366 — 6884 38 174 77 N 272 1 482 1 833 — 1007 1 — 49 — 147 39 98 15 1 32 — 40 179 14 — 160 — 24 — 198 — 377 41 76 66 N — — 124 26 216 — 292 6 4 77 — 157 42 80 4 2 61 — 43 294 81 N 11443 — 22 4 11550 — 11844 44 74 183 155 903 1 4 — 1246 — 1320 54 — 108 — 206 6 14 32 — 193 730 — 842 1085 45 98 1 2 51 — 46 161 1 — 11 — 25 — 87 3 179 — 4 5 28 — 78 2 — 985 — 1007 2003 47 112 107 1 595 2 48 906 17 1 71 — 49 50 — — 19 — 761 — 312 2 1779 — — 1 32 — 188 388 — 409 50 22 207 15 51 224 115 N 1350 — 52 156 — — 31 — 53 21 6 — 368 — 14 — 54 115 695 68 2295 5 19 1 3083 — 3198 55 18 1 — 1 — 1 7 10 — 28 57 36911 0 0 0 0 0 0 — — 36911 58 133 N U N — N — — — 56 2016 133 TX-DSHS-19-1309-A-000762 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E — 179 204 — — — I I 11 — F 3 I — G H I — — — I — — — J 35395 I 986 I TX-DSHS-19-1309-A-000763 2016 K 59 35781 60 997 11 L M N O N N N — — — — — P N — Q — I — R — I — S — I — T 35781 I 997 TX-DSHS-19-1309-A-000764 2016 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 70 1133 1015 6 1397 23 2175 0 0 70 0 0 0 0 0 0 896 1 1 24 4 276 8 16 0 0 73 9 7 5 20 7 4 11 8 7 2 19 34 9 15 1 5 1 4 1 1 31 0 99 19 2 10 4 3 8 5 3 0 954 3 1 17 1 138 13 5 1 11 82 8 219 3 29 6 1390 11 3 14 9 97 21 12 3 17 40 56 1 6 50 9 17 6 4 11 7 122 51 20 43 1 19 1 4 6 6 86 3 258 27 5 37 12 20 37 16 3 4 23 2175 9 0 0 23 103 18 783 101 10 6 5 13 15 0 0 0 2 0 0 1 1 0 1 0 1 7 0 0 0 0 0 1 0 11 0 25 0 0 1 0 4 4 1 4 4 13 8 16 21 2 3 4 2 1 1 60 3 112 9 1 11 2 5 23 3 4 2 E 1 1 3 1 2015 F G H I J 13 77 21 14 34 2 51 1 45 10 18 9 38 29 3 68 7 26 14 57 4 23 35 89 1 30 40 TX-DSHS-19-1309-A-000765 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5819 5137 2100 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 5137 18 n 3 209 4 n 120 18 1 24 34 n n 41 20 n 54 53 4 192 34 779 11 638 13 262 1 5 2100 2 n 123 192 n 910 93 5 19 63 4 35 160 4 5 n 328 1 n n n n n 3 n n 1 55 4 443 3 45 n n n 53 297 n 592 n 3 2 n 2 n 190 2 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4198 314 49825 16 55660 4198 288 n 17 889 10 7 5 19 314 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 16 55355 357 16 219 1154 1414 206 3037 483 155 419 247 227 41 569 228 366 313 252 98 1465 1969 5570 228 2593 159 676 31 144 24 714 5613 34 6386 854 83 306 500 80 9200 1280 106 78 Powassan Spotted fever rickettsiosis 38069 7 38069 25 9 12 7 98 2541 435 121 166 8 n 9 287 138 318 23 49 3 1201 1728 4224 148 1805 4 5 5 11 7 529 4855 4314 230 33 154 31 9048 904 42 5 1 3 1 1 Q 2 4 24 2 52 21 114 n 3 52 30 8 146 134 15 1 4 13 2 10 100 324 9 25 2 2 10 3 34 1 4 29 7 25 1 1 8 63 2 40 459 6 12 307 6 16 2 47 2 1 5 1 23 6 3 25 2015 R S 2 1 4 1 1 4 2 TX-DSHS-19-1309-A-000766 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 4 0 0 Territories American Samoa Puerto Rico 60 U.S. Virgin Islands C D 0 0 4 10 1 9 55 3 1 24 39 0 8 0 13 32 1 3 24 19 1 7 0 0 0 237 0 216 61 0 21 3 E 0 58 F G H 15 99 6 8 275 8 66 21 2 5 1 21 24 7 I J 9 8 0 0 0 0 7 TX-DSHS-19-1309-A-000767 2015 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N 49 461 18 4 135 103 7 39 10 82 11 2 145 116 1 6 628 1 1 305 0 281 0 N N 0 U N 0 N N — — — 60 24 9 n 2 56 26 54 7 710 1539 24 289 1894 1 O P Q R S T 605 61 7 3 1 5 296 4 9 5 1 4 4 1 2 21 717 128 21 864 1955 35 305 2586 23 0 — — 0 N N 0 — — 0 — — 0 — — 305 0 281 — — — — — 24 1 1 766 589 40 868 2090 138 312 2625 33 TX-DSHS-19-1309-A-000768 2015 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 96 7521 1226 8 1654 10 2205 0 0 96 0 0 0 0 0 0 0 0 0 1 2 0 0 1 2 0 0 0 0 0 0 2 0 8 1 0 0 0 0 0 0 0 0 23 0 31 0 0 0 0 0 0 2811 19 680 3 4 97 4 130 10 3 1 2 84 4 10 1 7 5 4 1 1 3 1 8 17 5 3 2 2 2 — 8 1 — — — — — — — — — — — — — — — — — — 1653 14 4 25 7 95 30 15 2 18 52 82 4 3 55 20 17 9 11 20 7 146 61 17 51 1 15 2 9 11 11 79 3 263 36 9 38 10 17 85 22 6 5 10 1 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2205 2 0 107 11 801 118 6 0 3 17 13 1 19 44 10 15 54 1 125 0 6 6 1 21 43 13 5 142 3 0 19 24 15 0 23 11 18 8 13 0 3 57 0 0 19 7 137 15 35 7 15 487 36 21 1 29 34 4 15 24 15 6 61 191 21 28 8 18 2 3 25 182 2 803 50 3 5 84 — 42 14 5 97 54 19 2 9 — — 70 8 — 6 5 2 — E 1 — — 1 — — — — — — 3 — — 2 — — — — — — — — — 2014 F G H I J TX-DSHS-19-1309-A-000769 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 12720 4488 1760 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 4488 19 n 1 252 7 n 75 24 1 36 16 n n 65 49 n 55 62 5 205 41 642 7 471 5 380 7 140 133 n 582 85 7 6 81 35 121 8 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3757 180 43654 10 56384 3757 220 N 16 824 11 5 6 24 — 180 — — — 10 29 37 N 1 89 36 10 110 53 18 3 6 8 — 1 — — — 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 51127 344 16 287 1147 1257 202 2712 476 79 864 194 36 34 531 268 245 291 197 189 1666 1643 6775 183 2054 114 723 23 184 27 951 4013 38 5966 868 60 270 359 85 7730 1278 110 75 Powassan Spotted fever rickettsiosis 33461 8 1760 1 N — — 33461 64 8 21 — 3 N 212 1 N N N N N 1 — 73 — 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 N N N — 42 2 537 2 49 N N — — N 41 169 N 471 N — 1 N 1 N 172 3 1 2360 417 40 155 4 N 9 233 110 194 20 44 2 1401 1373 5304 127 1416 2 10 7 7 6 724 3286 — 3736 170 14 119 — 45 7487 904 37 2 Q 42 — 16 — — — 7 2 1 27 1 1 — — 3 2 — — 7 50 265 4 13 1 2 58 2 21 496 3 12 219 5 7 — 20 1 6 — — 1 5 3 — 4 1 17 4 — — — 32 3 5 2014 R S 8 2 TX-DSHS-19-1309-A-000770 47 48 49 50 51 52 53 54 55 56 57 58 59 A B C D — — — — — — — — — E F Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 12 0 0 0 2 0 2 9 0 45 116 2 3 59 14 2 17 2 34 — Territories American Samoa Puerto Rico 0 4710 37 4274 546 — 527 1 399 19 — 60 U.S. Virgin Islands 4 16 9 1 8 — 0 G H 20 106 5 4 77 41 2 11 — 0 4 0 0 0 0 0 0 0 16 379 2 0 7 12 0 6 5 1 — 0 0 I 0 J 0 TX-DSHS-19-1309-A-000771 2014 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 95 639 9 11 161 76 7 51 5 101 15 5257 37 4802 60 418 — M N O P 0 0 0 0 0 0 0 2 0 558 94 8 — 43 — 17 40 13 599 1346 15 136 1361 3 0 N N 0 U N 0 N N 0 — — — N N — 69 137 5 538 1 — 3 N 4 — Q 2 — R S T 1 678 150 22 672 1856 25 147 1955 4 0 N N 0 — — 0 — — 0 — — 5257 37 4802 N — — — 418 1 1 — 373 2 5 11 — 4 1 — 773 789 31 683 2017 101 154 2006 9 TX-DSHS-19-1309-A-000772 2014 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 112 0 10727 8 1594 1 2469 0 0 4 Total: United States (excluding territories) 112 0 843 8 1594 1 2469 0 0 5 Alabama 2 5 — 2 — 9 6 Alaska 0 1 — 4 — 0 33 — 62 1 2 3 Reporting Area B E F G H 7 Arizona 0 1 — 8 Arkansas 0 2 1 2 — 18 9 California 0 119 — 103 — 379 32 — 322 10 Colorado 0 0 — 11 Connecticut 0 18 1 20 — 4 12 Delaware 0 2 — 9 — 3 13 — 1 13 District of Columbia 0 0 — 14 Florida 0 151 3 54 — 7 15 Georgia 2 9 1 67 — 10 1 — 0 5 — 40 117 16 Hawaii 0 10 — 17 Idaho 1 1 — 26 — 64 — 20 — 23 12 — 44 91 18 Illinois 0 19 Indiana 1 6 — 20 Iowa 0 2 — 8 — 8 — 9 — 3 9 — 54 0 21 Kansas 0 22 Kentucky 0 0 — 23 Louisiana 0 6 — 10 — 24 Maine 0 1 — 25 Maryland 0 11 — 147 — 16 26 Massachusetts 1 0 1 71 — 8 21 — 36 27 Michigan 0 16 — 28 Minnesota 6 22 — 67 — 79 29 Mississippi 3 1 — 3 — 45 2013 I J TX-DSHS-19-1309-A-000773 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3359 203 46231 4 61146 15 3359 203 46231 4 51262 24 0 255 — 294 312 14 0 N 1 15 20 97 193 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14911 4551 1796 4 5027 4551 5 18 6 5 1 2 3 O P Powassan Spotted fever rickettsiosis 36307 15 1796 36307 15 — 0 N Q R S 7 96 2 N 32 0 63 — 8 23 172 N — 0 480 38 690 713 9 601 9 3 112 0 15 2 141 742 0 6 1 7 361 10 354 0 N — 11 43 125 289 2925 0 — — 3339 3382 12 14 16 2 509 0 11 — 538 552 41 55 13 14 0 N 35 0 6 — 14 215 23 N 138 0 24 1 186 401 15 89 20 N 8 0 81 — 109 198 0 11 16 11 0 N N 0 N — 17 47 0 N 19 0 1 3 23 70 18 207 53 4 337 0 102 4 500 707 19 50 48 1 110 0 32 5 196 246 20 58 0 N 247 0 8 4 259 317 28 158 265 21 107 96 N 34 0 — 22 12 67 N 40 0 72 3 182 194 23 69 3 2 — 0 5 — 10 79 1512 1523 24 11 100 36 1373 1 2 — 25 174 38 9 1197 0 8 2 1254 1428 26 81 338 425 5290 1 1 8 6063 6144 179 252 3273 27 73 6 2 168 0 3 — 28 174 679 64 2340 1 15 — 3099 29 52 5 N — 0 39 — 44 2013 96 TX-DSHS-19-1309-A-000774 A B C D E F G H 30 Missouri 0 5 — 6 — 29 31 Montana 0 5 — — — 38 32 Nebraska 0 0 — 6 — 226 8 — 11 33 Nevada 1 4 — 34 New Hampshire 1 4 — 10 — 1 35 New Jersey 0 0 — 93 — 12 1 — 38 36 New Mexico 0 0 — 37 New York 3 184 0 254 0 32 38 North Carolina 13 13 1 27 — 3 3 — 125 39 North Dakota 0 1 — 40 Ohio 16 9 — 33 — 24 41 Oklahoma 0 4 — 14 — 89 13 — 16 42 Oregon 1 0 — 43 Pennsylvania 1 24 — 71 — 11 44 Rhode Island 1 9 — 14 — 1 9 — 7 7 — 149 24 45 South Carolina 1 7 — 46 South Dakota 0 3 — 10 — 19 — 90 1 183 7 — 7 2 47 Tennessee 23 48 Texas 0 95 — 49 Utah 0 0 — 2 — 5 — 75 — 6 30 — 1 1 50 Vermont 0 51 Virginia 2 22 — 52 Washington 0 13 — 2 — 53 West Virginia 11 2 — 54 Wisconsin 22 8 — 11 — 21 55 Wyoming 0 1 — — — 41 56 57 Territories 0 9884 0 0 0 0 58 American Samoa 0 0 I 0 J 0 0 TX-DSHS-19-1309-A-000775 2013 K L M N O P Q R S T 30 40 398 N 3 0 245 36 682 722 31 43 1 — 18 0 2 5 26 69 32 232 8 1 10 0 15 17 51 283 18 42 33 24 1 N 16 0 1 — 34 16 97 22 1687 1 4 — 1811 1827 35 105 132 171 3766 1 42 2 4114 4219 36 39 0 N 6 0 4 4 14 37 473 602 534 4615 5 28 — 5784 6257 38 57 93 N 180 0 426 2 701 758 43 172 4 57 39 129 11 1 29 0 2 — 40 82 16 N 93 0 23 2 134 216 41 107 116 N 3 0 241 10 370 477 42 30 1 — 43 0 2 3 49 79 43 107 61 N 5758 0 16 — 5835 5942 44 25 118 142 724 0 2 — 986 1011 110 134 45 24 7 1 42 0 60 — 46 159 1 1 4 0 7 7 20 179 47 76 96 — 25 0 549 4 674 750 48 369 8 1 82 0 83 1 175 544 49 14 1 — 15 0 7 2 25 39 — 949 958 50 9 50 6 893 0 — 51 105 143 N 1307 0 350 2 1802 1907 52 44 2 1 18 0 2 5 28 72 53 16 9 — 143 0 6 — 158 174 54 62 764 78 1872 5 11 1 2731 2793 55 42 0 — 3 0 2 — 5 47 56 57 9884 0 0 0 0 0 0 0 0 9884 58 0 0 U N — N — — — 0 TX-DSHS-19-1309-A-000776 2013 A B C D E F 59 Puerto Rico 9710 0 60 U.S. Virgin Islands 61 62 Total: 174 0 112 0 10727 8 1594 G 1 H 2469 I 0 J 0 TX-DSHS-19-1309-A-000777 2013 K L M N O P Q R S T 59 9710 0 N N — N — — — 9710 60 174 61 62 14911 0 N N — N — — — 174 4551 1796 36307 15 3359 203 46231 4 61146 TX-DSHS-19-1309-A-000778 2013 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 81 0 6714 15 1504 3 5674 0 0 4 Total: United States (excluding territories) 81 0 547 15 1503 3 5673 0 0 5 Alabama 0 4 — 10 62 6 Alaska 0 1 — 8 0 19 133 1 2 3 Reporting Area B E F G H 7 Arizona 0 8 — 8 Arkansas 0 0 — 4 64 9 California 0 64 — 108 479 24 131 10 Colorado 0 0 — 11 Connecticut 0 16 — 21 21 12 Delaware 0 0 — 2 9 6 10 13 District of Columbia 0 0 — 14 Florida 0 139 2 59 73 15 Georgia 0 11 1 66 99 4 0 16 Hawaii 0 8 — 17 Idaho 0 1 — 8 17 21 — 43 290 22 77 18 Illinois 0 19 Indiana 3 9 — 20 Iowa 0 2 — 6 31 1 — 7 56 10 23 21 Kansas 0 22 Kentucky 0 1 — 23 Louisiana 0 6 — 13 335 5 1 24 Maine 0 0 — 25 Maryland 0 9 — 112 47 26 Massachusetts 0 0 7 48 33 26 202 27 Michigan 0 9 — 28 Minnesota 4 9 — 58 70 29 Mississippi 1 1 — 4 247 2012 I J TX-DSHS-19-1309-A-000779 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4470 149 40119 4 54114 7 4470 149 40119 4 47945 25 — 167 — 218 294 10 — N 12 21 50 64 224 837 952 1020 103 754 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 13991 3725 937 4 7822 3725 5 76 6 9 1 2 3 O P Powassan Spotted fever rickettsiosis 30831 7 937 30831 26 — 0 N 7 160 1 N 13 — 8 68 93 N — — 4 70 — — 6 9 651 6 Q 2 — 22 2 21 R S 10 155 0 N — 11 58 142 123 2657 — — — 2922 2980 12 11 18 — 669 — 30 — 717 728 2 — 2 18 1 7 1 163 13 16 0 N N — 14 273 28 N 118 — 31 — 177 450 15 177 31 N 31 — 92 — 154 331 N — 0 12 4 10 36 411 765 147 258 174 213 90 154 110 144 16 12 0 N N — 17 26 0 N 5 — 204 — 33 18 354 50 2 1 4 151 19 111 35 1 74 — 20 39 0 N 165 — 8 19 — — 62 9 — 18 372 — 1179 1185 1707 1875 21 64 49 N 22 34 30 N 14 — 23 354 2 N 7 — 3 24 6 55 10 1111 — 25 168 42 3 1651 — 9 26 88 343 261 5138 — 7 27 237 8 — 98 — 28 141 529 40 1515 29 253 3 N 1 4 1 22 4 2 8 5757 5845 3 — 109 346 4 15 — 2103 2244 — 25 — 29 2012 282 TX-DSHS-19-1309-A-000780 A B C D E F G H 30 Missouri 0 6 — 31 Montana 0 2 — — 6 32 Nebraska 0 0 — 4 193 8 9 19 20 33 Nevada 0 2 — 34 New Hampshire 0 0 — 9 1 35 New Jersey 0 0 — 67 48 2 47 36 New Mexico 0 0 — 37 New York 1 111 0 267 107 38 North Carolina 26 7 2 34 7 2 89 39 North Dakota 0 0 — 40 Ohio 13 6 — 41 121 41 Oklahoma 0 1 — 24 191 12 11 42 Oregon 0 0 — 43 Pennsylvania 0 21 — 52 60 44 Rhode Island 0 0 — 17 4 9 29 45 South Carolina 2 2 — 46 South Dakota 0 2 — 5 203 6 — 12 33 102 47 Tennessee 9 48 Texas 3 16 — 49 Utah 0 0 — 14 5 50 Vermont 0 1 2 4 3 51 Virginia 2 17 1 65 30 52 Washington 0 16 — 26 4 2 10 3 53 West Virginia 14 0 54 Wisconsin 3 11 — 13 57 55 Wyoming 0 0 — — 7 56 57 Territories 0 6167 0 1 58 American Samoa — 0 0 J 1868 — 0 I 1 0 0 0 TX-DSHS-19-1309-A-000781 2012 K L M N O P Q 30 45 228 N 2 — 31 8 0 — 6 — 3 32 197 2 1 15 — 9 — 1 315 27 3 6 R S T 572 617 12 20 33 230 11 30 33 19 0 N 10 — 34 10 55 19 1450 — 2 — 1526 1536 35 115 198 92 3576 — 128 — 3994 4109 4 35 36 49 0 N 1 — 37 486 407 254 2998 1 122 — 1 23 38 76 132 N 39 91 3 — 15 — 40 181 5 N 67 — 4 — 41 216 145 N 42 23 0 — 48 — 43 133 31 N 5033 44 21 107 56 — 17 1 56 3695 4181 846 922 22 113 95 276 575 791 1 49 — 41 — 5105 5238 217 — 13 — 393 414 61 — 107 149 1 11 221 811 871 157 2149 14 33 534 544 1721 1836 N 44 46 210 1 N 4 — 83 — 30 — 77 6 48 1992 5 N 75 49 19 1 N 5 — 522 — 461 1 51 115 148 N 1110 — 52 46 0 — 15 — 5 2 696 — 2 3 6 — 2 9 1 409 45 42 50 10 — 591 — 47 60 1 — 2 — 1 2 5 2 74 21 67 2 — 101 127 — 2529 2613 7 14 53 26 2 N 97 — 54 84 670 69 1766 2 22 55 7 0 — 4 — 2 56 57 6169 0 0 0 0 0 0 0 0 6169 58 0 0 U N — N — — — 0 1 TX-DSHS-19-1309-A-000782 2012 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E 6025 142 F G 1 I — I H I J 1 I 0 I TX-DSHS-19-1309-A-000783 2012 I K 59 6027 60 142 11 L M 0 — 0 — N O N — N — P Q R N — — N — — S — I — T 6027 I 142 I TX-DSHS-19-1309-A-000784 2012 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 137 0 1795 4 1726 6 712 0 0 137 1 0 1 0 0 0 0 0 0 1 2 0 0 1 2 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 26 0 50 0 0 0 0 1 0 0 254 4 0 2 0 5 0 1 2 0 66 6 11 0 8 2 5 1 4 3 0 6 0 6 6 0 0 0 0 1 0 0 2 53 4 1 2 0 0 16 0 1 0 4 — — — — — — — — — — — — — — — — — — — — — 1724 9 5 21 7 129 24 20 7 18 99 91 7 2 66 14 22 10 10 2 6 128 68 34 46 1 21 2 8 8 3 97 5 280 49 — 6 1 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 712 5 0 69 1 158 7 9 1 15 24 22 0 3 34 9 9 4 5 10 0 19 6 34 2 52 10 1 29 16 0 7 4 44 2 4 21 1 0 6 1 0 2 0 0 1 — — — 1 — — — — — — 1 — — — — — — — — — 2011 F 41 10 22 61 6 7 2 G H I J TX-DSHS-19-1309-A-000785 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4380 3586 1128 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 3586 9 0 4 61 2 0 152 18 0 26 38 0 0 36 18 0 25 16 2 27 42 172 9 788 4 194 0 3 0 33 193 0 406 105 3 16 119 6 16 75 3 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2802 166 40795 3 45178 2802 79 N 77 558 8 3 — 166 — — — 3 20 4 12 88 N 2 51 33 7 — 1 — — — — 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 43635 133 16 189 667 404 37 3295 923 37 343 279 18 13 395 173 146 68 44 29 1049 1580 2943 192 3062 87 526 18 65 33 1351 4864 26 5716 601 40 205 482 74 5482 316 85 21 Powassan Spotted fever rickettsiosis 33097 16 1128 1 — — — 33097 24 11 15 — 4 — 92 — 74 1 — — — — 3039 873 N 115 32 N 4 194 94 100 17 3 2 1006 1351 2476 104 2124 5 8 11 11 5 1299 4262 6 4490 88 27 53 2 38 5362 159 37 4 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 N — — — N N — 9 4 208 — 73 — N — — N 13 166 — 418 N 1 N N 1 N 73 — N Q 37 6 3 — 2 5 1 3 11 1 — — — 4 10 1 29 4 4 11 24 270 1 10 2 3 136 — 8 — — — 21 3 4 1 — 3 7 — — 24 327 2 21 335 1 19 2 36 1 2 1 15 5 1 — — 8 2011 R S 2 1 TX-DSHS-19-1309-A-000786 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 12 0 0 0 1 0 26 9 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 3 7 1 3 8 9 0 5 0 0 — — — — — — — E F G H 1 — 21 102 5 6 78 24 1 19 — 0 0 0 0 0 0 0 0 0 18 27 3 1 9 0 2 3 3 1541 0 1541 0 — — 2 1 1 0 0 0 0 0 0 0 — — 0 0 I 0 J 0 TX-DSHS-19-1309-A-000787 2011 47 48 49 50 51 52 53 54 55 56 K 54 136 9 10 96 33 29 37 3 L M 79 6 1 8 131 1 3 731 1 1 N N 1 N — — 57 1543 58 1 59 1542 0 0 0 — 60 0 0 N O 37 74 9 623 1023 19 118 3649 2 0 0 0 0 0 0 0 4 0 N N N 0 0 0 N N 0 80 — P Q 263 52 8 — 3 — 231 4 4 11 10 6 5 — R S T 1 1 383 132 19 632 1391 29 125 4476 14 N N — — — — — — — — 1543 1 1542 N — — — 0 1 — 437 268 28 642 1487 62 154 4513 17 TX-DSHS-19-1309-A-000788 2011 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 75 0 11611 10 1778 10 1021 0 0 75 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 1 0 0 2 0 2 1 0 0 0 0 0 0 0 0 1 22 0 24 0 0 0 0 0 0 0 700 4 1 12 1 36 0 0 0 0 191 12 0 3 23 14 2 4 2 4 6 0 0 9 14 0 6 4 7 4 0 29 1 178 8 1 16 5 0 22 1 13 1 10 ------------------4 ----------------------1 3 ------------------1 ------------1 ----- 1773 9 5 28 4 126 21 22 2 13 139 71 4 5 60 15 14 13 8 5 6 99 73 31 48 2 21 3 15 6 5 106 1 352 52 1 43 6 14 61 15 6 3 10 0 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1021 3 0 167 7 111 81 11 0 6 12 13 0 1 61 13 9 19 3 27 0 23 7 29 8 8 3 0 39 2 1 30 25 128 0 9 5 1 0 28 0 1 20 0 0 2010 F G H I J TX-DSHS-19-1309-A-000789 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14505 2615 0 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 2615 19 N 0 24 4 N 43 22 0 13 22 N N 28 15 N 7 17 1 21 39 0 6 743 6 142 N 2 N 25 130 N 266 127 N 9 106 0 6 41 6 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1985 124 34890 2 49397 1985 83 N 17 162 7 2 --22 1 14 57 N 5 37 27 5 --6 3 2 49 --2 2 26 278 3 5 --1 61 1 30 286 1 15 236 1 15 2 20 --- 124 ----1 19 8 3 --------------1 3 --16 2 ------3 ------18 1 5 1 1 1 1 --3 1 --8 3 1 ----11 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 2 38481 120 13 227 219 421 110 3144 702 64 457 187 4 23 345 165 115 69 44 43 786 1829 3347 179 2779 42 473 15 81 15 1372 4069 34 4382 580 46 156 362 59 3938 241 75 36 Powassan Spotted fever rickettsiosis 30158 8 30158 2 7 2 --129 3 3068 656 42 84 10 N 9 135 78 85 10 5 3 751 1617 3263 95 1960 --4 4 8 2 1339 3712 5 3425 82 33 44 --39 3805 181 29 1 8 ----------------------------------------------3 ----------------1 ------------------- 2010 Q R S 2 TX-DSHS-19-1309-A-000790 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 11 1 0 0 0 0 8 0 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 C 0 D 1 19 0 3 14 19 2 8 0 ------------------- 10911 0 10911 0 ----- 0 --- E F G H 12 98 3 3 67 39 3 15 --- 0 3 0 0 0 0 0 0 0 4 89 2 0 5 2 0 2 6 5 --5 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000791 2010 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 28 210 5 6 86 60 13 25 6 76 7 0 2 93 0 3 544 0 10916 0 10916 0 N N 0 60 0 M N O P Q R S T 36 142 3 356 1245 16 145 3488 --- --------------4 --- 310 34 3 --145 1 --7 1 3 1 2 --1 3 ----3 425 184 8 358 1484 20 148 4043 4 453 394 13 364 1570 80 161 4068 10 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 10916 0 10916 — --- --- --- — — 0 TX-DSHS-19-1309-A-000792 2010 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 2759 4 1456 12 720 0 0 55 1 0 0 0 0 0 0 0 0 0 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 3 16 0 5 0 0 0 0 0 0 0 200 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1451 9 2 10 5 126 26 7 5 17 93 68 1 3 70 25 10 8 13 8 2 80 40 31 43 4 13 5 8 --4 103 --257 32 1 37 2 12 53 5 7 1 12 0 0 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 720 0 0 20 6 112 103 0 0 2 3 4 0 38 5 4 5 13 3 21 0 1 0 1 4 53 5 5 52 12 0 3 8 7 0 1 2 10 11 0 0 3 21 0 0 3 57 5 3 3 6 9 1 5 2 1 2 57 1 3 4 2 2 E 2009 F G H I J TX-DSHS-19-1309-A-000793 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5006 2267 0 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 2267 10 0 1 44 6 0 22 24 0 14 19 0 0 42 21 0 7 12 0 16 34 108 6 363 6 167 0 2 0 24 172 0 339 56 0 14 146 0 34 43 3 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1815 93 42649 8 47663 1815 68 N 23 184 1 1 --19 1 10 52 N 1 49 13 5 1 1 2 5 40 7 5 5 9 253 10 12 1 1 63 1 24 255 --18 342 --23 --19 --- 93 --2 --17 1 3 1 ----1 ------3 1 1 4 1 ----1 4 --1 --13 2 5 ----2 1 1 1 --1 7 1 1 ----5 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 8 N 45099 92 11 64 260 363 134 4186 1032 81 288 190 1 58 307 152 129 51 31 32 996 2180 5415 152 1970 75 460 28 85 28 1445 5316 21 6343 458 17 138 509 62 5837 285 76 28 Powassan Spotted fever rickettsiosis 38468 6 38468 3 7 7 --117 1 4156 984 61 110 40 N 16 136 83 108 18 1 --970 2024 5256 103 1543 --3 3 5 13 1415 4973 5 5651 96 15 58 2 38 5722 235 42 1 6 ----------------------------------------------2 ----------------3 ------------------- 2009 Q R S 1 6 TX-DSHS-19-1309-A-000794 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 8 0 0 0 1 0 14 1 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 61 0 C D 4 14 11 4 0 2559 2559 E F G H 0 0 0 0 0 0 0 0 0 9 87 4 4 61 26 4 10 --- 0 4 0 0 0 1 0 0 0 9 115 2 0 5 38 0 1 12 0 0 0 5 --5 0 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000795 2009 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 30 220 6 4 67 76 18 16 12 90 7 0 1 72 0 2 340 0 2564 0 2564 0 0 0 0 60 0 61 M N O P Q R S T 37 276 9 408 908 16 201 2589 3 --------1 --------- 190 36 1 1 53 --2 5 3 4 ----1 --5 ----2 321 319 10 411 1034 21 205 2934 8 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 2564 0 2564 — --- --- ----- --- — — 0 1 351 539 17 415 1101 97 223 2950 20 TX-DSHS-19-1309-A-000796 2009 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 62 0 1118 4 1257 13 1356 0 0 62 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 1 1 0 0 0 0 1 4 0 0 0 0 0 0 0 6 9 0 9 0 0 0 0 0 0 0 201 2 4 1 ----------------1 ----------------------1 ----------------------1 ----------------- 1255 5 6 15 1 125 5 14 3 7 65 57 3 3 77 5 12 9 6 4 1 80 33 18 29 1 14 --8 5 5 65 3 230 31 --31 5 4 42 3 9 --- 13 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 0 0 1 1 0 0 0 1356 18 0 114 9 445 71 8 1 8 3 8 0 39 20 4 6 31 3 49 0 14 1 17 10 65 15 5 47 16 0 10 8 46 3 37 15 9 16 14 1 1 39 0 0 25 2 5 2 20 3 3 1 1 71 6 7 2 3 E 2008 F G H I J TX-DSHS-19-1309-A-000797 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 3810 2107 0 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 2107 9 0 2 87 0 0 47 24 0 12 20 0 0 34 4 0 0 13 1 18 66 106 3 336 0 227 0 4 0 21 102 0 326 40 0 12 121 0 9 48 1 1 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2563 123 39993 3 43806 2563 93 N 17 129 --1 --33 6 19 78 N 1 110 6 8 --1 6 1 92 2 3 --11 407 3 20 3 1 85 4 54 511 1 31 268 3 15 3 57 3 123 ------11 2 2 ------------2 1 ----2 2 ----1 19 --2 --21 --7 2 --2 1 1 3 3 --7 4 ------10 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 3 42887 137 12 157 241 646 82 3966 833 95 214 202 3 54 350 61 140 58 31 67 930 2471 4744 133 1681 82 694 25 98 41 1629 3749 26 8529 654 51 150 414 66 3902 265 97 56 Powassan Spotted fever rickettsiosis 35198 2 35198 9 6 8 --74 3 3896 772 74 88 35 N 9 108 42 109 16 5 3 908 2218 4582 92 1282 1 6 17 12 12 1601 3485 8 7794 47 10 45 2 38 3818 210 29 3 2 ----------------------------------------------1 ----------------1 ------------------- 2008 Q R S 1 1 1 TX-DSHS-19-1309-A-000798 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 6 0 0 0 2 0 14 6 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 22 8 14 1 3 0 917 917 E F G H ------------------- 15 87 5 5 49 32 2 21 --- 0 0 0 0 0 0 0 0 0 19 64 26 0 1 3 1 8 8 0 ----- 2 --2 0 0 0 0 0 0 --- --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-000799 2008 47 48 49 50 51 52 53 54 55 56 K 40 173 31 5 60 49 18 38 8 57 919 58 0 59 919 60 0 L M 78 29 0 0 65 0 0 241 0 N 31 153 5 404 933 23 135 2034 3 O ------------------- P 233 62 7 --155 --10 --10 Q R S T 2 --8 --1 4 --1 2 344 244 20 404 1154 27 145 2276 15 — — — 919 0 919 — 0 0 0 0 U N N N ----- N N ----- — — — 0 — N --- N --- — 384 417 51 409 1214 76 163 2314 23 TX-DSHS-19-1309-A-000800 2008 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 4484 4 1411 9 3630 0 0 55 0 347 5 4 1 1408 7 2 12 2 130 23 30 4 3 56 39 2 6 63 11 3 4 9 14 8 76 34 20 29 2 8 3 7 3 9 72 5 287 22 5 28 10 18 44 8 7 1 9 3630 24 0 0 8 2 53 10 1 1 1 6 9 5 4 1 2 10 140 9 10 3 3 15 3 2007 F G 2 H I J 97 20 380 576 4 1 3 50 3 2 1 1 132 101 24 30 40 4 40 10 6 17 101 136 77 202 163 12 1 1 60 22 8 369 23 107 26 10 5 208 TX-DSHS-19-1309-A-000801 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 9593 1999 0 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 1999 15 0 82 9 31 14 21 14 50 1 1 4 12 39 80 364 222 3 108 316 60 3 106 1 6 22 5 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2221 137 31808 7 41408 2221 96 137 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 7 37268 161 13 134 244 596 605 3123 751 122 182 186 2 151 404 98 180 69 29 63 549 2765 3124 92 1749 161 673 210 204 35 912 3348 82 4974 819 386 116 431 56 4087 207 112 224 Powassan Spotted fever rickettsiosis 27444 7 27444 13 10 2 1 75 7 9 149 55 123 8 6 2 529 2576 2988 51 1238 1 10 4 7 15 896 3134 5 4165 53 12 33 1 6 3994 177 31 1 3 15 1 3 10 122 1 3 3058 715 116 30 11 Q 17 3 19 60 4 39 6 17 12 5 4 6 1 1 4 1 63 9 4 6 20 315 1 14 1 7 1 32 6 35 665 1 1 1 1 1 10 186 2 18 18 3 1 35 10 64 5 7 2007 R S 2 5 TX-DSHS-19-1309-A-000802 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D E 14 32 22 10 1 10 11 4 0 0 4137 F G 21 130 13 5 65 30 1 17 0 3 H I J 11 260 70 5 13 181 0 0 0 0 58 American Samoa 59 Puerto Rico 4137 3 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000803 2007 47 48 49 50 51 52 53 54 55 56 K 46 422 83 5 92 40 13 44 181 L M 38 32 N 31 87 7 138 959 12 84 1814 3 1 39 1 299 O 1 P Q 155 49 2 1 9 123 3 1 R 6 1 13 4 226 169 16 139 1124 13 91 2115 20 S T 272 591 99 144 1216 53 104 2159 201 57 4140 0 0 0 0 0 0 — — 4140 58 0 0 U N — N — — — 0 N — — — 4140 — — — — 0 59 4140 0 N N — 60 0 0 — — — TX-DSHS-19-1309-A-000804 2007 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 69 0 882 8 1476 10 4269 0 0 69 0 105 1 8 1474 9 23 23 4 157 24 13 5 5 61 88 8 1 83 13 2 8 4 9 4 79 29 21 50 6 6 2 4 4 10 90 5 223 32 2 29 10 13 49 4 10 1 10 4269 8 0 0 2 150 29 278 345 9 8 2 1 1 21 1 1 6 3 1 1 3 1 5 2 1 1 15 3 2 1 17 11 1 11 1 9 3 1 1 2006 F G H I J 2 3 8 1 1 2 1 996 215 80 37 30 6 180 11 3 55 65 183 62 34 264 124 1 1 5 8 24 1 137 48 48 69 9 1 113 TX-DSHS-19-1309-A-000805 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 6714 1455 0 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 1455 4 0 40 1 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2288 95 23770 17 30501 2288 94 95 17 11 104 1 6 5 3 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 29722 127 26 205 183 528 377 1847 532 70 147 176 8 1024 473 132 144 50 25 204 356 1506 1529 142 1246 202 353 43 315 135 633 2684 40 5120 993 148 173 247 96 3331 345 82 120 Powassan Spotted fever rickettsiosis 19931 1 19931 11 3 10 1 85 5 37 21 6 16 32 4 4 2 14 75 37 3 196 99 4 1 2 116 377 58 6 47 1 1 23 6 1788 482 62 34 8 7 110 26 97 4 7 1 338 1248 1432 55 914 3 5 1 11 4 617 2432 3 4460 31 7 43 7 3242 308 20 1 Q 22 1 21 53 14 26 6 5 1 3 5 1 1 1 7 1 93 12 6 5 9 163 2 25 11 14 4 7 1 1 41 8 23 852 7 1 1 2 26 139 2 26 10 43 3 4 1 5 2006 R S 2 4 1 8 TX-DSHS-19-1309-A-000806 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories 58 American Samoa 59 Puerto Rico B C D E 7 8 4 16 3 0 8 0 777 F 6 106 18 1 55 43 3 19 0 777 2 G 1 H I J 22 354 158 5 3 1 21 65 0 0 0 0 2 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000807 2006 47 48 49 50 51 52 53 54 55 56 K 35 469 176 1 60 50 20 51 65 L M 35 7 N 15 29 5 105 357 8 28 1466 1 8 171 1 O P Q 265 40 3 3 114 1 1 1 4 1 7 R 315 76 8 105 479 9 33 1639 12 S 1 1 T 350 546 185 106 539 59 53 1690 77 57 779 58 0 59 779 0 0 0 0 U N 0 N N 0 — — 0 N N 0 — — — — — — — — 779 0 779 60 0 0 — — — — — — — 0 TX-DSHS-19-1309-A-000808 2006 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 80 0 2462 21 1498 13 3000 0 0 80 1 0 104 21 2 1494 6 7 21 6 177 24 24 3 11 68 50 18 13 3000 10 0 0 1 113 28 880 106 6 2 5 21 20 5 1 1 1 18 5 5 1 1 1 1 1 4 2 1 F 74 10 9 7 10 5 5 99 39 24 41 2 9 18 2 7 1 15 32 15 G 11 1 1 2005 3 4 6 79 3 251 40 1 30 12 12 37 10 11 H I J 13 252 23 37 25 5 171 5 6 62 45 70 30 25 188 31 6 33 38 4 86 61 31 7 25 1 5 229 TX-DSHS-19-1309-A-000809 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Ehr lichiosis Babesiosis Lyme disease 7074 1404 0 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 1404 3 0 1 42 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1936 154 26800 8 33882 1936 72 154 1 1 2 19 3 5 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 8 31520 98 12 178 232 1160 142 1872 665 28 179 180 18 18 474 70 143 45 31 189 258 1487 2484 158 1218 98 272 28 207 40 282 3584 51 6189 787 91 200 365 26 4399 77 117 245 Powassan Spotted fever rickettsiosis 23305 1 23305 3 4 10 1 25 137 95 4 32 7 5 11 1810 646 10 47 6 6 73 81 2 211 2 127 33 89 3 5 3 247 1235 2336 62 917 54 15 3 106 1 308 37 2 3 265 3363 3 5565 49 3 58 7 5 3 96 16 24 14 3 4287 39 15 2 7 2 14 86 1 3 11 1 7 5 3 6 1 2 5 3 75 6 6 2 18 128 1 6 1 Q 12 2 27 2 8 1 30 4 9 625 1 21 206 2 32 3 70 5 2 2 1 20 2 2 1 8 2005 R S 1 3 4 TX-DSHS-19-1309-A-000810 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 2 Territories American Samoa Puerto Rico 0 C D E 32 4 3 3 15 4 5 1 0 2358 0 2358 F G 14 130 7 2 44 21 3 16 2 1 4 N 4 0 H I J 18 195 52 1 17 12 0 0 0 — 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000811 2005 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N O 35 357 59 2 52 24 18 42 15 24 8 2362 0 2362 0 0 0 0 U N 0 N N 0 — — 0 — — — 60 0 8 69 2 54 274 13 61 1459 3 13 2 205 P 136 30 Q 9 1 1 T 0 — — 0 — — 0 — — 2362 0 2362 — — — 0 9 0 S 2 121 10 2 3 R 177 108 3 54 408 22 73 1666 8 212 465 62 56 460 46 91 1708 23 TX-DSHS-19-1309-A-000812 2005 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 118 0 721 7 1458 15 2539 0 0 118 0 10 7 1458 12 2 17 8 146 16 22 5 13 93 65 4 2 47 17 4 9 5 6 7 81 53 21 30 5 20 1 4 6 5 74 5 268 23 3 30 10 18 44 11 15 2539 16 0 0 4 391 28 779 291 1 2 5 9 2 2 3 4 1 2 1 13 26 1 4 2004 F G H I J 2 41 21 2 3 60 13 23 43 7 109 16 3 1 1 16 34 51 36 6 53 44 1 88 10 3 20 12 22 3 15 TX-DSHS-19-1309-A-000813 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4858 875 0 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 875 5 0 O 2 1 226 2698 1 5100 122 49 83 27388 1713 54 134 3 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 3 26677 96 5 429 273 977 317 1407 352 31 211 194 4 16 226 71 80 66 36 125 233 1108 1696 70 1242 84 278 12 79 51 234 2790 96 5553 742 24 134 294 36 4075 350 4 188 2 4 3 6 1348 339 16 46 12 1 151 45 3 1 25 2 2 22527 19804 6 3 13 63 45 81 134 1 149 1 1713 19804 6 87 32 49 3 15 2 225 891 1532 27 1023 4 Plague Powassan 48 7 13 Tularemia Total TickBorne Diseases: T Total VectorBorne Diseases: Spotted fever rickettsiosis 29 33 2 P 50 3 11 3985 249 Q 20 2 3 22 78 4 14 6 2 1 5 1 9 5 3 5 1 75 15 2 4 28 106 3 16 11 28 2 2 14 2 24 535 1 1 1 19 2 1 11 190 2 30 7 2004 R S 3 TX-DSHS-19-1309-A-000814 45 46 47 48 49 50 51 52 53 54 55 56 A South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D 1 E 1 13 3 2 30 8 0 2 0 711 0 F 10 1 12 111 8 4 59 24 2 14 1 0 G 4 H I J 2 51 14 176 11 5 12 10 0 0 0 0 58 American Samoa 59 Puerto Rico 711 60 U.S. Virgin Islands TX-DSHS-19-1309-A-000815 2004 45 46 47 48 49 50 51 52 53 54 55 56 K L M N 14 52 39 294 19 4 66 24 32 36 11 6 57 711 0 0 0 58 0 0 U 59 711 0 0 60 0 O 22 1 20 98 1 50 216 14 38 1144 4 P Q R S T 7 2 5 1 1 92 9 149 119 4 54 267 18 45 1222 10 0 0 0 — — 711 N — N — — — 0 N N — N — — — 711 — — — — — — — 0 20 3 6 75 64 4 105 20 1 1 45 4 4 1 2 4 106 61 188 413 23 58 333 42 77 1258 21 TX-DSHS-19-1309-A-000816 2004 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area A B 2004 C 2005 D 2006 E 2007 F 2008 G 2009 Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota 4858 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 14 52 7074 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 6714 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 9593 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 3810 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 5006 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 14505 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 4380 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 13991 7822 76 9 160 68 651 155 58 11 16 273 177 12 26 354 111 39 64 34 354 6 168 88 237 141 253 45 8 197 19 10 115 49 486 76 91 181 216 23 133 21 42 210 14911 5027 18 5 96 23 601 354 43 14 14 215 89 11 47 207 50 58 107 12 69 11 174 81 73 174 52 40 43 232 24 16 105 39 473 57 129 82 107 30 107 25 24 159 12720 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 5819 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 TX-DSHS-19-1309-A-000817 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 47461 10550 75 7 186 31 1245 250 140 36 74 1253 192 70 18 370 95 98 73 56 116 24 333 245 175 270 73 82 23 119 54 29 338 26 1518 174 96 179 76 80 294 74 98 161 150842 68382 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 TX-DSHS-19-1309-A-000818 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F G H I J K L M Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 39 294 19 4 66 24 32 36 11 35 357 59 2 52 24 18 42 15 35 469 176 1 60 50 20 51 65 46 422 83 5 92 40 13 44 181 40 173 31 5 60 49 18 38 8 30 220 6 4 67 76 18 16 12 28 210 5 6 86 60 13 25 6 54 136 9 10 96 33 29 37 3 60 1992 19 10 115 46 26 84 7 76 369 14 9 105 44 16 62 42 95 639 9 11 161 76 7 51 5 49 461 18 4 135 103 7 39 10 Territories American Samoa Puerto Rico U.S. Virgin Islands 711 0 711 0 2362 0 2362 0 779 0 779 0 4140 0 4140 0 919 0 919 0 2564 0 2564 0 10916 0 10916 0 1543 1 1542 0 6169 0 6027 142 9884 0 9710 174 5257 37 4802 418 305 0 281 24 14911 TX-DSHS-19-1309-A-000819 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 112 906 50 22 224 156 21 115 18 699 6648 498 93 1319 781 238 640 383 36911 133 35781 997 82460 171 80534 1755 TX-DSHS-19-1309-A-000820 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B 2005 2006 2007 2008 G 2009 H 2004 C D E F 2010 I 2011 J 2012 K 2013 L 2014 M 2015 22527 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 92 9 26800 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 23770 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 31808 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 39993 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 42649 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 34890 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 40795 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 40119 40119 218 12 64 952 103 7 2922 717 2 177 154 0 10 411 147 174 90 110 18 1179 1707 5757 109 2103 29 572 12 33 11 1526 3994 6 3695 846 22 95 575 49 5105 393 107 11 46231 46231 294 15 97 690 141 7 3339 538 41 186 109 0 23 500 196 259 158 182 10 1512 1254 6063 179 3099 44 682 26 51 18 1811 4114 14 5784 701 43 134 370 49 5835 986 110 20 43654 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 49825 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 TX-DSHS-19-1309-A-000821 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 48610 48610 513 16 45 1074 159 18 2181 545 115 262 92 0 27 352 216 261 251 249 29 1957 1917 1582 251 2963 121 647 32 65 19 968 4786 8 5366 833 49 198 216 77 11550 1246 108 32 491671 491671 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 TX-DSHS-19-1309-A-000822 TBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Territories American Samoa Puerto Rico U.S. Virgin Islands C 149 119 4 54 267 18 45 1222 10 — — — — D 177 108 3 54 408 22 73 1666 8 — — — 0 E 315 76 8 105 479 9 33 1639 12 — — — — F 226 169 16 139 1124 13 91 2115 20 — — — — G 344 244 20 404 1154 27 145 2276 15 — — — — H 321 319 10 411 1034 21 205 2934 8 — — — 0 I 425 184 8 358 1484 20 148 4043 4 — — — 0 J 383 132 19 632 1391 29 125 4476 14 — — — — K 811 157 14 534 1721 21 101 2529 7 — — — 0 L 674 175 25 949 1802 28 158 2731 5 — — — 0 M 678 150 22 672 1856 25 147 1955 4 — — — 0 717 128 21 864 1955 35 305 2586 23 — — — 46231 TX-DSHS-19-1309-A-000823 TBDs 0 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 730 179 28 985 1779 32 388 3083 10 5950 2140 198 6161 16454 300 1964 33255 140 — — — — TX-DSHS-19-1309-A-000824 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington B 2004 3 C 2005 1 3 D 2006 E F 2007 2008 2 1 G 2009 N H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 2 2 1 8 1 4 1 1 4 1 1 1 4 8 5 1 6 2 1 1 1 2 1 1 2 4 2 4 2 1 TX-DSHS-19-1309-A-000825 Plague N 2016 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — O 1 Total: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 0 0 0 TX-DSHS-19-1309-A-000826 Plague 50 51 52 53 54 55 56 57 A West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B — — — C — — — D — — — E — — — F — — — G — — — H — — — I — — — J — — — K — — — L — — — M — — — #N/A TX-DSHS-19-1309-A-000827 Plague — — — — — — N Plague 120,000 100,000 80,000 60,000 40,000 20,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Sheet 23 TX-DSHS-19-1309-A-000829 60000 - 50000 40000 - 30000 20000 10000 0 2004 2005 2006 2007 ■ 2008 2009 2010 2011 2012 2013 2014 2015 2016 Reported tick-borne disease cases in US states ■ Reported mosquito-borne disease cases in US territories ■ Reported mosquito-borne disease cases in US states Sheet 24 TX-DSHS-19-1309-A-000830 Reported Cases of NationallyNotifiable Vector-BorneDiseases, 2004-2016 100000 80000 60000 40000 20000 0 -----,----- ---,----- ---,----- -----,--- -----,--- -----,--- 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - Total Vector-Borne Diseases Sheet 25 TX-DSHS-19-1309-A-000831 Reported Cases of NationallyNotifiable Tick-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 -- 2016 Total Tickborne Diseases Sheet 26 TX-DSHS-19-1309-A-000832 Reported Cases of NationallyNotifiable Mosquito-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,------ -----,----------,----------,----------,----------,----------,----------,----------,----------,----------,----------,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - 4842 6970 6610 9247 3609 4806 14505 4363 13990 14911 12719 5808 47500 Sheet 27 TX-DSHS-19-1309-A-000833 ReportedCases of NationallyNotifiableMosquito -Borne and TickborneDiseases by Vector, 2004-2016 60000 50000 40000 30000 20000 10000 0 2004 2005 -- 2006 2007 2008 2009 2010 2011 2012 Total Mosquito-Borne Diseases Sheet 28 -- 2013 2014 2015 2016 Total Tickborne Diseases TX-DSHS-19-1309-A-000834 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 21, 2019 6:05 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Supplementary Information for 2019 Attachment(s): "Supplementary Information for ELC FY 2019_v1.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please find the Supplementary Information for Applying to 2019 ELC NOFO document attached here, and also located in REDCap in the file repository. As mentioned in previous communications, this document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • • • • describe the new ELC structure and contrast it with previous project periods, offer tips for developing effective work plans, milestones, and budgets, provide additional information about the submission process and tools that may aid applicants, illustrate materials from the ELC and partner program webinars, including a compilation of frequently asked questions for applicants to reference, and instructions on how to download the recorded ELC webinars. PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Thank you, ELC Team TX-DSHS-19-1309-A-000835 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) March 2019 Centers for Disease Control and Prevention 1 TX-DSHS-19-1309-A-000836 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 19 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 20 5. Submission Process ................................................................................................................................. 21 Submission Checklist ............................................................................................................................... 21 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 21 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 26 7. Program-Specific Frequently Asked Questions and Guidance................................................................ 33 Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance................................................... Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-000837 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-000838 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-000839 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 19-1904 CK 14-1401 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-000840 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-000841 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-000842 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-000843 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-000844 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-000845 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-000846 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-000847 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-000848 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Three other related programs and projectsin this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases • G. Hospital-acquired infections and antimicrobial resistance • O. Vaccine preventable diseases To simplify the application process, for those three specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-000849 through the program-specific activity (i.e., Activity F, G, or O); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those three activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-000850 barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. • The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-000851 • “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. o Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Prepare a report identifying the populations and outlining strategies to improve coverage.  Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities.  Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks.  Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission.  Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-000852 P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. • Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-000853 NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-000854 NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-000855 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-000856 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method will be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDFfrom .Eile... ~ PDF from .S.canner f'~ PDFfrom Web Page... Saveas Otner EJcporlTo Shift+Ctr l+O f'e,PDFfrom .Clipboard ~ J.!➔..I ~:!!I Combine Filesinto a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF£ortfolio ... ~ udget.pdf PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-000857 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF,click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 24 TX-DSHS-19-1309-A-000859 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.pdl ~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.pdf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDFand save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-000860 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q: Where can I locate the FY19 NOFO? A: The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A: The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A: The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q: What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: AwardsMade ELC NOFO Published Budget Webinar Appl ications Due 2014-20 18 Closeout Report & 2018 Perform ance Measures Due ELC Kick-Off Webi nar Feb 28 2019 HAI/AR Perform ance Measures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toRrnca y Aue 1 Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-000861 Q: What is the application due date? A: The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A: Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q: When should we submit our Close-Out Reports? A: A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in Centers for Disease Control and Prevention 27 TX-DSHS-19-1309-A-000862 FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q: Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Q: Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q: Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o • Performance measures will NOT be collected with application. o • Enter these narratives on “approach” tab in each template. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-000863 • • • • Therefore, the activities names are hard coded. Work plan details are not pre-populated, as this is the first of a five year period of performance Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q .Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. What are some of the new ELC Budget Template Features? A: There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-000864 funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-000865 A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users Submitting Your Applications Questions Q: Where do I submit my completed application? A: Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Q: Are recipients still required to submit applications to GrantSolutions? A: No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q: How do I gain access to REDCap A: In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-000866 Q. What should we submit via REDCap? A: The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q: What resources will be available for recipients to complete applications? A: The ELC will release the following resources to assist recipients with completing and submitting their grant application: Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-000867 ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com 7. Program-Specific Frequently Asked Questions and Guidance Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-000868 *Users can access bookmarks to navigate the FAQ sections* 2019 ELC Section F: Frequently Asked Questions General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE FoodNet Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSS Enhanced OHHABS and GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvp2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov; 404.718.4155) Amy Kirby (agk1@cdc.gov; 404.718.3161) Mia Mattioli (kuk9@cdc.gov; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhq5@cdc.gov; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814) Jared Reynolds (uvz6@cdc.gov; 404.639.3519) Erin Stokes (ykt3@cdc.gov; 404.718.1175) Aron Hall (esg3@cdc.gov; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Aron Hall (esg3@cdc.gov; 404.639.1869) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Jonathan Yoder (jey9@cdc.gov; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov; 404.639.0704), Efrain Ribot (eyr4@cdc.gov; 404.639.3521) Template-related questions 1. What happened to the ‘other’ option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an ‘other’ option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000869 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 1. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 2. What we if have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000870 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity 1. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. Waterborne (General) 1. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 2. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 3. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. CryptoNet 4. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) 3 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000871 Great Lakes Restoration Initiative (GLRI) 5. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 6. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 4 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000872 7. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-disease-reporting-table.html. 8. For activity IV (e), what does environmental contamination mean? 9. Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). Activity IX: Advance electronic information exchange implementation (p 107) 10. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 11. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. 5 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000873 FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #5 for more information about how to apply for GLRI funding). 6 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000874 Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 4. What are the minimum activities for a CoE? Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If 7 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000875 an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 8 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000876 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. o Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding 9 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000877 6. 7. 8. 9. tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 10 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000878 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-000879 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-000880 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-000881 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-000882 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-000883 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-000884 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-000885 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-000886 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-000887 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-000888 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-000889 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-000890 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-000891 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-000892 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-000893 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-000894 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-000895 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-000896 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-000897 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-000898 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-000899 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-000900 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-000901 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-000902 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-000903 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-000904 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-000905 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-000906 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-000907 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-000908 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-000909 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-000910 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-000911 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-000912 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-000913 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-000914 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-000915 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-000916 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-000917 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-000918 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-000919 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-000920 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. TX-DSHS-19-1309-A-000921 From: Vector-Borne ELC (CDC) Sent: Friday, March 22, 2019 11:39 AM EDT To: harit.agroia@cdph.ca.gov ; a.tufa@doh.as ; Fleischauer, Aaron (CDC dhhs.nc.gov) ; abdi.elmi@ct.gov ; abigail.taylor@maryland.gov ; adrienne.armstead@maryland.gov ; amie.worthington@ks.gov ; amy.bergquist@dhhs.nh.gov ; Schlabach,Amy (DSHS) ; Nakashima, Allyn (CDC utah.gov) ; anambiar@pa.gov ; andrew.connet@idph.iowa.gov ; angela.fritzinger@dgs.virginia.gov ; Farmer, Ann (CDC maine.gov) ; Garvey, Ann (CDC idph.iowa.gov) ; Thomas, Ann (CDC state.or.us) ; Likos, Anna (CDC flhealth.gov) ; annemarie.santos@dphss.guam.gov ; Anthony.muyombwe@ct.gov ; anthony.tran@dc.gov ; Bell, Linda (CDC dhec.sc.gov) ; Benita.Bosier-Ingram@arkansas.gov ; benjamin.chan@dhhs.nh.gov ; Bernard Jilly ; bill.whitmar@health.mo.gov ; boydj1@michigan.gov ; brett.ellis@doh.vi.gov ; Bryan.Oconnor@vermont.gov ; Blackmore, Carina (CDC flhealth.gov) ; Carl Williams ; carla.lundquist@health.ri.gov ; carmen.deseda@salud.pr.gov ; Johnson, Caroline ( PHILA ) (CDC phila.gov) ; Carolyn.fredette@dhhs.nh.gov ; Carolyn.Haberman@Illinois.gov ; Carrell.Rush@ky.gov ; caryn.masters@ks.gov ; catherine.brown@massmail.state.ma.us ; cbiskupiak@mt.gov ; cburnett@utah.gov ; ceci.dunn@state.ma.us ; Smelser, Chad CS (CDC state.nm.us) ; Drenzek, Cherie (CDC dph.ga.gov) ; Cheryl.Achilles@vermont.gov ; Chris.Carlson@state.sd.us ; christi.d.clark@wv.gov ; Tan, Christina (CDC doh.state.nj.us) ; Christine.Hahn@dhw.idaho.gov ; christine.laing@maine.gov ; Christine.Muganda@dhs.wisconsin.gov ; christine.romalewski@la.gov ; Christopher.Ball@dhw.idaho.gov ; Vanhouten, Clay (CDC wyo.gov) ; clbean@dhhs.nh.gov ; clmassen@nd.gov ; Austin, Connie (CDC illinois.gov) ; corazon.pablo@dph.gov.mp ; dana.perella@phila.gov ; daniel.kuhles@health.ny.gov ; daniela.quilliam@health.ri.gov ; daphne.ware@msdh.ms.gov ; Blythe, David (CDC maryland.gov) ; david.crosby@state.co.us ; david.crum@maryland.gov ; david.neitzel@state.mn.us ; davismm@dhec.sc.gov ; Boothe, Dustin (CDC carson.org) ; Debbie.Freeman@Illinois.gov ; debbie.ogden@state.de.us ; debgibson@mt.gov ; Blog, Debra (CDC health.ny.gov) ; dee.pettit@dhhs.nc.gov ; diana.eaton@ct.gov ; dimple.patel@ky.gov ; Haselow, Dirk (CDC arkansas.gov) ; dlindeman@mt.gov ; Drociuk, Dan (CDC dhec.sc.gov) ; drp_dauterman@yahoo.com ; duc.vugia@cdph.ca.gov ; dxia@pa.gov ; Anzures, Edlen (CDC gmail.com) ; eden.uchel@palauhealth.org ; Lifshitz, Edward (CDC doh.state.nj.us) ; Hawkins, Eric (CDC isdh.in.gov) ; eleanor.johannes@doh.vi.gov ; Elizabeth.Brotheridge@dhs.wisconsin.gov ; elizabeth.schiffman@state.mn.us ; Emily Elzeftawy ; Emerson, Emily (CDC state.mn.us) ; emily.hanlin@state.de.us ; emily.travanty@state.co.us ; encijar.hassan@salud.pr.gov ; erdaly@dhhs.nh.gov ; eric.mcvicker@wyo.gov ; Erika.Baldry@mt.gov ; ada, Estelle (CDC dphss.guam.gov) ; Ellis, Esther (CDC doh.vi.gov) ; Muña, Esther (CDC dph.gov.mp) ; eugene.livar@azdhs.gov ; ewa.king@health.ri.gov ; farah.ahmed@ks.gov ; farautu@doh.as ; PRAMS District of Columbia (CDC dc.gov) ; fostere@michigan.gov ; francine.lang@doh.vi.gov ; francis.termeteet@palauhealth.org ; george.turabelidze@health.mo.gov ; ggonzalez@salud.pr.gov ; glen.baker@arkansas.gov ; gracelda.simmons@doh.hawaii.gov ; heckrl@dhec.sc.gov ; howard.pue@health.mo.gov ; Hull, Noah (CDC wyo.gov) ; Garcia,Imelda M (DSHS) ; Iugafono, Sunia (CDC doh.as) ; jafar.razeq@ct.gov ; Watt, James (CDC cdph.ca.gov) ; Janis.Pritchett@adph.state.al.us ; janis.thompson@arkansas.gov ; Maillard, Jean-Marie (CDC dhhs.nc.gov) ; jeff.hamik@nebraska.gov ; Jennifer.Crew@Illinois.gov ; Jennifer.Levy@cityofchicago.org ; Rigler, Jessica (CDC azdhs.gov) ; jleo@doh.as ; jlute@pa.gov ; Mullins, Jocelyn (CDC ct.gov) ; joel.sevinsky@state.co.us ; Davies-Cole, John (CDC dc.gov) ; john.l.fontana@state.or.us ; JohnFM@health.ok.gov ; jomil.torres@salud.pr.gov ; McLaughlin, Joseph (CDC alaska.gov) TX-DSHS-19-1309-A-000922 ; josephine.omallan@dphss.guam.gov ; Joshua.Clayton@state.sd.us ; Rakeman, Jennifer JR (CDC health.nyc.gov) ; jsarofalpiy@fsmhealth.fm ; juan.oquendo@salud.pr.gov ; Kauerauf, Judy (CDC illinois.gov) ; Julie Decker ; julie.gabel@dph.ga.gov ; julie.miracle@doh.wa.gov ; Morita, Julie (CDC cityofchicago.org) ; kari.williams@state.sd.us ; karin.thurman@msdh.ms.gov ; Kathryn.Turner@dhw.idaho.gov ; katya.ledin@cdph.ca.gov ; Stevens, Kelly (CDC adph.state.al.us) ; Komatsu, Kenneth (CDC azdhs.gov) ; ken.pote@maine.gov ; Kenneth.Sharp@idph.iowa.gov ; kerri.gerage@la.gov ; Buchs, Kerry (CDC phila.gov) ; Kim.Cervantes@doh.nj.gov ; Kirstin.Short@houstontx.gov ; Milhon, Karl (CDC mt.gov) ; Kristen.Ehresmann@state.mn.us ; kristen.feemster@phila.gov ; kschwarzkopf@nd.gov ; kwainwright@isdh.in.gov ; Seigler, Larry (CDC houstontx.gov) ; Laura.Rothfeldt@arkansas.gov ; Burnsed, Laurence (CDC health.ok.gov) ; lbarrow@fsmhealth.fm ; lcronquist@nd.gov ; leo.casil@dphss.guam.gov ; Lisa.Drake@state.nm.us ; lmorrow@agri.nv.gov ; lori.simmons@arkansas.gov ; Castrodale, Louisa (CDC alaska.gov) ; lstubbs@pa.gov ; lyoncallos@michigan.gov ; Del Rosario, Maria (CDC wv.gov) ; marie.desrosiers@health.ny.gov ; marion.kainer@tn.gov ; Mark.ONeill@flhealth.gov ; Pacilli, Massimo (CDC cityofchicago.org) ; mataina@doh.as ; Cartter, Matthew (CDC ct.gov) ; matt.charles@illinois.gov ; matthew.a.osborne@state.ma.us ; matthew.mccarroll@dc.gov ; mdethloff@nd.gov ; melissastevens@utah.gov ; Fisher,Michael L (HHSC/DSHS NTH) ; Landen, Michael (CDC state.nm.us) ; Boysun, Mike (CDC doh.wa.gov) ; Qu, Ming (CDC nebraska.gov) ; Layton, Marci (CDC health.nyc.gov) ; Walter, Magdalena (CDC fsmhealth.fm) ; myra.ching-lee@doh.hawaii.gov ; nancy.l.barrett@ct.gov ; natalie.kwit@vermont.gov ; neriwase@hotmail.com ; ngantt@health.nyc.gov ; ngunsalus@kdheks.gov ; nianest.alersbarreto@doh.hawaii.gov ; Green, Nicole (CDC ph.lacounty.gov) ; p.tomokane@gmail.com ; patricia.kludt@state.ma.us ; Patsy.Kelso@vermont.gov ; paul.byers@msdh.ms.gov ; paul.kimsey@cdph.ca.gov ; paul.lalita@gmail.com ; paul.white@dph.gov.mp ; paula.eggers@state.de.us ; pbartella@health.nv.gov ; peter.shult@slh.wisc.edu ; piwen@unmc.edu ; portia.tomokane@dph.gov.mp ; Iyengar, Preetha (CDC dc.gov) ; quanta.brown@odh.ohio.gov ; Herlihy, Rachel (CDC state.co.us) ; Rachel.Hinnenkamp@mt.gov ; ransenjr@gmail.com ; Ratard, Raoult (CDC la.gov) ; rebecca.curtiss@idph.iowa.gov ; Rebecca.Osborn@dhs.wisconsin.gov ; rebecca.sciulli@doh.hawaii.gov ; Danila, Richard (CDC state.mn.us) ; richard.steece@tn.gov ; rina.warehall@doh.state.nj.us ; rmatkinson@utah.gov ; Rmclaurin@phfe.org ; Madera, Robbie (CDC phila.gov) ; robert.myers-phd@maryland.gov ; robhad@yahoo.com ; Williams, Robin (CDC nebraska.gov) ; romesh.gautom@doh.wa.gov ; ronald.limberger@health.ny.gov ; Eggert, Russell (CDC flhealth.gov) ; ruth.thompson@maryland.gov ; Wozniak, Ryan (CDC dhs.wisconsin.gov) ; Sandra.Melman@state.nm.us ; Sandra.smole@state.ma.us ; sandy.peterson@vdh.virginia.gov ; Robinson, Sara (CDC maine.gov) ; Vetter, Sara SV (CDC state.mn.us) ; sarah.buss@wyo.gov ; Kemble, Sarah SK (CDC cityofchicago.org) ; sarah.park@doh.hawaii.gov ; Balter, Sharon (CDC ph.lacounty.gov) ; scott.j.zimmerman@dhhs.nc.gov ; Levine, Seth (CDC vdh.virginia.gov) ; shahs@michigan.gov ; Sharon Massingale ; sharon.messenger@cdph.ca.gov ; shawatkins@pa.gov ; shawna.dereemer@wyo.gov ; shelley.russell@ks.gov ; Madraisau, Sherilynn (CDC palauhealth.org) ; Davidson, Sherri (CDC adph.state.al.us) ; deFijter, Sietske (CDC odh.ohio.gov) ; signsk@michigan.gov ; SReynaldo@ph.lacounty.gov ; Black, Stephanie SB (CDC cityofchicago.org) ; stephanie.ostrowski@health.ny.gov ; stephen.g.ladd-wilson@state.or.us ; Alles, Steve (CDC phila.gov) ; stewart.matthews@arkansas.gov ; Stobierski, Mary Grace (CDC michigan.gov) ; stubach@kdheks.gov ; Susan.Mikorski@doh.nj.gov ; svanhooser@medicine.nevada.edu ; tamara.cruz@dphss.guam.gov ; TX-DSHS-19-1309-A-000923 tengelse@dhw.idaho.gov ; terrence.williams@dc.gov ; Sokol, Theresa (CDC la.gov) ; Aldridge,Tiffany (DSHS) ; Jones, Tim F. (CDC tn.gov) ; tim.southern@state.sd.us ; Miller, Tracy (CDC nd.gov) ; tmong.udui@palauhealth.org ; tolulope.olumuyiwa@houstontx.gov ; Safranek, Thomas (CDC nebraska.gov) ; tonia.parrott@dph.ga.gov ; DeSalvo, Traci (CDC dhs.wisconsin.gov) ; Bandy, Utpala (CDC health.ri.gov) ; Vicki.Kramer@cdph.ca.gov ; victor.waddell@azdhs.gov ; victoria.catoe@dph.ga.gov ; Vivek Raman ; wade-aldous@uiowa.edu ; warren.villagomez@dph.gov.mp ; wasejacklick@gmail.com ; Wayne Clifford ; Wayne.Turnberg@doh.wa.gov ; YTong@ph.lacounty.gov ; Moore, Zackary (CDC dhhs.nc.gov) CC: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) ; Vector-Borne ELC (CDC) ; Borchert, Jeff N. (CDC/DDID/NCEZID/DVBD) Subject: UPDATE: ELC Program H - Questions and Answers WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning, ELC Program H applicants – Contrary to what was stated in the Vector-Borne webinar, you CAN request more than 1.0 FTE to support Tier 1 activities, so long as the total request for Tier 1 does not exceed the $150,000 to $250,000 amounts listed in the announcement. To the extent that the additional personnel also support Tier 2 and/or Tier 3 activities, please indicate this in your narrative. Our Program H team is working on a comprehensive FAQ. We’re hoping to have this available and shared within the next week. Please continue to send all questions to our inbox. Thank you, The VBD Extramural Program Management Team vbdelc@cdc.gov TX-DSHS-19-1309-A-000924 From: ZIKApregnancy (CDC) Sent: Friday, March 22, 2019 4:10 PM EDT To: ZIKApregnancy (CDC) ; Baez Santiago, Madelyn (CDC/DDNID/NCBDDD/DCDD) (CTR) ; Reynolds, Megan (CDC/DDNID/NCBDDD/DCDD) ; King, Kellianne M. (CDC/DDNID/NCBDDD/DCDD) (CTR) Subject: Supplemental ELC NOFO Guidance Attachment(s): "Supplementary Information for ELC FY 2019_v1.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon Jurisdictional Partners, We want to share supplemental application information that we recently received from ELC regarding the CDC-RFA-CK19-1904 ELC 2019 Notice of Funding Opportunity (NOFO). Please refer to pages 85-86, which contain common questions and answers regarding the application for Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats”. We hope that this supplemental information will be useful when drafting your application. However, if you have any questions, please reach out to ELC at ELC@cdc.gov. As a reminder, the deadline to submit your completed application is Friday, May 10, 2019 at 11:59pm ET. Best Regards, Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities ZIKApregnancy@cdc.gov TX-DSHS-19-1309-A-000925 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) March 2019 Centers for Disease Control and Prevention 1 TX-DSHS-19-1309-A-000926 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 19 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 20 5. Submission Process ................................................................................................................................. 21 Submission Checklist ............................................................................................................................... 21 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 21 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 26 7. Program-Specific Frequently Asked Questions and Guidance................................................................ 33 Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance................................................... Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-000927 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-000928 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-000929 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 19-1904 CK 14-1401 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-000930 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-000931 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-000932 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-000933 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-000934 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-000935 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-000936 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-000937 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-000938 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Three other related programs and projectsin this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases • G. Hospital-acquired infections and antimicrobial resistance • O. Vaccine preventable diseases To simplify the application process, for those three specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-000939 through the program-specific activity (i.e., Activity F, G, or O); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those three activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-000940 barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. • The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-000941 • “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. o Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Prepare a report identifying the populations and outlining strategies to improve coverage.  Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities.  Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks.  Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission.  Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-000942 P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. • Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-000943 NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-000944 NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-000945 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-000946 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method will be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDFfrom .Eile... ~ PDF from .S.canner f'~ PDFfrom Web Page... Saveas Otner EJcporlTo Shift+Ctr l+O f'e,PDFfrom .Clipboard ~ J.!➔..I ~:!!I Combine Filesinto a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF£ortfolio ... ~ udget.pdf PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-000947 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF,click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 24 TX-DSHS-19-1309-A-000949 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.pdl ~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.pdf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDFand save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-000950 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q: Where can I locate the FY19 NOFO? A: The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A: The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A: The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q: What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: AwardsMade ELC NOFO Published Budget Webinar Appl ications Due 2014-20 18 Closeout Report & 2018 Perform ance Measures Due ELC Kick-Off Webi nar Feb 28 2019 HAI/AR Perform ance Measures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toRrnca y Aue 1 Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-000951 Q: What is the application due date? A: The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A: Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q: When should we submit our Close-Out Reports? A: A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in Centers for Disease Control and Prevention 27 TX-DSHS-19-1309-A-000952 FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q: Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Q: Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q: Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o • Performance measures will NOT be collected with application. o • Enter these narratives on “approach” tab in each template. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-000953 • • • • Therefore, the activities names are hard coded. Work plan details are not pre-populated, as this is the first of a five year period of performance Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q .Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. What are some of the new ELC Budget Template Features? A: There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-000954 funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-000955 A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users Submitting Your Applications Questions Q: Where do I submit my completed application? A: Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Q: Are recipients still required to submit applications to GrantSolutions? A: No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q: How do I gain access to REDCap A: In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-000956 Q. What should we submit via REDCap? A: The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q: What resources will be available for recipients to complete applications? A: The ELC will release the following resources to assist recipients with completing and submitting their grant application: Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-000957 ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com 7. Program-Specific Frequently Asked Questions and Guidance Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-000958 *Users can access bookmarks to navigate the FAQ sections* 2019 ELC Section F: Frequently Asked Questions General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE FoodNet Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSS Enhanced OHHABS and GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvp2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov; 404.718.4155) Amy Kirby (agk1@cdc.gov; 404.718.3161) Mia Mattioli (kuk9@cdc.gov; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhq5@cdc.gov; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814) Jared Reynolds (uvz6@cdc.gov; 404.639.3519) Erin Stokes (ykt3@cdc.gov; 404.718.1175) Aron Hall (esg3@cdc.gov; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Aron Hall (esg3@cdc.gov; 404.639.1869) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Jonathan Yoder (jey9@cdc.gov; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov; 404.639.0704), Efrain Ribot (eyr4@cdc.gov; 404.639.3521) Template-related questions 1. What happened to the ‘other’ option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an ‘other’ option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000959 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 1. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 2. What we if have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000960 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity 1. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. Waterborne (General) 1. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 2. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 3. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. CryptoNet 4. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) 3 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000961 Great Lakes Restoration Initiative (GLRI) 5. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 6. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 4 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000962 7. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-disease-reporting-table.html. 8. For activity IV (e), what does environmental contamination mean? 9. Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). Activity IX: Advance electronic information exchange implementation (p 107) 10. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 11. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. 5 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000963 FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #5 for more information about how to apply for GLRI funding). 6 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000964 Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 4. What are the minimum activities for a CoE? Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If 7 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000965 an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 8 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000966 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. o Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding 9 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000967 6. 7. 8. 9. tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 10 ELC NOFO FAQ: Section F (ver. 03/21/2019) TX-DSHS-19-1309-A-000968 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-000969 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-000970 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-000971 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-000972 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-000973 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-000974 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-000975 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-000976 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-000977 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-000978 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-000979 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-000980 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-000981 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-000982 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-000983 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-000984 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-000985 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-000986 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-000987 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-000988 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-000989 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-000990 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-000991 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-000992 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-000993 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-000994 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-000995 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-000996 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-000997 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-000998 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-000999 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-001000 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-001001 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-001002 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001003 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001004 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001005 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-001006 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-001007 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-001008 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-001009 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-001010 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. TX-DSHS-19-1309-A-001011 From: Portia Tomokane Sent: Monday, March 25, 2019 7:53 PM EDT To: Vector-Borne ELC (CDC) CC: harit.agroia@cdph.ca.gov ; a.tufa@doh.as ; Fleischauer, Aaron (CDC dhhs.nc.gov) ; abdi.elmi@ct.gov ; abigail.taylor@maryland.gov ; adrienne.armstead@maryland.gov ; amie.worthington@ks.gov ; amy.bergquist@dhhs.nh.gov ; Schlabach,Amy (DSHS) ; Nakashima, Allyn (CDC utah.gov) ; anambiar@pa.gov ; andrew.connet@idph.iowa.gov ; angela.fritzinger@dgs.virginia.gov ; Farmer, Ann (CDC maine.gov) ; Garvey, Ann (CDC idph.iowa.gov) ; Thomas, Ann (CDC state.or.us) ; Likos, Anna (CDC flhealth.gov) ; annemarie.santos@dphss.guam.gov ; Anthony.muyombwe@ct.gov ; anthony.tran@dc.gov ; Bell, Linda (CDC dhec.sc.gov) ; Benita.Bosier-Ingram@arkansas.gov ; benjamin.chan@dhhs.nh.gov ; Bernard Jilly ; bill.whitmar@health.mo.gov ; boydj1@michigan.gov ; brett.ellis@doh.vi.gov ; Bryan.Oconnor@vermont.gov ; Blackmore, Carina (CDC flhealth.gov) ; Carl Williams ; carla.lundquist@health.ri.gov ; carmen.deseda@salud.pr.gov ; Johnson, Caroline ( PHILA ) (CDC phila.gov) ; Carolyn.fredette@dhhs.nh.gov ; Carolyn.Haberman@Illinois.gov ; Carrell.Rush@ky.gov ; caryn.masters@ks.gov ; catherine.brown@massmail.state.ma.us ; cbiskupiak@mt.gov ; cburnett@utah.gov ; ceci.dunn@state.ma.us ; Smelser, Chad CS (CDC state.nm.us) ; Drenzek, Cherie (CDC dph.ga.gov) ; Cheryl.Achilles@vermont.gov ; Chris.Carlson@state.sd.us ; christi.d.clark@wv.gov ; Tan, Christina (CDC doh.state.nj.us) ; Christine.Hahn@dhw.idaho.gov ; christine.laing@maine.gov ; Christine.Muganda@dhs.wisconsin.gov ; christine.romalewski@la.gov ; Christopher.Ball@dhw.idaho.gov ; Vanhouten, Clay (CDC wyo.gov) ; clbean@dhhs.nh.gov ; clmassen@nd.gov ; Austin, Connie (CDC illinois.gov) ; corazon.pablo@dph.gov.mp ; dana.perella@phila.gov ; daniel.kuhles@health.ny.gov ; daniela.quilliam@health.ri.gov ; daphne.ware@msdh.ms.gov ; Blythe, David (CDC maryland.gov) ; david.crosby@state.co.us ; david.crum@maryland.gov ; david.neitzel@state.mn.us ; davismm@dhec.sc.gov ; Boothe, Dustin (CDC carson.org) ; Debbie.Freeman@Illinois.gov ; debbie.ogden@state.de.us ; debgibson@mt.gov ; Blog, Debra (CDC health.ny.gov) ; dee.pettit@dhhs.nc.gov ; diana.eaton@ct.gov ; dimple.patel@ky.gov ; Haselow, Dirk (CDC arkansas.gov) ; dlindeman@mt.gov ; Drociuk, Dan (CDC dhec.sc.gov) ; drp_dauterman@yahoo.com ; duc.vugia@cdph.ca.gov ; dxia@pa.gov ; Anzures, Edlen (CDC gmail.com) ; eden.uchel@palauhealth.org ; Lifshitz, Edward (CDC doh.state.nj.us) ; Hawkins, Eric (CDC isdh.in.gov) ; eleanor.johannes@doh.vi.gov ; Elizabeth.Brotheridge@dhs.wisconsin.gov ; elizabeth.schiffman@state.mn.us ; Emily Elzeftawy ; Emerson, Emily (CDC state.mn.us) ; emily.hanlin@state.de.us ; emily.travanty@state.co.us ; encijar.hassan@salud.pr.gov ; erdaly@dhhs.nh.gov ; eric.mcvicker@wyo.gov ; Erika.Baldry@mt.gov ; ada, Estelle (CDC dphss.guam.gov) ; Ellis, Esther (CDC doh.vi.gov) ; Muña, Esther (CDC dph.gov.mp) ; eugene.livar@azdhs.gov ; ewa.king@health.ri.gov ; farah.ahmed@ks.gov ; farautu@doh.as ; PRAMS District of Columbia (CDC dc.gov) ; fostere@michigan.gov ; francine.lang@doh.vi.gov ; francis.termeteet@palauhealth.org ; george.turabelidze@health.mo.gov ; ggonzalez@salud.pr.gov ; glen.baker@arkansas.gov ; gracelda.simmons@doh.hawaii.gov ; heckrl@dhec.sc.gov ; howard.pue@health.mo.gov ; Hull, Noah (CDC wyo.gov) ; Garcia,Imelda M (DSHS) ; Iugafono, Sunia (CDC doh.as) ; jafar.razeq@ct.gov ; Watt, James (CDC cdph.ca.gov) ; Janis.Pritchett@adph.state.al.us ; janis.thompson@arkansas.gov ; Maillard, Jean-Marie (CDC dhhs.nc.gov) ; jeff.hamik@nebraska.gov ; Jennifer.Crew@Illinois.gov ; Jennifer.Levy@cityofchicago.org ; Rigler, Jessica (CDC azdhs.gov) ; jleo@doh.as ; jlute@pa.gov ; Mullins, Jocelyn (CDC ct.gov) ; joel.sevinsky@state.co.us ; Davies-Cole, John (CDC dc.gov) ; john.l.fontana@state.or.us ; JohnFM@health.ok.gov ; TX-DSHS-19-1309-A-001012 jomil.torres@salud.pr.gov ; McLaughlin, Joseph (CDC alaska.gov) ; josephine.omallan@dphss.guam.gov ; Joshua.Clayton@state.sd.us ; Rakeman, Jennifer JR (CDC health.nyc.gov) ; jsarofalpiy@fsmhealth.fm ; juan.oquendo@salud.pr.gov ; Kauerauf, Judy (CDC illinois.gov) ; Julie Decker ; julie.gabel@dph.ga.gov ; julie.miracle@doh.wa.gov ; Morita, Julie (CDC cityofchicago.org) ; kari.williams@state.sd.us ; karin.thurman@msdh.ms.gov ; Kathryn.Turner@dhw.idaho.gov ; katya.ledin@cdph.ca.gov ; Stevens, Kelly (CDC adph.state.al.us) ; Komatsu, Kenneth (CDC azdhs.gov) ; ken.pote@maine.gov ; Kenneth.Sharp@idph.iowa.gov ; kerri.gerage@la.gov ; Buchs, Kerry (CDC phila.gov) ; Kim.Cervantes@doh.nj.gov ; Kirstin.Short@houstontx.gov ; Milhon, Karl (CDC mt.gov) ; Kristen.Ehresmann@state.mn.us ; kristen.feemster@phila.gov ; kschwarzkopf@nd.gov ; kwainwright@isdh.in.gov ; Seigler, Larry (CDC houstontx.gov) ; Laura.Rothfeldt@arkansas.gov ; Burnsed, Laurence (CDC health.ok.gov) ; lbarrow@fsmhealth.fm ; lcronquist@nd.gov ; leo.casil@dphss.guam.gov ; Lisa.Drake@state.nm.us ; lmorrow@agri.nv.gov ; lori.simmons@arkansas.gov ; Castrodale, Louisa (CDC alaska.gov) ; lstubbs@pa.gov ; lyoncallos@michigan.gov ; Del Rosario, Maria (CDC wv.gov) ; marie.desrosiers@health.ny.gov ; marion.kainer@tn.gov ; Mark.ONeill@flhealth.gov ; Pacilli, Massimo (CDC cityofchicago.org) ; mataina@doh.as ; Cartter, Matthew (CDC ct.gov) ; matt.charles@illinois.gov ; matthew.a.osborne@state.ma.us ; matthew.mccarroll@dc.gov ; mdethloff@nd.gov ; melissastevens@utah.gov ; Fisher,Michael L (HHSC/DSHS NTH) ; Landen, Michael (CDC state.nm.us) ; Boysun, Mike (CDC doh.wa.gov) ; Qu, Ming (CDC nebraska.gov) ; Layton, Marci (CDC health.nyc.gov) ; Walter, Magdalena (CDC fsmhealth.fm) ; myra.ching-lee@doh.hawaii.gov ; nancy.l.barrett@ct.gov ; natalie.kwit@vermont.gov ; neriwase@hotmail.com ; ngantt@health.nyc.gov ; ngunsalus@kdheks.gov ; nianest.alersbarreto@doh.hawaii.gov ; Green, Nicole (CDC ph.lacounty.gov) ; p.tomokane@gmail.com ; patricia.kludt@state.ma.us ; Patsy.Kelso@vermont.gov ; paul.byers@msdh.ms.gov ; paul.kimsey@cdph.ca.gov ; paul.lalita@gmail.com ; paul.white@dph.gov.mp ; paula.eggers@state.de.us ; pbartella@health.nv.gov ; peter.shult@slh.wisc.edu ; piwen@unmc.edu ; Iyengar, Preetha (CDC dc.gov) ; quanta.brown@odh.ohio.gov ; Herlihy, Rachel (CDC state.co.us) ; Rachel.Hinnenkamp@mt.gov ; ransenjr@gmail.com ; Ratard, Raoult (CDC la.gov) ; rebecca.curtiss@idph.iowa.gov ; Rebecca.Osborn@dhs.wisconsin.gov ; rebecca.sciulli@doh.hawaii.gov ; Danila, Richard (CDC state.mn.us) ; richard.steece@tn.gov ; rina.warehall@doh.state.nj.us ; rmatkinson@utah.gov ; Rmclaurin@phfe.org ; Madera, Robbie (CDC phila.gov) ; robert.myersphd@maryland.gov ; robhad@yahoo.com ; Williams, Robin (CDC nebraska.gov) ; romesh.gautom@doh.wa.gov ; ronald.limberger@health.ny.gov ; Eggert, Russell (CDC flhealth.gov) ; ruth.thompson@maryland.gov ; Wozniak, Ryan (CDC dhs.wisconsin.gov) ; Sandra.Melman@state.nm.us ; Sandra.smole@state.ma.us ; sandy.peterson@vdh.virginia.gov ; Robinson, Sara (CDC maine.gov) ; Vetter, Sara SV (CDC state.mn.us) ; sarah.buss@wyo.gov ; Kemble, Sarah SK (CDC cityofchicago.org) ; sarah.park@doh.hawaii.gov ; Balter, Sharon (CDC ph.lacounty.gov) ; scott.j.zimmerman@dhhs.nc.gov ; Levine, Seth (CDC vdh.virginia.gov) ; shahs@michigan.gov ; Sharon Massingale ; sharon.messenger@cdph.ca.gov ; shawatkins@pa.gov ; shawna.dereemer@wyo.gov ; shelley.russell@ks.gov ; Madraisau, Sherilynn (CDC palauhealth.org) ; Davidson, Sherri (CDC adph.state.al.us) ; deFijter, Sietske (CDC odh.ohio.gov) ; signsk@michigan.gov ; SReynaldo@ph.lacounty.gov ; Black, Stephanie SB (CDC cityofchicago.org) ; stephanie.ostrowski@health.ny.gov ; stephen.g.ladd-wilson@state.or.us ; Alles, Steve (CDC phila.gov) ; stewart.matthews@arkansas.gov ; Stobierski, Mary Grace (CDC michigan.gov) ; stubach@kdheks.gov ; Susan.Mikorski@doh.nj.gov ; svanhooser@medicine.nevada.edu ; tamara.cruz@dphss.guam.gov ; TX-DSHS-19-1309-A-001013 tengelse@dhw.idaho.gov ; terrence.williams@dc.gov ; Sokol, Theresa (CDC la.gov) ; Aldridge,Tiffany (DSHS) ; Jones, Tim F. (CDC tn.gov) ; tim.southern@state.sd.us ; Miller, Tracy (CDC nd.gov) ; tmong.udui@palauhealth.org ; tolulope.olumuyiwa@houstontx.gov ; Safranek, Thomas (CDC nebraska.gov) ; tonia.parrott@dph.ga.gov ; DeSalvo, Traci (CDC dhs.wisconsin.gov) ; Bandy, Utpala (CDC health.ri.gov) ; Vicki.Kramer@cdph.ca.gov ; victor.waddell@azdhs.gov ; victoria.catoe@dph.ga.gov ; Vivek Raman ; wade-aldous@uiowa.edu ; warren.villagomez@dph.gov.mp ; wasejacklick@gmail.com ; Wayne Clifford ; Wayne.Turnberg@doh.wa.gov ; YTong@ph.lacounty.gov ; Moore, Zackary (CDC dhhs.nc.gov) ; Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) ; Borchert, Jeff N. (CDC/DDID/NCEZID/DVBD) Subject: Re: UPDATE: ELC Program H - Questions and Answers WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Thank you for the information! Best Regards, Portia Tomokane ELC Coordinator Public Health Emergency Preparedness and Epidemiology Laboratory Capacity Program Commonwealth Healthcare Corporation P.O. Box 500409 CK Saipan, MP 96950 Telephone: (670) 236.8211 Facsimile: (670) 236.8207 Email Confidentiality Disclaimer and Notification: This message is intended for the sole use of the individual and entity to whom it is addressed, and may contain information that is privileged, confidential, and exempt from disclosure under applicable law. If you are not the intended addressee, you are hereby notified that you may not use, copy, disclose, or distribute to anyone the message or the information contained in the message. If you have received this message in error, please immediately advise the sender by reply email and delete the message. On Sat, Mar 23, 2019 at 1:39 AM Vector-Borne ELC (CDC) wrote: Good morning, ELC Program H applicants – Contrary to what was stated in the Vector-Borne webinar, you CAN request more than 1.0 FTE to support Tier 1 activities, so long as the total request for Tier 1 does not exceed the $150,000 to $250,000 amounts listed in the announcement. To the extent that the additional personnel also support Tier 2 and/or Tier 3 activities, please indicate this in your narrative. Our Program H team is working on a comprehensive FAQ. We’re hoping to have this available and shared within the next week. Please continue to send all questions to our inbox. Thank you, The VBD Extramural Program Management Team vbdelc@cdc.gov TX-DSHS-19-1309-A-001014 From: Vector-Borne ELC (CDC) Sent: Tuesday, March 26, 2019 6:53 PM EDT CC: Vector-Borne ELC (CDC) Subject: ELC Program H - VBD Webinar Q&A Attachment(s): "VBD Webinar QA 3-26-19.pdf","VBD ELC Webinar 3-20-19.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, ELC Program H Applicants, As promised, we would like to share a list of the comprehensive questions and answers posed during the vector-borne diseases webinar last week. A copy of the slides are also attached, for your convenience. Please continue to send additional questions to our inbox. Thank you, The VBD Extramural Program Management Team vbdelc@cdc.gov TX-DSHS-19-1309-A-001015 ELC2019- Program H Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond March 20, 2019 Division of Vector-Borne Diseases National Center for Emerging Zoonotic and Infectious Diseases TX-DSHS-19-1309-A-001016 Agenda • Welcome and Introductions • Overview of current vector-borne disease (VBD) issues in the US • Overview of NEW VBD Guidance • Tiered approach • CDC Priorities • Points of Contact • Questions TX-DSHS-19-1309-A-001017 Current State of VBDs in the U.S. - Increasing Cases (2004-2016) • Between 2004 and 2016, more than 640,000 cases of VBDs were reported in the US • The reported data substantially underestimates actual disease occurrence (8 to 70 fold depending on the disease) • The number of reported cases of disease spread by fleas, ticks and mosquitos has more than tripled • Tickborne diseases accounted for over 75% of reported VBD cases • Mosquito-borne disease epidemics happen more frequently Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. TX-DSHS-19-1309-A-001018 MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. Reported Nationally Notifiable Mosquito-borne*, Tickborne, and Fleaborne+ Disease Cases - US States and Territories, 2004-2016 60000 50000 40000 30000 20000 10000 0 2.004 2.005 2.006 2.007 2.008 2.009 2012 2.011 2.010 Reported mosqLiito-borne dis.ease cases in US st ates ■ Reported mos,quito -bome disease cases.in US territories 2013 2014 2016 2015 Reported tick -borne disease cas.esin US states ■ "Mosquito-borne case counts include both locally transmitted and travel-associated cases. + A total of 89 flea borne disease cases (plague) were reported during 2004-2016, ranging from two cases in 2010 to 16 cases in 2015. The cases are not depicted on the figure. Source: Rosenberg R, et al. Trends in Reported Vector-Borne Diseases Cases - United States and U.S. Territories, 2004-2016. MMWR Morb Mortal Wkly Rep. Vol. 67, 2018. TX-DSHS-19-1309-A-001019 Division of Vector-Borne Diseases VISION: Create a future where vector-borne diseases no longer threaten public health MISSION: Reduce illness and death due to VBDs GOAL 1: Identify and detect vector-borne pathogens that cause disease in people GOAL 2: Understand when, where, how often and how people are exposed to vector-borne pathogens GOAL 3: Prevent exposure to vector-borne pathogens and mitigate consequences of infection GOAL 4: Implement vector-borne disease diagnostics, surveillance, control and prevention programs TX-DSHS-19-1309-A-001020 A Call to Action for a National Strategy/National Action Plan Am. J. 1~ . Me/Jt . f-00_, i ~) . 20 19 . A] •. 242 - 2-4$ oo :10.4 269/a:_nim.iS-0841 Oopyligliit e 2'019 by-TheAmerican SocieWofTrq:iicalMed.ldne aoo HygieM P erspec1 1-.1v:e p·iece r C,omba11ing t he ~ncr,easing Thr,eat ,of V,ec:t ,or-lBorne Dis,ease in the Unit,ed States with a National Vee:1 :or---B,orne Disease Prev,en1ion and Control Syst em 1 1 1 1 1 ly l'e R. Pietierse n , Charl:es 8. Beam, .al1ldSusanin.aN. Viss,er* Division of Vee10.r -Bome Diseases1 Natiarisl ce ,uer tot EmetgituJ tJJ1d Z oon01.icl11fecrious,Ds~e,s, 1 1 Ce.i1:te.r:s for DisaeiSe a,mro-l Md Prevention, Fen Collins, CcJlot8do • Highlightsthe importance of sustaining states health departments in their role of combating VBDs and the need for a common national strategy to protect the US from VBD threats TX-DSHS-19-1309-A-001021 ELCVBD Funding 2012-2019 Arbo $72,307,103 Total $74,108,830 $30 $25 $20 V, C: ,Q $15 ~ $10 $5 $0 2012 2013 2014 ■ M1 -Arbo 2015 ■ N1 - Lyme 2016 ■ 2017 N2 - Non-Lyme Tickborne 2018 2019 TX-DSHS-19-1309-A-001022 DVBDApproach to Prevention and Control of VBDs Goal • Sustained, national capacity to detect, prevent, investigate, report, and control new and emerging vector-borne threats ELCVBD Goal • Support Jurisdictions to build sustainable, locally relevant programs to identify, prevent and respond to vector-borne diseases TX-DSHS-19-1309-A-001023 VBD ELC2019 - Overview • Vector-Borne Diseases moving from Project to Program • Combined VBD guidance • No longer Ml, Nl and N2 • New tiered approach • Core activities - Tier 1 • Enhanced activities - Tiers 2 and 3 • Focus on priority VBDs of the jurisdiction • FY2019 Funding - ~$16 million TX-DSHS-19-1309-A-001024 VBD ELC2019 - Overview • Average award range: $150,000-260,000 • Opportunity to fund a limited of jurisdictions for Tier 3 • 5-7 jurisdictions at $500,000-750,000 total • Communicate your current capacity • Baseline for comparison to future year capacity • Please include jurisdiction • • • • POCs: Arbovirus Lyme Disease, plague, tularemia Rickettsial diseases Parasitic vector-borne diseases (non-malaria) TX-DSHS-19-1309-A-001025 Tier 1 • Core activities for VBD programs - Summary • Epidemiology • Surveillance of nationally notifiable VBDs: data collection, reporting and evaluation • Limited educational outreach • Capacity to investigate and respond to VBD cases as necessary • Laboratory • Testing for VBDs of public health importance to the jurisdiction • Participation in VBD proficiency panels • Ecology • Report passively collected vector, sentinel animal, or veterinary cases • Ability to advise local agencies on vector control TX-DSHS-19-1309-A-001026 Tier 2 • Enhanced activities for VBD programs - Summary • Epidemiology • Surveillance and reporting of NON-nationally notifiable VBDs • Develop and maintain surveillance and response plan for VBDs • Laboratory • Enhanced laboratory capacity • Ecology • Actively conduct or coordinate ecologic/vector surveillance and reporting (e.g. ArboNET, MosquitoNET) • Pathogen testing in ticks, in collaboration with CDC • Pathogen testing in mosquitos • Insecticide resistance testing for mosquitos • Tick surveillance - Guidance released*, Tick module in ArboNET ~ https://www.cdc.gov/ticks/resources/TickSu rve i Ila nee lsca pu la ris-P.pdf TX-DSHS-19-1309-A-001027 Tier 3 • Regional focus, local reach/resource sharing • Collaboration with public health and academic partners • Epidemiology • Enhanced surveillance • Capacity to lead complex investigations; assisting other jurisdictions • Novel surveillance and interventions • Laboratory • Regional reference laboratory support for other jurisdictions • Advanced diagnostics TX-DSHS-19-1309-A-001028 Tier 3 - Continued • Ecology • Vector-control implementation/coordination • Develop and implement a comprehensive integrated vector surveillance and control plans • Pathogen testing in ticks (at jurisdiction) • Enhanced communication activities • Advanced message dissemination and reporting • VBD communication plans • Multi-faceted outreach to diverse audiences TX-DSHS-19-1309-A-001029 2019 Priorities • • • • Jurisdiction's priority VBDs and vectors Communicating your current capacity If you don't ask for it, we can't fund it Assuring Core (Tier 1) capabilities in every jurisdiction • Inclusion of one FTE (or% FTE)to support activities • Travel to ELCGrantee meeting AND 4 day VBD meeting ("'Feb 2020) • Supplies/shipping • Education materia Is TX-DSHS-19-1309-A-001030 2019 Priorities - Enhanced • Enhanced (Tier 2) • Demonstrated Tier 1 capacity • Enhanced ecology activities • Tick surveillance - reporting in Tick Module in ArboNET • Mosquito surveillance/ insecticide resistance MosquitoNET • Additional FTEs(or% FTE) • Travel for staff to VBD meeting in Feb 2020 • Supplies/shipping to support enhanced lab activities • Education materials TX-DSHS-19-1309-A-001031 2019 Priorities - Enhanced • Enhanced (Tier 3) • Demonstrated Tier 1 and 2 capacity • Supporting comprehensive programs that develop and maintain capacity to: • Use surveillance data for decision making and coordinate complex investigations and responses, including vector control and communications planning • Collaborate between stakeholders and lower level health and vector control jurisdictions • Demonstrate linkage of surveillance to prevention and control ofVBD TX-DSHS-19-1309-A-001032 Points of Contact • VBD ELC Guidance - Jeff Borchert gqxl@cdc.gov • Technical POCs • • • • Arbovirus diseases: Stacey Martin, zmt0@cdc.gov Lyme disease, plague, tularemia: Kiersten Kugeler, bio1@cdc.gov Rickettsial diseases: Kristen Nichols Heitman, wwd7@cdc.gov ; Parasitic vector-borne diseases (non-malaria): Elizabeth Gray, din8@cdc.gov • Tick surveil la nee guidelines - ticksu rvei Ila nce@cdc.gov TX-DSHS-19-1309-A-001033 New Vector-Borne Disease Program Inbox VBDELC@cdc.gov Questions? 60000 50000 40000 30000 20000 10000 0 2004 2005 2006 2007 2008 2009 2010 Reported mosquito-borne disease cases in US states ■ Reported 2011 2012 ■ Reported mosquito-borne disease cases in US territories 2013 2014 2015 2016 tick-borne disease cases in US states Chartl TX-DSHS-19-1309-A-001036 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 A B C D E F G H I J K L M TABLE 1. Vector-borne disease cases reported to National Notifiable Disease Surveillance System U.S. and territories, 2004-2016* N Disease 2004 Tickborne Diseases Lyme Disease 19,804 Anaplasmosis/Ehrlichiosis† 875 Spotted Fever Rickettsioses§ 1,713 Babesiosis N Tularemia 134 Powassan virus 1 Subtotal Tickborne Diseases 22,527 2005 2006 2007 2008 2009 Year 2010 2011 2012 2013 2014 2015 2016 23,305 1,404 1,936 N 154 1 26,800 19,931 1,455 2,288 N 95 1 23,770 27,444 1,999 2,221 N 137 7 31,808 35,198 2,107 2,563 N 123 2 39,993 38,468 2,267 1,815 N 93 6 42,649 30,158 2,615 1,985 N 124 8 34,890 33,097 3,586 2,802 1,128 166 16 40,795 30,831 3,725 4,470 937 149 7 40,119 36,307 4,551 3,359 1,796 203 15 46,231 33,461 4,488 3,757 1,760 180 8 43,654 38,069 5,137 4,198 2,100 314 7 49,825 36,429 5,750 4,269 1,910 230 22 48,610 Mosquito-Borne Diseases** Dengue viruses¶ 721 Zika virus N West Nile virus 2,539 Malaria 1,458 Chikungunya virus N California serogroup viruses†† 118 St. Louis encephalitis virus 15 Eastern equine encephalitis virus 7 Yellow fever virus 0 Subtotal Mosquito-Borne Diseases 4,858 2,462 N 3,000 1,498 N 80 13 21 0 7,074 882 N 4,269 1,476 N 69 10 8 0 6,714 4,484 N 3,630 1,411 N 55 9 4 0 9,593 1,118 N 1,356 1,257 N 62 13 4 0 3,810 2,759 N 720 1,456 N 55 12 4 0 5,006 11,611 N 1,021 1,778 N 75 10 10 0 14,505 1,795 N 712 1,726 N 137 6 4 0 4,380 6,714 N 5,674 1,504 N 81 3 15 0 13,991 10,727 N 2,469 1,594 N 112 1 8 0 14,911 1,226 N 2,205 1,654 7,521 96 10 8 0 12,720 1,015 N 2,175 1,397 1,133 70 23 6 0 5,819 1,178 41,680 2,149 1,958 427 53 8 7 1 47,461 8 17 7 3 8 2 3 4 4 10 16 4 Total Vector-Borne Diseases 27,388 33,882 30,501 41,408 43,806 47,663 49,397 45,178 Abbreviations: N = not notifiable * Unless stated otherwise, all cases reported from continental U.S., Hawaii, and Alaska † Anaplasmosis and ehrlichiosis were reported separately after 2008 but are combined here for the entire period. § Includes R. 54,114 61,146 56,384 55,660 96,075 Fleaborne Disease Plague 3 rickettsii, R. parkeri, R. 32 philippi ¶ Dengue became reportable to NNDSS from 2010. Data 2004-2009 from Dengue Branch, Division of Vector-Borne Diseases, 33 CDC. ** Cases reported from U.S. states, District of Columbia, 34 and territories 35 †† Includes Jamestown Canyon, La Crosse, and unspecified California serogroup viruses §§ For babesiosis and malaria, surveillance data are reported independently to different CDC programs. For this reason, surveillance data reported elsewhere might vary slightly from data 36 reported in this summary TX-DSHS-19-1309-A-001037 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 O Total 402,502 39,959 37,376 9,631 2,102 101 491,671 46,692 41,680 31,919 20,167 9,081 1,063 133 106 1 150,842 89 642,602 32 33 34 35 slightly from data 36 TX-DSHS-19-1309-A-001038 MMWR Table 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah B MBDs C TBDs 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 699 6648 498 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 5950 2140 198 D E Plague F Total VBD: 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 2859 204 2737 7458 10666 3004 37272 8610 1024 5670 2848 414 1583 6268 2233 2577 1823 1363 1635 12977 24091 51443 2553 28344 1676 7196 577 2159 574 13883 53482 599 76480 10043 1376 2717 5523 950 75005 7389 1455 1537 6649 8789 699 TX-DSHS-19-1309-A-001039 Map Data 47 48 49 50 51 52 53 54 55 56 57 A Vermont Virginia Washington West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B C 93 1319 781 238 640 383 171 80534 1755 6161 16454 300 1964 33255 140 D E F 0 0 0 0 0 0 0 0 0 6254 17773 1081 2202 33895 523 171 80534 1755 Total: 642602 TX-DSHS-19-1309-A-001040 Map Data A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 B C D E Reported mosquito-borne disease Reported mosquito-borne cases in Reported tick- and flea-borne Reported tick- and flea-borne cases in US states US territories disease cases in US states disease cases in US territories 4147 711 22527 4712 2362 26800 5935 779 23770 5453 4140 31,808 2891 919 39993 2442 2564 42649 3589 10916 34890 2837 1543 40795 7822 6169 40119 5027 9884 46231 7463 5257 43654 5514 305 49825 10550 36911 48610 Reported mosquito-borne disease cases in US states 2004 4147 Reported mosquito-borne disease cases in US territories 0 0 0 0 0 0 0 0 0 0 0 0 0 Reported tick-borne disease cases in US states 711 22527 2005 4712 2362 26800 2006 5935 779 23770 2007 5453 4140 31808 2008 2891 919 39993 2009 2442 2564 42649 2010 3589 10916 34890 2011 2837 1543 40795 2012 7822 6169 40119 2013 5027 9884 46231 Histogram TX-DSHS-19-1309-A-001041 49 50 51 52 53 54 55 56 57 A B 2014 C 7463 D E 5257 43654 2015 5514 305 49825 2016 10550 36911 48610 TX-DSHS-19-1309-A-001042 Histogram 1 2 3 4 5 6 7 8 A Year Total Mosquito-Borne Diseases B J K L 2005 7074 2006 6714 2007 9593 2008 3810 G 2009 5006 H 2004 4858 C D E F 2010 14505 I 2011 4380 2012 13991 2013 14911 2014 12720 M 2015 5819 Year Total Tickborne Diseases 2004 22527 2005 26800 2006 23770 2007 31808 2008 39993 2009 42649 2010 34890 2011 40795 2012 40119 2013 46231 2014 43654 2015 49825 Year Total Vector-Borne Diseases 2004 27388 2005 33882 2006 30501 2007 41408 2008 43806 2009 47663 2010 49397 2011 45178 2012 54114 2013 61146 2014 56384 2015 55660 TX-DSHS-19-1309-A-001043 Line Summaries Line Summaries 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 A B C D E F G Tickborne Diseases H Reporting Area Lyme disease Anaplasmosis/Ehrlichiosis* Spotted fever rickettsioses† Babesiosis Tularemia Powassan Subtotal Tickborne Diseases: United States (excluding territories) 36429 5750 4269 1910 230 22 Alabama 38 21 453 — 1 — Alaska 15 N N N 1 Arizona 13 2 27 N Arkansas 2 218 821 California 134 6 Colorado — Connecticut I J K L Mosquito-borne Diseases Dengue Zika West Nile Virus Malaria 48610 961 5168 2149 1955 513 5 37 19 13 — 16 5 — — 2 3 — 45 13 54 78 38 1 32 — 1074 3 13 9 5 14 3 2 — 159 197 421 442 125 N 4 N 14 — 18 21 55 149 25 1748 104 6 322 — 1 2181 6 118 1 13 Delaware 506 20 17 2 — — 545 2 17 — 16 District of Columbia 103 6 4 2 — — 115 9 41 1 23 Florida 216 34 12 N — — 262 68 1107 8 62 Georgia 4 14 74 N — — 92 20 107 6 57 Hawaii N N N N — — 0 56 11 — — Idaho 17 N 7 N 3 — 27 4 5 9 — Illinois 237 40 68 2 5 — 352 35 105 154 62 Indiana 152 24 40 — — — 216 9 49 18 17 Iowa 232 14 11 1 3 — 261 11 26 37 22 Kansas 39 57 130 N 25 — 251 4 20 37 11 Kentucky 33 46 167 1 2 — 249 1 31 8 13 Louisiana 7 3 17 2 — — 29 6 38 59 12 Maine 1487 383 4 82 — 1 1957 2 12 — 10 Maryland 1866 44 1 6 — — 1917 13 130 6 180 Massachusetts 198 848 8 518 5 5 1582 8 119 17 93 Michigan 221 14 13 2 1 — 251 16 67 43 43 Minnesota 2126 773 6 50 3 5 2963 29 66 83 67 Mississippi 1 9 111 N — — 121 — 23 43 7 Missouri 10 252 350 1 34 — 647 13 37 11 20 Montana 17 2 9 1 3 — 32 2 9 6 4 Nebraska 14 9 31 1 10 — 65 3 13 95 7 Nevada 15 — 4 N — — 19 6 22 16 7 New Hampshire 891 60 2 13 1 1 968 3 11 — 14 New Jersey New Mexico 4350 1 193 N 64 — 174 N 5 7 — — 4786 8 51 5 180 10 11 6 84 2 New York 3882 964 37 481 — 2 5366 136 1002 22 319 North Carolina 272 77 482 N 1 1 833 13 100 2 46 North Dakota 32 15 1 1 — — 49 2 3 85 5 Ohio 160 14 24 — — — 198 6 83 17 60 Oklahoma — 66 124 N 26 — 216 5 29 35 7 Oregon 61 4 6 2 4 — 77 9 47 4 20 Pennsylvania 11443 81 22 N 4 — 11550 21 175 16 77 Rhode Island 903 183 4 155 — 1 1246 5 55 2 9 South Carolina 51 1 54 2 — — 108 11 61 8 14 South Dakota 11 1 6 — 14 — 32 2 3 152 4 Tennessee 25 107 595 1 2 — 730 12 61 7 24 TX-DSHS-19-1309-A-001045 2016 Table MMWR 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 M N O P Q R Chikungunya California Serogroup Viruses§ St. Louis encephalitis EEE Yellow fever Subtotal Mosquito-Borne Diseases: 248 53 8 7 1 1 — — — — — — — — 3 — — 1 — 57 S Fleaborne Diseases T Plague Total Vector-Borne Diseases: 10550 4 59164 75 — 588 — 7 — 23 — — 186 — 231 — — — 31 — 1105 — 3 — — 1245 — 1404 — — — — — 250 — 268 2 — — — — 140 — 2321 1 — — — — 36 — 581 — — — — — 74 — 189 8 — — — — 1253 — 1515 1 — — 1 — 192 — 284 3 — — — — 70 — 70 — — — — — 18 — 45 13 — 1 — — 370 — 722 2 — — — — 95 — 311 2 — — — — 98 — 359 1 — — — — 73 — 324 3 — — — — 56 — 305 1 — — — — 116 — 145 — — — — — 24 — 1981 4 — — — — 333 — 2250 6 2 — — — 245 — 1827 4 — — 2 — 175 — 426 16 9 — — — 270 — 3233 — — — — — 73 — 194 1 — — — — 82 — 729 1 — — 1 — 23 — 55 1 — — — — 119 — 184 — — 3 — — 54 — 73 1 — — — — 29 — 997 11 3 — — — — 1 — — — 338 26 38 — — — 1 3 8 — 2 — 1 — — — 4 9 — — — — — 4 5124 38 1518 — 6884 174 — 1007 — 96 — 145 — — 179 — 377 — — — 76 — 292 — — — — 80 — 157 5 — — — — 294 — 11844 3 — — — — 74 — 1320 4 — — — — 98 — 206 — — — — — 161 — 193 4 4 — — — 112 — 842 U V W TX-DSHS-19-1309-A-001046 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F Texas 71 17 87 1 3 — Utah 19 — 4 — 5 G H I J K L 179 45 312 370 159 — 28 6 21 13 8 — 985 3 11 2 6 Vermont 761 207 2 15 — Virginia 1350 115 312 N 2 — 1779 28 108 8 74 Washington 31 — — — 1 — 32 24 69 9 44 West Virginia 368 6 14 — — — 388 — 11 1 1 Wisconsin 2295 695 19 68 1 5 3083 7 60 13 20 Wyoming 1 1 1 — 7 — 10 — 3 11 4 Territories 0 0 0 0 0 0 — 217 36512 — 3 U — — — 2 131 — — — — 3 American Samoa N N N Puerto Rico N N N N — 204 35395 — U.S. Virgin Islands — — — — — — — 11 986 — — Total: 36429 5750 4269 1910 230 22 48610 1178 41680 2149 1958 TX-DSHS-19-1309-A-001047 2016 Table MMWR 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 M N — O 20 — — 1 — 1 — — — — — 6 — — 10 — — P — Q R S T 906 — — 50 — 78 — 22 — 1007 — — 224 — 2003 — — — 156 — 188 8 — — — 21 — 409 2 13 — — — 115 — 3198 — — — — — 18 — 28 179 0 — — — 36911 — 36911 — — — — — 133 — 133 179 — — — — 35781 — 35781 — — — — — 997 — 997 427 53 8 7 1 47461 4 96075 U V W 1085 TX-DSHS-19-1309-A-001048 2016 Table MMWR A 1 2 3 Reporting Area B California Serogroup Viruses C D E F G H I J Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 53 427 1178 7 1958 8 2149 1 41680 53 248 961 7 1955 8 2149 1 5168 5 — 11 — 19 — 37 2 — — — — 4 Total: United States (excluding territories) 5 Alabama — 1 6 Alaska — — 5 — 7 Arizona — 3 13 — 38 — 78 — 54 8 Arkansas — 1 3 — 5 — 9 — 13 California — 57 197 — 125 3 442 — 421 10 Colorado — — 21 — 25 — 149 — 55 11 Connecticut — 2 6 — 13 — 1 — 118 12 Delaware — 1 2 — 16 — — — 17 13 District of Columbia — — 9 — 23 — 1 — 41 14 Florida — 8 68 — 62 — 8 — 1107 15 Georgia — 1 20 1 57 — 6 — 107 16 Hawaii — 3 56 — — — — — 11 17 Idaho — — 4 — — — 9 — 5 18 Illinois — 13 35 — 62 1 154 — 105 19 Indiana — 2 9 — 17 — 18 — 49 20 Iowa — 2 11 — 22 — 37 — 26 21 Kansas — 1 4 — 11 — 37 — 20 22 Kentucky — 3 1 — 13 — 8 — 31 23 Louisiana — 1 6 — 12 — 59 — 38 24 Maine — — 2 — 10 — — — 12 25 Maryland — 4 13 — 180 — 6 — 130 26 Massachusetts 2 6 8 — 93 — 17 — 119 27 Michigan — 4 16 2 43 — 43 — 67 28 Minnesota 9 16 29 — 67 — 83 — 66 29 Mississippi — — — — 7 — 43 — 23 9 TX-DSHS-19-1309-A-001049 2016 K Total MosquitoAnaplasmosis/Eh Borne Disease Cases: rlichiosis Babesiosis Lyme disease Powassan Spotted fever rickettsiosis Tularemia R Total TickBorne Diseases: 47461 5750 1910 36429 22 4269 230 48610 4 96075 4 10550 5750 1910 36429 22 4269 230 48610 4 59164 5 73 21 — 38 — 453 1 513 — 586 15 — 16 — 23 27 3 45 — 231 821 32 1074 — 1105 159 — 1404 268 1 2 3 6 7 L N M N N O P N Q 1 S Plague T Total VectorBorne Diseases: 7 186 2 N 13 — 8 31 218 1 2 — 3 134 — — 4 14 18 — 6 — 2181 — 2321 545 — 581 9 1245 6 14 2 10 250 N N — 11 140 104 322 1748 1 17 — 12 36 20 2 506 — 13 74 6 2 103 — 4 — 115 — 189 14 1253 34 N 216 — 12 — 262 — 1515 74 — 92 — 284 15 192 14 N 4 — 16 70 N N N — N — 0 — 70 17 18 N N 17 — 7 3 27 — 45 68 5 352 — 722 18 370 40 2 237 — 19 95 24 — 152 — 40 — 216 — 311 20 98 14 1 232 — 11 3 261 — 359 130 25 251 — 324 21 73 57 N 39 — 22 56 46 1 33 — 167 2 249 — 305 23 116 3 2 7 — 17 — 29 — 145 1957 — 1981 24 24 383 82 1487 1 4 — 25 333 44 6 1866 — 1 — 1917 — 2250 26 245 848 518 198 5 8 5 1582 — 1827 13 1 251 — 426 6 3 2963 — 3233 111 — 121 — 194 27 175 14 2 221 — 28 270 773 50 2126 5 1 — 29 73 9 N TX-DSHS-19-1309-A-001050 2016 A B C 30 Missouri — 1 31 Montana — 32 Nebraska D E 13 — 1 2 — 1 33 Nevada — 34 New Hampshire F G 20 — 1 4 3 — 7 — 6 — 7 — 1 3 — 35 New Jersey — 11 51 1 36 New Mexico — 3 37 New York — 38 North Carolina 8 39 North Dakota — 40 Ohio H I J 11 — 37 — 6 — 9 — 95 — 13 3 16 — 22 14 — — — 11 84 — 11 — 180 5 — 2 — 6 — 10 38 136 — 319 — 22 1 1002 3 13 2 46 — 2 — 100 1 2 — 7 — 85 — 3 9 4 6 — 60 — 17 — 83 41 Oklahoma — — 5 — 7 — 35 — 29 42 Oregon — — 9 — 20 — 4 — 47 43 Pennsylvania — 5 21 — 77 — 16 — 175 44 Rhode Island — 3 5 — 9 — 2 — 55 45 South Carolina — 4 11 — 14 — 8 — 61 46 South Dakota — — 2 — 4 — 152 — 3 12 — 24 — 7 — 61 159 — 370 — 312 8 1 13 — 21 11 47 Tennessee 4 48 Texas — 20 45 — 49 Utah — 1 6 — 50 Vermont — — 3 — 6 — 2 — 51 Virginia — 6 28 — 74 — 8 — 108 52 Washington — 10 24 — 44 — 9 — 69 53 West Virginia 8 — — — 1 — 1 — 11 54 Wisconsin 13 2 7 — 20 — 13 — 60 55 Wyoming — — — — 4 — 11 — 3 57 Territories 0 179 217 — 3 — — — 36512 58 American Samoa — — 2 — — — — — 131 4 56 2016 TX-DSHS-19-1309-A-001051 K L M N O P Q R S T 30 82 252 1 10 — 31 23 2 1 17 — 9 3 32 — 55 32 119 9 1 14 — 31 10 65 — 184 33 54 — N 15 — 4 — 19 — 73 34 29 60 13 891 1 2 1 968 — 997 35 338 193 174 4350 — 64 5 4786 — 5124 — 7 8 4 38 350 34 647 — 729 36 26 N N 1 — 37 1518 964 481 3882 2 37 — 5366 — 6884 38 174 77 N 272 1 482 1 833 — 1007 1 — 49 — 147 39 98 15 1 32 — 40 179 14 — 160 — 24 — 198 — 377 41 76 66 N — — 124 26 216 — 292 6 4 77 — 157 42 80 4 2 61 — 43 294 81 N 11443 — 22 4 11550 — 11844 44 74 183 155 903 1 4 — 1246 — 1320 54 — 108 — 206 6 14 32 — 193 730 — 842 1085 45 98 1 2 51 — 46 161 1 — 11 — 25 — 87 3 179 — 4 5 28 — 78 2 — 985 — 1007 2003 47 112 107 1 595 2 48 906 17 1 71 — 49 50 — — 19 — 761 — 312 2 1779 — — 1 32 — 188 388 — 409 50 22 207 15 51 224 115 N 1350 — 52 156 — — 31 — 53 21 6 — 368 — 14 — 54 115 695 68 2295 5 19 1 3083 — 3198 55 18 1 — 1 — 1 7 10 — 28 57 36911 0 0 0 0 0 0 — — 36911 58 133 N U N — N — — — 56 2016 133 TX-DSHS-19-1309-A-001052 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E — 179 204 — — — I I 11 — F 3 I — G H I — — — I — — — J 35395 I 986 I TX-DSHS-19-1309-A-001053 2016 K 59 35781 60 997 11 L M N O N N N — — — — — P N — Q — I — R — I — S — I — T 35781 I 997 TX-DSHS-19-1309-A-001054 2016 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 70 1133 1015 6 1397 23 2175 0 0 70 0 0 0 0 0 0 896 1 1 24 4 276 8 16 0 0 73 9 7 5 20 7 4 11 8 7 2 19 34 9 15 1 5 1 4 1 1 31 0 99 19 2 10 4 3 8 5 3 0 954 3 1 17 1 138 13 5 1 11 82 8 219 3 29 6 1390 11 3 14 9 97 21 12 3 17 40 56 1 6 50 9 17 6 4 11 7 122 51 20 43 1 19 1 4 6 6 86 3 258 27 5 37 12 20 37 16 3 4 23 2175 9 0 0 23 103 18 783 101 10 6 5 13 15 0 0 0 2 0 0 1 1 0 1 0 1 7 0 0 0 0 0 1 0 11 0 25 0 0 1 0 4 4 1 4 4 13 8 16 21 2 3 4 2 1 1 60 3 112 9 1 11 2 5 23 3 4 2 E 1 1 3 1 2015 F G H I J 13 77 21 14 34 2 51 1 45 10 18 9 38 29 3 68 7 26 14 57 4 23 35 89 1 30 40 TX-DSHS-19-1309-A-001055 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5819 5137 2100 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 5137 18 n 3 209 4 n 120 18 1 24 34 n n 41 20 n 54 53 4 192 34 779 11 638 13 262 1 5 2100 2 n 123 192 n 910 93 5 19 63 4 35 160 4 5 n 328 1 n n n n n 3 n n 1 55 4 443 3 45 n n n 53 297 n 592 n 3 2 n 2 n 190 2 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4198 314 49825 16 55660 4198 288 n 17 889 10 7 5 19 314 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 16 55355 357 16 219 1154 1414 206 3037 483 155 419 247 227 41 569 228 366 313 252 98 1465 1969 5570 228 2593 159 676 31 144 24 714 5613 34 6386 854 83 306 500 80 9200 1280 106 78 Powassan Spotted fever rickettsiosis 38069 7 38069 25 9 12 7 98 2541 435 121 166 8 n 9 287 138 318 23 49 3 1201 1728 4224 148 1805 4 5 5 11 7 529 4855 4314 230 33 154 31 9048 904 42 5 1 3 1 1 Q 2 4 24 2 52 21 114 n 3 52 30 8 146 134 15 1 4 13 2 10 100 324 9 25 2 2 10 3 34 1 4 29 7 25 1 1 8 63 2 40 459 6 12 307 6 16 2 47 2 1 5 1 23 6 3 25 2015 R S 2 1 4 1 1 4 2 TX-DSHS-19-1309-A-001056 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 4 0 0 Territories American Samoa Puerto Rico 60 U.S. Virgin Islands C D 0 0 4 10 1 9 55 3 1 24 39 0 8 0 13 32 1 3 24 19 1 7 0 0 0 237 0 216 61 0 21 3 E 0 58 F G H 15 99 6 8 275 8 66 21 2 5 1 21 24 7 I J 9 8 0 0 0 0 7 TX-DSHS-19-1309-A-001057 2015 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N 49 461 18 4 135 103 7 39 10 82 11 2 145 116 1 6 628 1 1 305 0 281 0 N N 0 U N 0 N N — — — 60 24 9 n 2 56 26 54 7 710 1539 24 289 1894 1 O P Q R S T 605 61 7 3 1 5 296 4 9 5 1 4 4 1 2 21 717 128 21 864 1955 35 305 2586 23 0 — — 0 N N 0 — — 0 — — 0 — — 305 0 281 — — — — — 24 1 1 766 589 40 868 2090 138 312 2625 33 TX-DSHS-19-1309-A-001058 2015 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 96 7521 1226 8 1654 10 2205 0 0 96 0 0 0 0 0 0 0 0 0 1 2 0 0 1 2 0 0 0 0 0 0 2 0 8 1 0 0 0 0 0 0 0 0 23 0 31 0 0 0 0 0 0 2811 19 680 3 4 97 4 130 10 3 1 2 84 4 10 1 7 5 4 1 1 3 1 8 17 5 3 2 2 2 — 8 1 — — — — — — — — — — — — — — — — — — 1653 14 4 25 7 95 30 15 2 18 52 82 4 3 55 20 17 9 11 20 7 146 61 17 51 1 15 2 9 11 11 79 3 263 36 9 38 10 17 85 22 6 5 10 1 0 1 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2205 2 0 107 11 801 118 6 0 3 17 13 1 19 44 10 15 54 1 125 0 6 6 1 21 43 13 5 142 3 0 19 24 15 0 23 11 18 8 13 0 3 57 0 0 19 7 137 15 35 7 15 487 36 21 1 29 34 4 15 24 15 6 61 191 21 28 8 18 2 3 25 182 2 803 50 3 5 84 — 42 14 5 97 54 19 2 9 — — 70 8 — 6 5 2 — E 1 — — 1 — — — — — — 3 — — 2 — — — — — — — — — 2014 F G H I J TX-DSHS-19-1309-A-001059 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 12720 4488 1760 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 4488 19 n 1 252 7 n 75 24 1 36 16 n n 65 49 n 55 62 5 205 41 642 7 471 5 380 7 140 133 n 582 85 7 6 81 35 121 8 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3757 180 43654 10 56384 3757 220 N 16 824 11 5 6 24 — 180 — — — 10 29 37 N 1 89 36 10 110 53 18 3 6 8 — 1 — — — 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 51127 344 16 287 1147 1257 202 2712 476 79 864 194 36 34 531 268 245 291 197 189 1666 1643 6775 183 2054 114 723 23 184 27 951 4013 38 5966 868 60 270 359 85 7730 1278 110 75 Powassan Spotted fever rickettsiosis 33461 8 1760 1 N — — 33461 64 8 21 — 3 N 212 1 N N N N N 1 — 73 — 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 N N N — 42 2 537 2 49 N N — — N 41 169 N 471 N — 1 N 1 N 172 3 1 2360 417 40 155 4 N 9 233 110 194 20 44 2 1401 1373 5304 127 1416 2 10 7 7 6 724 3286 — 3736 170 14 119 — 45 7487 904 37 2 Q 42 — 16 — — — 7 2 1 27 1 1 — — 3 2 — — 7 50 265 4 13 1 2 58 2 21 496 3 12 219 5 7 — 20 1 6 — — 1 5 3 — 4 1 17 4 — — — 32 3 5 2014 R S 8 2 TX-DSHS-19-1309-A-001060 47 48 49 50 51 52 53 54 55 56 57 58 59 A B C D — — — — — — — — — E F Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 12 0 0 0 2 0 2 9 0 45 116 2 3 59 14 2 17 2 34 — Territories American Samoa Puerto Rico 0 4710 37 4274 546 — 527 1 399 19 — 60 U.S. Virgin Islands 4 16 9 1 8 — 0 G H 20 106 5 4 77 41 2 11 — 0 4 0 0 0 0 0 0 0 16 379 2 0 7 12 0 6 5 1 — 0 0 I 0 J 0 TX-DSHS-19-1309-A-001061 2014 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 95 639 9 11 161 76 7 51 5 101 15 5257 37 4802 60 418 — M N O P 0 0 0 0 0 0 0 2 0 558 94 8 — 43 — 17 40 13 599 1346 15 136 1361 3 0 N N 0 U N 0 N N 0 — — — N N — 69 137 5 538 1 — 3 N 4 — Q 2 — R S T 1 678 150 22 672 1856 25 147 1955 4 0 N N 0 — — 0 — — 0 — — 5257 37 4802 N — — — 418 1 1 — 373 2 5 11 — 4 1 — 773 789 31 683 2017 101 154 2006 9 TX-DSHS-19-1309-A-001062 2014 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 112 0 10727 8 1594 1 2469 0 0 4 Total: United States (excluding territories) 112 0 843 8 1594 1 2469 0 0 5 Alabama 2 5 — 2 — 9 6 Alaska 0 1 — 4 — 0 33 — 62 1 2 3 Reporting Area B E F G H 7 Arizona 0 1 — 8 Arkansas 0 2 1 2 — 18 9 California 0 119 — 103 — 379 32 — 322 10 Colorado 0 0 — 11 Connecticut 0 18 1 20 — 4 12 Delaware 0 2 — 9 — 3 13 — 1 13 District of Columbia 0 0 — 14 Florida 0 151 3 54 — 7 15 Georgia 2 9 1 67 — 10 1 — 0 5 — 40 117 16 Hawaii 0 10 — 17 Idaho 1 1 — 26 — 64 — 20 — 23 12 — 44 91 18 Illinois 0 19 Indiana 1 6 — 20 Iowa 0 2 — 8 — 8 — 9 — 3 9 — 54 0 21 Kansas 0 22 Kentucky 0 0 — 23 Louisiana 0 6 — 10 — 24 Maine 0 1 — 25 Maryland 0 11 — 147 — 16 26 Massachusetts 1 0 1 71 — 8 21 — 36 27 Michigan 0 16 — 28 Minnesota 6 22 — 67 — 79 29 Mississippi 3 1 — 3 — 45 2013 I J TX-DSHS-19-1309-A-001063 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 3359 203 46231 4 61146 15 3359 203 46231 4 51262 24 0 255 — 294 312 14 0 N 1 15 20 97 193 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14911 4551 1796 4 5027 4551 5 18 6 5 1 2 3 O P Powassan Spotted fever rickettsiosis 36307 15 1796 36307 15 — 0 N Q R S 7 96 2 N 32 0 63 — 8 23 172 N — 0 480 38 690 713 9 601 9 3 112 0 15 2 141 742 0 6 1 7 361 10 354 0 N — 11 43 125 289 2925 0 — — 3339 3382 12 14 16 2 509 0 11 — 538 552 41 55 13 14 0 N 35 0 6 — 14 215 23 N 138 0 24 1 186 401 15 89 20 N 8 0 81 — 109 198 0 11 16 11 0 N N 0 N — 17 47 0 N 19 0 1 3 23 70 18 207 53 4 337 0 102 4 500 707 19 50 48 1 110 0 32 5 196 246 20 58 0 N 247 0 8 4 259 317 28 158 265 21 107 96 N 34 0 — 22 12 67 N 40 0 72 3 182 194 23 69 3 2 — 0 5 — 10 79 1512 1523 24 11 100 36 1373 1 2 — 25 174 38 9 1197 0 8 2 1254 1428 26 81 338 425 5290 1 1 8 6063 6144 179 252 3273 27 73 6 2 168 0 3 — 28 174 679 64 2340 1 15 — 3099 29 52 5 N — 0 39 — 44 2013 96 TX-DSHS-19-1309-A-001064 A B C D E F G H 30 Missouri 0 5 — 6 — 29 31 Montana 0 5 — — — 38 32 Nebraska 0 0 — 6 — 226 8 — 11 33 Nevada 1 4 — 34 New Hampshire 1 4 — 10 — 1 35 New Jersey 0 0 — 93 — 12 1 — 38 36 New Mexico 0 0 — 37 New York 3 184 0 254 0 32 38 North Carolina 13 13 1 27 — 3 3 — 125 39 North Dakota 0 1 — 40 Ohio 16 9 — 33 — 24 41 Oklahoma 0 4 — 14 — 89 13 — 16 42 Oregon 1 0 — 43 Pennsylvania 1 24 — 71 — 11 44 Rhode Island 1 9 — 14 — 1 9 — 7 7 — 149 24 45 South Carolina 1 7 — 46 South Dakota 0 3 — 10 — 19 — 90 1 183 7 — 7 2 47 Tennessee 23 48 Texas 0 95 — 49 Utah 0 0 — 2 — 5 — 75 — 6 30 — 1 1 50 Vermont 0 51 Virginia 2 22 — 52 Washington 0 13 — 2 — 53 West Virginia 11 2 — 54 Wisconsin 22 8 — 11 — 21 55 Wyoming 0 1 — — — 41 56 57 Territories 0 9884 0 0 0 0 58 American Samoa 0 0 I 0 J 0 0 TX-DSHS-19-1309-A-001065 2013 K L M N O P Q R S T 30 40 398 N 3 0 245 36 682 722 31 43 1 — 18 0 2 5 26 69 32 232 8 1 10 0 15 17 51 283 18 42 33 24 1 N 16 0 1 — 34 16 97 22 1687 1 4 — 1811 1827 35 105 132 171 3766 1 42 2 4114 4219 36 39 0 N 6 0 4 4 14 37 473 602 534 4615 5 28 — 5784 6257 38 57 93 N 180 0 426 2 701 758 43 172 4 57 39 129 11 1 29 0 2 — 40 82 16 N 93 0 23 2 134 216 41 107 116 N 3 0 241 10 370 477 42 30 1 — 43 0 2 3 49 79 43 107 61 N 5758 0 16 — 5835 5942 44 25 118 142 724 0 2 — 986 1011 110 134 45 24 7 1 42 0 60 — 46 159 1 1 4 0 7 7 20 179 47 76 96 — 25 0 549 4 674 750 48 369 8 1 82 0 83 1 175 544 49 14 1 — 15 0 7 2 25 39 — 949 958 50 9 50 6 893 0 — 51 105 143 N 1307 0 350 2 1802 1907 52 44 2 1 18 0 2 5 28 72 53 16 9 — 143 0 6 — 158 174 54 62 764 78 1872 5 11 1 2731 2793 55 42 0 — 3 0 2 — 5 47 56 57 9884 0 0 0 0 0 0 0 0 9884 58 0 0 U N — N — — — 0 TX-DSHS-19-1309-A-001066 2013 A B C D E F 59 Puerto Rico 9710 0 60 U.S. Virgin Islands 61 62 Total: 174 0 112 0 10727 8 1594 G 1 H 2469 I 0 J 0 TX-DSHS-19-1309-A-001067 2013 K L M N O P Q R S T 59 9710 0 N N — N — — — 9710 60 174 61 62 14911 0 N N — N — — — 174 4551 1796 36307 15 3359 203 46231 4 61146 TX-DSHS-19-1309-A-001068 2013 A C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 81 0 6714 15 1504 3 5674 0 0 4 Total: United States (excluding territories) 81 0 547 15 1503 3 5673 0 0 5 Alabama 0 4 — 10 62 6 Alaska 0 1 — 8 0 19 133 1 2 3 Reporting Area B E F G H 7 Arizona 0 8 — 8 Arkansas 0 0 — 4 64 9 California 0 64 — 108 479 24 131 10 Colorado 0 0 — 11 Connecticut 0 16 — 21 21 12 Delaware 0 0 — 2 9 6 10 13 District of Columbia 0 0 — 14 Florida 0 139 2 59 73 15 Georgia 0 11 1 66 99 4 0 16 Hawaii 0 8 — 17 Idaho 0 1 — 8 17 21 — 43 290 22 77 18 Illinois 0 19 Indiana 3 9 — 20 Iowa 0 2 — 6 31 1 — 7 56 10 23 21 Kansas 0 22 Kentucky 0 1 — 23 Louisiana 0 6 — 13 335 5 1 24 Maine 0 0 — 25 Maryland 0 9 — 112 47 26 Massachusetts 0 0 7 48 33 26 202 27 Michigan 0 9 — 28 Minnesota 4 9 — 58 70 29 Mississippi 1 1 — 4 247 2012 I J TX-DSHS-19-1309-A-001069 K L M N Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 4470 149 40119 4 54114 7 4470 149 40119 4 47945 25 — 167 — 218 294 10 — N 12 21 50 64 224 837 952 1020 103 754 Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 13991 3725 937 4 7822 3725 5 76 6 9 1 2 3 O P Powassan Spotted fever rickettsiosis 30831 7 937 30831 26 — 0 N 7 160 1 N 13 — 8 68 93 N — — 4 70 — — 6 9 651 6 Q 2 — 22 2 21 R S 10 155 0 N — 11 58 142 123 2657 — — — 2922 2980 12 11 18 — 669 — 30 — 717 728 2 — 2 18 1 7 1 163 13 16 0 N N — 14 273 28 N 118 — 31 — 177 450 15 177 31 N 31 — 92 — 154 331 N — 0 12 4 10 36 411 765 147 258 174 213 90 154 110 144 16 12 0 N N — 17 26 0 N 5 — 204 — 33 18 354 50 2 1 4 151 19 111 35 1 74 — 20 39 0 N 165 — 8 19 — — 62 9 — 18 372 — 1179 1185 1707 1875 21 64 49 N 22 34 30 N 14 — 23 354 2 N 7 — 3 24 6 55 10 1111 — 25 168 42 3 1651 — 9 26 88 343 261 5138 — 7 27 237 8 — 98 — 28 141 529 40 1515 29 253 3 N 1 4 1 22 4 2 8 5757 5845 3 — 109 346 4 15 — 2103 2244 — 25 — 29 2012 282 TX-DSHS-19-1309-A-001070 A B C D E F G H 30 Missouri 0 6 — 31 Montana 0 2 — — 6 32 Nebraska 0 0 — 4 193 8 9 19 20 33 Nevada 0 2 — 34 New Hampshire 0 0 — 9 1 35 New Jersey 0 0 — 67 48 2 47 36 New Mexico 0 0 — 37 New York 1 111 0 267 107 38 North Carolina 26 7 2 34 7 2 89 39 North Dakota 0 0 — 40 Ohio 13 6 — 41 121 41 Oklahoma 0 1 — 24 191 12 11 42 Oregon 0 0 — 43 Pennsylvania 0 21 — 52 60 44 Rhode Island 0 0 — 17 4 9 29 45 South Carolina 2 2 — 46 South Dakota 0 2 — 5 203 6 — 12 33 102 47 Tennessee 9 48 Texas 3 16 — 49 Utah 0 0 — 14 5 50 Vermont 0 1 2 4 3 51 Virginia 2 17 1 65 30 52 Washington 0 16 — 26 4 2 10 3 53 West Virginia 14 0 54 Wisconsin 3 11 — 13 57 55 Wyoming 0 0 — — 7 56 57 Territories 0 6167 0 1 58 American Samoa — 0 0 J 1868 — 0 I 1 0 0 0 TX-DSHS-19-1309-A-001071 2012 K L M N O P Q 30 45 228 N 2 — 31 8 0 — 6 — 3 32 197 2 1 15 — 9 — 1 315 27 3 6 R S T 572 617 12 20 33 230 11 30 33 19 0 N 10 — 34 10 55 19 1450 — 2 — 1526 1536 35 115 198 92 3576 — 128 — 3994 4109 4 35 36 49 0 N 1 — 37 486 407 254 2998 1 122 — 1 23 38 76 132 N 39 91 3 — 15 — 40 181 5 N 67 — 4 — 41 216 145 N 42 23 0 — 48 — 43 133 31 N 5033 44 21 107 56 — 17 1 56 3695 4181 846 922 22 113 95 276 575 791 1 49 — 41 — 5105 5238 217 — 13 — 393 414 61 — 107 149 1 11 221 811 871 157 2149 14 33 534 544 1721 1836 N 44 46 210 1 N 4 — 83 — 30 — 77 6 48 1992 5 N 75 49 19 1 N 5 — 522 — 461 1 51 115 148 N 1110 — 52 46 0 — 15 — 5 2 696 — 2 3 6 — 2 9 1 409 45 42 50 10 — 591 — 47 60 1 — 2 — 1 2 5 2 74 21 67 2 — 101 127 — 2529 2613 7 14 53 26 2 N 97 — 54 84 670 69 1766 2 22 55 7 0 — 4 — 2 56 57 6169 0 0 0 0 0 0 0 0 6169 58 0 0 U N — N — — — 0 1 TX-DSHS-19-1309-A-001072 2012 A 59 Puerto Rico 60 U.S. Virgin Islands 11 B C D E 6025 142 F G 1 I — I H I J 1 I 0 I TX-DSHS-19-1309-A-001073 2012 I K 59 6027 60 142 11 L M 0 — 0 — N O N — N — P Q R N — — N — — S — I — T 6027 I 142 I TX-DSHS-19-1309-A-001074 2012 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 137 0 1795 4 1726 6 712 0 0 137 1 0 1 0 0 0 0 0 0 1 2 0 0 1 2 0 0 1 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 26 0 50 0 0 0 0 1 0 0 254 4 0 2 0 5 0 1 2 0 66 6 11 0 8 2 5 1 4 3 0 6 0 6 6 0 0 0 0 1 0 0 2 53 4 1 2 0 0 16 0 1 0 4 — — — — — — — — — — — — — — — — — — — — — 1724 9 5 21 7 129 24 20 7 18 99 91 7 2 66 14 22 10 10 2 6 128 68 34 46 1 21 2 8 8 3 97 5 280 49 — 6 1 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 712 5 0 69 1 158 7 9 1 15 24 22 0 3 34 9 9 4 5 10 0 19 6 34 2 52 10 1 29 16 0 7 4 44 2 4 21 1 0 6 1 0 2 0 0 1 — — — 1 — — — — — — 1 — — — — — — — — — 2011 F 41 10 22 61 6 7 2 G H I J TX-DSHS-19-1309-A-001075 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4380 3586 1128 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 3586 9 0 4 61 2 0 152 18 0 26 38 0 0 36 18 0 25 16 2 27 42 172 9 788 4 194 0 3 0 33 193 0 406 105 3 16 119 6 16 75 3 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2802 166 40795 3 45178 2802 79 N 77 558 8 3 — 166 — — — 3 20 4 12 88 N 2 51 33 7 — 1 — — — — 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 43635 133 16 189 667 404 37 3295 923 37 343 279 18 13 395 173 146 68 44 29 1049 1580 2943 192 3062 87 526 18 65 33 1351 4864 26 5716 601 40 205 482 74 5482 316 85 21 Powassan Spotted fever rickettsiosis 33097 16 1128 1 — — — 33097 24 11 15 — 4 — 92 — 74 1 — — — — 3039 873 N 115 32 N 4 194 94 100 17 3 2 1006 1351 2476 104 2124 5 8 11 11 5 1299 4262 6 4490 88 27 53 2 38 5362 159 37 4 16 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 N — — — N N — 9 4 208 — 73 — N — — N 13 166 — 418 N 1 N N 1 N 73 — N Q 37 6 3 — 2 5 1 3 11 1 — — — 4 10 1 29 4 4 11 24 270 1 10 2 3 136 — 8 — — — 21 3 4 1 — 3 7 — — 24 327 2 21 335 1 19 2 36 1 2 1 15 5 1 — — 8 2011 R S 2 1 TX-DSHS-19-1309-A-001076 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 12 0 0 0 1 0 26 9 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 3 7 1 3 8 9 0 5 0 0 — — — — — — — E F G H 1 — 21 102 5 6 78 24 1 19 — 0 0 0 0 0 0 0 0 0 18 27 3 1 9 0 2 3 3 1541 0 1541 0 — — 2 1 1 0 0 0 0 0 0 0 — — 0 0 I 0 J 0 TX-DSHS-19-1309-A-001077 2011 47 48 49 50 51 52 53 54 55 56 K 54 136 9 10 96 33 29 37 3 L M 79 6 1 8 131 1 3 731 1 1 N N 1 N — — 57 1543 58 1 59 1542 0 0 0 — 60 0 0 N O 37 74 9 623 1023 19 118 3649 2 0 0 0 0 0 0 0 4 0 N N N 0 0 0 N N 0 80 — P Q 263 52 8 — 3 — 231 4 4 11 10 6 5 — R S T 1 1 383 132 19 632 1391 29 125 4476 14 N N — — — — — — — — 1543 1 1542 N — — — 0 1 — 437 268 28 642 1487 62 154 4513 17 TX-DSHS-19-1309-A-001078 2011 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 75 0 11611 10 1778 10 1021 0 0 75 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 1 0 0 2 0 2 1 0 0 0 0 0 0 0 0 1 22 0 24 0 0 0 0 0 0 0 700 4 1 12 1 36 0 0 0 0 191 12 0 3 23 14 2 4 2 4 6 0 0 9 14 0 6 4 7 4 0 29 1 178 8 1 16 5 0 22 1 13 1 10 ------------------4 ----------------------1 3 ------------------1 ------------1 ----- 1773 9 5 28 4 126 21 22 2 13 139 71 4 5 60 15 14 13 8 5 6 99 73 31 48 2 21 3 15 6 5 106 1 352 52 1 43 6 14 61 15 6 3 10 0 0 0 2 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1021 3 0 167 7 111 81 11 0 6 12 13 0 1 61 13 9 19 3 27 0 23 7 29 8 8 3 0 39 2 1 30 25 128 0 9 5 1 0 28 0 1 20 0 0 2010 F G H I J TX-DSHS-19-1309-A-001079 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 14505 2615 0 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 2615 19 N 0 24 4 N 43 22 0 13 22 N N 28 15 N 7 17 1 21 39 0 6 743 6 142 N 2 N 25 130 N 266 127 N 9 106 0 6 41 6 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1985 124 34890 2 49397 1985 83 N 17 162 7 2 --22 1 14 57 N 5 37 27 5 --6 3 2 49 --2 2 26 278 3 5 --1 61 1 30 286 1 15 236 1 15 2 20 --- 124 ----1 19 8 3 --------------1 3 --16 2 ------3 ------18 1 5 1 1 1 1 --3 1 --8 3 1 ----11 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 2 38481 120 13 227 219 421 110 3144 702 64 457 187 4 23 345 165 115 69 44 43 786 1829 3347 179 2779 42 473 15 81 15 1372 4069 34 4382 580 46 156 362 59 3938 241 75 36 Powassan Spotted fever rickettsiosis 30158 8 30158 2 7 2 --129 3 3068 656 42 84 10 N 9 135 78 85 10 5 3 751 1617 3263 95 1960 --4 4 8 2 1339 3712 5 3425 82 33 44 --39 3805 181 29 1 8 ----------------------------------------------3 ----------------1 ------------------- 2010 Q R S 2 TX-DSHS-19-1309-A-001080 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 11 1 0 0 0 0 8 0 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 C 0 D 1 19 0 3 14 19 2 8 0 ------------------- 10911 0 10911 0 ----- 0 --- E F G H 12 98 3 3 67 39 3 15 --- 0 3 0 0 0 0 0 0 0 4 89 2 0 5 2 0 2 6 5 --5 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-001081 2010 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 28 210 5 6 86 60 13 25 6 76 7 0 2 93 0 3 544 0 10916 0 10916 0 N N 0 60 0 M N O P Q R S T 36 142 3 356 1245 16 145 3488 --- --------------4 --- 310 34 3 --145 1 --7 1 3 1 2 --1 3 ----3 425 184 8 358 1484 20 148 4043 4 453 394 13 364 1570 80 161 4068 10 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 10916 0 10916 — --- --- --- — — 0 TX-DSHS-19-1309-A-001082 2010 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 2759 4 1456 12 720 0 0 55 1 0 0 0 0 0 0 0 0 0 2 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 3 16 0 5 0 0 0 0 0 0 0 200 1 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1451 9 2 10 5 126 26 7 5 17 93 68 1 3 70 25 10 8 13 8 2 80 40 31 43 4 13 5 8 --4 103 --257 32 1 37 2 12 53 5 7 1 12 0 0 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 720 0 0 20 6 112 103 0 0 2 3 4 0 38 5 4 5 13 3 21 0 1 0 1 4 53 5 5 52 12 0 3 8 7 0 1 2 10 11 0 0 3 21 0 0 3 57 5 3 3 6 9 1 5 2 1 2 57 1 3 4 2 2 E 2009 F G H I J TX-DSHS-19-1309-A-001083 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 5006 2267 0 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 2267 10 0 1 44 6 0 22 24 0 14 19 0 0 42 21 0 7 12 0 16 34 108 6 363 6 167 0 2 0 24 172 0 339 56 0 14 146 0 34 43 3 0 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1815 93 42649 8 47663 1815 68 N 23 184 1 1 --19 1 10 52 N 1 49 13 5 1 1 2 5 40 7 5 5 9 253 10 12 1 1 63 1 24 255 --18 342 --23 --19 --- 93 --2 --17 1 3 1 ----1 ------3 1 1 4 1 ----1 4 --1 --13 2 5 ----2 1 1 1 --1 7 1 1 ----5 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 8 N 45099 92 11 64 260 363 134 4186 1032 81 288 190 1 58 307 152 129 51 31 32 996 2180 5415 152 1970 75 460 28 85 28 1445 5316 21 6343 458 17 138 509 62 5837 285 76 28 Powassan Spotted fever rickettsiosis 38468 6 38468 3 7 7 --117 1 4156 984 61 110 40 N 16 136 83 108 18 1 --970 2024 5256 103 1543 --3 3 5 13 1415 4973 5 5651 96 15 58 2 38 5722 235 42 1 6 ----------------------------------------------2 ----------------3 ------------------- 2009 Q R S 1 6 TX-DSHS-19-1309-A-001084 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 8 0 0 0 1 0 14 1 0 Territories American Samoa Puerto Rico 0 0 0 60 U.S. Virgin Islands 61 0 C D 4 14 11 4 0 2559 2559 E F G H 0 0 0 0 0 0 0 0 0 9 87 4 4 61 26 4 10 --- 0 4 0 0 0 1 0 0 0 9 115 2 0 5 38 0 1 12 0 0 0 5 --5 0 0 0 0 0 0 0 --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-001085 2009 47 48 49 50 51 52 53 54 55 56 57 58 59 K L 30 220 6 4 67 76 18 16 12 90 7 0 1 72 0 2 340 0 2564 0 2564 0 0 0 0 60 0 61 M N O P Q R S T 37 276 9 408 908 16 201 2589 3 --------1 --------- 190 36 1 1 53 --2 5 3 4 ----1 --5 ----2 321 319 10 411 1034 21 205 2934 8 0 U N 0 N N 0 ----- 0 N N 0 ----- 0 — — 0 — — 2564 0 2564 — --- --- ----- --- — — 0 1 351 539 17 415 1101 97 223 2950 20 TX-DSHS-19-1309-A-001086 2009 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 62 0 1118 4 1257 13 1356 0 0 62 0 0 0 0 0 0 0 0 0 1 2 0 0 0 0 0 0 1 1 0 0 0 0 1 4 0 0 0 0 0 0 0 6 9 0 9 0 0 0 0 0 0 0 201 2 4 1 ----------------1 ----------------------1 ----------------------1 ----------------- 1255 5 6 15 1 125 5 14 3 7 65 57 3 3 77 5 12 9 6 4 1 80 33 18 29 1 14 --8 5 5 65 3 230 31 --31 5 4 42 3 9 --- 13 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 0 0 0 1 1 0 0 0 1356 18 0 114 9 445 71 8 1 8 3 8 0 39 20 4 6 31 3 49 0 14 1 17 10 65 15 5 47 16 0 10 8 46 3 37 15 9 16 14 1 1 39 0 0 25 2 5 2 20 3 3 1 1 71 6 7 2 3 E 2008 F G H I J TX-DSHS-19-1309-A-001087 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 3810 2107 0 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 2107 9 0 2 87 0 0 47 24 0 12 20 0 0 34 4 0 0 13 1 18 66 106 3 336 0 227 0 4 0 21 102 0 326 40 0 12 121 0 9 48 1 1 0 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2563 123 39993 3 43806 2563 93 N 17 129 --1 --33 6 19 78 N 1 110 6 8 --1 6 1 92 2 3 --11 407 3 20 3 1 85 4 54 511 1 31 268 3 15 3 57 3 123 ------11 2 2 ------------2 1 ----2 2 ----1 19 --2 --21 --7 2 --2 1 1 3 3 --7 4 ------10 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 3 42887 137 12 157 241 646 82 3966 833 95 214 202 3 54 350 61 140 58 31 67 930 2471 4744 133 1681 82 694 25 98 41 1629 3749 26 8529 654 51 150 414 66 3902 265 97 56 Powassan Spotted fever rickettsiosis 35198 2 35198 9 6 8 --74 3 3896 772 74 88 35 N 9 108 42 109 16 5 3 908 2218 4582 92 1282 1 6 17 12 12 1601 3485 8 7794 47 10 45 2 38 3818 210 29 3 2 ----------------------------------------------1 ----------------1 ------------------- 2008 Q R S 1 1 1 TX-DSHS-19-1309-A-001088 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming B C 6 0 0 0 2 0 14 6 0 57 Territories 58 American Samoa 59 Puerto Rico 0 0 0 60 U.S. Virgin Islands 0 D 22 8 14 1 3 0 917 917 E F G H ------------------- 15 87 5 5 49 32 2 21 --- 0 0 0 0 0 0 0 0 0 19 64 26 0 1 3 1 8 8 0 ----- 2 --2 0 0 0 0 0 0 --- --- 0 0 I 0 J 0 TX-DSHS-19-1309-A-001089 2008 47 48 49 50 51 52 53 54 55 56 K 40 173 31 5 60 49 18 38 8 57 919 58 0 59 919 60 0 L M 78 29 0 0 65 0 0 241 0 N 31 153 5 404 933 23 135 2034 3 O ------------------- P 233 62 7 --155 --10 --10 Q R S T 2 --8 --1 4 --1 2 344 244 20 404 1154 27 145 2276 15 — — — 919 0 919 — 0 0 0 0 U N N N ----- N N ----- — — — 0 — N --- N --- — 384 417 51 409 1214 76 163 2314 23 TX-DSHS-19-1309-A-001090 2008 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 55 0 4484 4 1411 9 3630 0 0 55 0 347 5 4 1 1408 7 2 12 2 130 23 30 4 3 56 39 2 6 63 11 3 4 9 14 8 76 34 20 29 2 8 3 7 3 9 72 5 287 22 5 28 10 18 44 8 7 1 9 3630 24 0 0 8 2 53 10 1 1 1 6 9 5 4 1 2 10 140 9 10 3 3 15 3 2007 F G 2 H I J 97 20 380 576 4 1 3 50 3 2 1 1 132 101 24 30 40 4 40 10 6 17 101 136 77 202 163 12 1 1 60 22 8 369 23 107 26 10 5 208 TX-DSHS-19-1309-A-001091 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 9593 1999 0 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 1999 15 0 82 9 31 14 21 14 50 1 1 4 12 39 80 364 222 3 108 316 60 3 106 1 6 22 5 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2221 137 31808 7 41408 2221 96 137 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 7 37268 161 13 134 244 596 605 3123 751 122 182 186 2 151 404 98 180 69 29 63 549 2765 3124 92 1749 161 673 210 204 35 912 3348 82 4974 819 386 116 431 56 4087 207 112 224 Powassan Spotted fever rickettsiosis 27444 7 27444 13 10 2 1 75 7 9 149 55 123 8 6 2 529 2576 2988 51 1238 1 10 4 7 15 896 3134 5 4165 53 12 33 1 6 3994 177 31 1 3 15 1 3 10 122 1 3 3058 715 116 30 11 Q 17 3 19 60 4 39 6 17 12 5 4 6 1 1 4 1 63 9 4 6 20 315 1 14 1 7 1 32 6 35 665 1 1 1 1 1 10 186 2 18 18 3 1 35 10 64 5 7 2007 R S 2 5 TX-DSHS-19-1309-A-001092 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D E 14 32 22 10 1 10 11 4 0 0 4137 F G 21 130 13 5 65 30 1 17 0 3 H I J 11 260 70 5 13 181 0 0 0 0 58 American Samoa 59 Puerto Rico 4137 3 60 U.S. Virgin Islands TX-DSHS-19-1309-A-001093 2007 47 48 49 50 51 52 53 54 55 56 K 46 422 83 5 92 40 13 44 181 L M 38 32 N 31 87 7 138 959 12 84 1814 3 1 39 1 299 O 1 P Q 155 49 2 1 9 123 3 1 R 6 1 13 4 226 169 16 139 1124 13 91 2115 20 S T 272 591 99 144 1216 53 104 2159 201 57 4140 0 0 0 0 0 0 — — 4140 58 0 0 U N — N — — — 0 N — — — 4140 — — — — 0 59 4140 0 N N — 60 0 0 — — — TX-DSHS-19-1309-A-001094 2007 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 69 0 882 8 1476 10 4269 0 0 69 0 105 1 8 1474 9 23 23 4 157 24 13 5 5 61 88 8 1 83 13 2 8 4 9 4 79 29 21 50 6 6 2 4 4 10 90 5 223 32 2 29 10 13 49 4 10 1 10 4269 8 0 0 2 150 29 278 345 9 8 2 1 1 21 1 1 6 3 1 1 3 1 5 2 1 1 15 3 2 1 17 11 1 11 1 9 3 1 1 2006 F G H I J 2 3 8 1 1 2 1 996 215 80 37 30 6 180 11 3 55 65 183 62 34 264 124 1 1 5 8 24 1 137 48 48 69 9 1 113 TX-DSHS-19-1309-A-001095 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 6714 1455 0 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 1455 4 0 40 1 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 2288 95 23770 17 30501 2288 94 95 17 11 104 1 6 5 3 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 29722 127 26 205 183 528 377 1847 532 70 147 176 8 1024 473 132 144 50 25 204 356 1506 1529 142 1246 202 353 43 315 135 633 2684 40 5120 993 148 173 247 96 3331 345 82 120 Powassan Spotted fever rickettsiosis 19931 1 19931 11 3 10 1 85 5 37 21 6 16 32 4 4 2 14 75 37 3 196 99 4 1 2 116 377 58 6 47 1 1 23 6 1788 482 62 34 8 7 110 26 97 4 7 1 338 1248 1432 55 914 3 5 1 11 4 617 2432 3 4460 31 7 43 7 3242 308 20 1 Q 22 1 21 53 14 26 6 5 1 3 5 1 1 1 7 1 93 12 6 5 9 163 2 25 11 14 4 7 1 1 41 8 23 852 7 1 1 2 26 139 2 26 10 43 3 4 1 5 2006 R S 2 4 1 8 TX-DSHS-19-1309-A-001096 47 48 49 50 51 52 53 54 55 56 A Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories 58 American Samoa 59 Puerto Rico B C D E 7 8 4 16 3 0 8 0 777 F 6 106 18 1 55 43 3 19 0 777 2 G 1 H I J 22 354 158 5 3 1 21 65 0 0 0 0 2 60 U.S. Virgin Islands TX-DSHS-19-1309-A-001097 2006 47 48 49 50 51 52 53 54 55 56 K 35 469 176 1 60 50 20 51 65 L M 35 7 N 15 29 5 105 357 8 28 1466 1 8 171 1 O P Q 265 40 3 3 114 1 1 1 4 1 7 R 315 76 8 105 479 9 33 1639 12 S 1 1 T 350 546 185 106 539 59 53 1690 77 57 779 58 0 59 779 0 0 0 0 U N 0 N N 0 — — 0 N N 0 — — — — — — — — 779 0 779 60 0 0 — — — — — — — 0 TX-DSHS-19-1309-A-001098 2006 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 80 0 2462 21 1498 13 3000 0 0 80 1 0 104 21 2 1494 6 7 21 6 177 24 24 3 11 68 50 18 13 3000 10 0 0 1 113 28 880 106 6 2 5 21 20 5 1 1 1 18 5 5 1 1 1 1 1 4 2 1 F 74 10 9 7 10 5 5 99 39 24 41 2 9 18 2 7 1 15 32 15 G 11 1 1 2005 3 4 6 79 3 251 40 1 30 12 12 37 10 11 H I J 13 252 23 37 25 5 171 5 6 62 45 70 30 25 188 31 6 33 38 4 86 61 31 7 25 1 5 229 TX-DSHS-19-1309-A-001099 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Ehr lichiosis Babesiosis Lyme disease 7074 1404 0 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 1404 3 0 1 42 4 O P Tularemia Total TickBorne Diseases: Plague T Total VectorBorne Diseases: 1936 154 26800 8 33882 1936 72 154 1 1 2 19 3 5 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 8 31520 98 12 178 232 1160 142 1872 665 28 179 180 18 18 474 70 143 45 31 189 258 1487 2484 158 1218 98 272 28 207 40 282 3584 51 6189 787 91 200 365 26 4399 77 117 245 Powassan Spotted fever rickettsiosis 23305 1 23305 3 4 10 1 25 137 95 4 32 7 5 11 1810 646 10 47 6 6 73 81 2 211 2 127 33 89 3 5 3 247 1235 2336 62 917 54 15 3 106 1 308 37 2 3 265 3363 3 5565 49 3 58 7 5 3 96 16 24 14 3 4287 39 15 2 7 2 14 86 1 3 11 1 7 5 3 6 1 2 5 3 75 6 6 2 18 128 1 6 1 Q 12 2 27 2 8 1 30 4 9 625 1 21 206 2 32 3 70 5 2 2 1 20 2 2 1 8 2005 R S 1 3 4 TX-DSHS-19-1309-A-001100 47 48 49 50 51 52 53 54 55 56 57 58 59 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 2 Territories American Samoa Puerto Rico 0 C D E 32 4 3 3 15 4 5 1 0 2358 0 2358 F G 14 130 7 2 44 21 3 16 2 1 4 N 4 0 H I J 18 195 52 1 17 12 0 0 0 — 60 U.S. Virgin Islands TX-DSHS-19-1309-A-001101 2005 47 48 49 50 51 52 53 54 55 56 57 58 59 K L M N O 35 357 59 2 52 24 18 42 15 24 8 2362 0 2362 0 0 0 0 U N 0 N N 0 — — 0 — — — 60 0 8 69 2 54 274 13 61 1459 3 13 2 205 P 136 30 Q 9 1 1 T 0 — — 0 — — 0 — — 2362 0 2362 — — — 0 9 0 S 2 121 10 2 3 R 177 108 3 54 408 22 73 1666 8 212 465 62 56 460 46 91 1708 23 TX-DSHS-19-1309-A-001102 2005 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island B C D E California Serogroup Viruses Chikungunya Dengue EEE Malaria St. Louis encephalitis West Nile Virus Yellow fever Zika 118 0 721 7 1458 15 2539 0 0 118 0 10 7 1458 12 2 17 8 146 16 22 5 13 93 65 4 2 47 17 4 9 5 6 7 81 53 21 30 5 20 1 4 6 5 74 5 268 23 3 30 10 18 44 11 15 2539 16 0 0 4 391 28 779 291 1 2 5 9 2 2 3 4 1 2 1 13 26 1 4 2004 F G H I J 2 41 21 2 3 60 13 23 43 7 109 16 3 1 1 16 34 51 36 6 53 44 1 88 10 3 20 12 22 3 15 TX-DSHS-19-1309-A-001103 K 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 L M N Total MosquitoBorne Disease Cases: Anaplasmosis/Eh rlichiosis Babesiosis Lyme disease 4858 875 0 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 875 5 0 O 2 1 226 2698 1 5100 122 49 83 27388 1713 54 134 3 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 3 26677 96 5 429 273 977 317 1407 352 31 211 194 4 16 226 71 80 66 36 125 233 1108 1696 70 1242 84 278 12 79 51 234 2790 96 5553 742 24 134 294 36 4075 350 4 188 2 4 3 6 1348 339 16 46 12 1 151 45 3 1 25 2 2 22527 19804 6 3 13 63 45 81 134 1 149 1 1713 19804 6 87 32 49 3 15 2 225 891 1532 27 1023 4 Plague Powassan 48 7 13 Tularemia Total TickBorne Diseases: T Total VectorBorne Diseases: Spotted fever rickettsiosis 29 33 2 P 50 3 11 3985 249 Q 20 2 3 22 78 4 14 6 2 1 5 1 9 5 3 5 1 75 15 2 4 28 106 3 16 11 28 2 2 14 2 24 535 1 1 1 19 2 1 11 190 2 30 7 2004 R S 3 TX-DSHS-19-1309-A-001104 45 46 47 48 49 50 51 52 53 54 55 56 A South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 57 Territories B C D 1 E 1 13 3 2 30 8 0 2 0 711 0 F 10 1 12 111 8 4 59 24 2 14 1 0 G 4 H I J 2 51 14 176 11 5 12 10 0 0 0 0 58 American Samoa 59 Puerto Rico 711 60 U.S. Virgin Islands TX-DSHS-19-1309-A-001105 2004 45 46 47 48 49 50 51 52 53 54 55 56 K L M N 14 52 39 294 19 4 66 24 32 36 11 6 57 711 0 0 0 58 0 0 U 59 711 0 0 60 0 O 22 1 20 98 1 50 216 14 38 1144 4 P Q R S T 7 2 5 1 1 92 9 149 119 4 54 267 18 45 1222 10 0 0 0 — — 711 N — N — — — 0 N N — N — — — 711 — — — — — — — 0 20 3 6 75 64 4 105 20 1 1 45 4 4 1 2 4 106 61 188 413 23 58 333 42 77 1258 21 TX-DSHS-19-1309-A-001106 2004 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Reporting Area A B 2004 C 2005 D 2006 E 2007 F 2008 G 2009 Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota 4858 4147 28 2 412 36 925 307 23 5 15 136 91 4 5 116 32 29 54 12 118 7 97 57 41 66 56 56 7 58 50 6 75 93 278 40 23 72 33 21 59 11 14 52 7074 4712 19 7 140 34 1057 130 30 5 16 112 77 18 13 328 34 47 32 15 180 5 104 49 86 88 80 48 25 191 37 13 85 37 304 76 87 117 43 19 62 11 17 230 6714 5935 18 23 183 33 435 369 22 7 7 86 99 8 998 304 96 41 38 11 195 4 90 37 78 131 190 72 36 268 128 13 95 14 259 51 139 98 58 82 61 4 13 114 9593 5453 37 2 117 24 510 599 34 5 3 112 101 2 138 165 35 40 44 13 57 8 86 40 37 140 140 91 205 170 20 14 73 65 451 40 374 70 120 44 69 8 12 212 3810 2891 26 6 129 14 570 76 22 4 15 95 69 3 42 97 9 23 40 10 57 3 94 35 35 60 70 33 5 55 24 6 75 12 353 53 37 62 16 21 60 4 10 39 5006 2442 11 2 33 15 238 129 7 5 19 153 79 1 41 76 34 15 21 16 30 5 81 40 38 56 60 24 13 61 14 5 106 8 325 50 2 47 12 23 57 7 12 22 H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 14505 3589 16 6 207 14 273 102 33 2 21 346 98 4 9 144 42 25 36 14 36 12 124 81 76 71 10 31 7 61 12 6 165 27 660 82 11 88 12 14 111 17 20 24 4380 2837 20 5 93 11 292 31 30 10 33 190 121 18 5 109 27 36 15 20 15 6 154 75 75 55 54 33 3 37 25 3 104 11 378 81 5 114 11 22 83 7 9 4 13991 7822 76 9 160 68 651 155 58 11 16 273 177 12 26 354 111 39 64 34 354 6 168 88 237 141 253 45 8 197 19 10 115 49 486 76 91 181 216 23 133 21 42 210 14911 5027 18 5 96 23 601 354 43 14 14 215 89 11 47 207 50 58 107 12 69 11 174 81 73 174 52 40 43 232 24 16 105 39 473 57 129 82 107 30 107 25 24 159 12720 7463 40 8 249 29 1163 173 59 10 38 643 137 36 24 136 71 40 79 37 163 15 221 277 45 111 57 48 11 151 20 44 364 29 1153 117 32 131 42 30 201 81 30 64 5819 5514 24 5 181 32 1294 143 43 10 33 208 90 227 27 176 37 40 56 15 75 15 199 104 63 95 42 56 9 78 15 8 204 20 529 71 31 118 107 29 98 24 11 46 TX-DSHS-19-1309-A-001107 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 47461 10550 75 7 186 31 1245 250 140 36 74 1253 192 70 18 370 95 98 73 56 116 24 333 245 175 270 73 82 23 119 54 29 338 26 1518 174 96 179 76 80 294 74 98 161 150842 68382 408 87 2186 364 9254 2818 544 124 304 3822 1420 414 1393 2582 673 531 659 265 1465 121 1925 1209 1059 1458 1137 659 395 1678 442 173 1904 430 7167 968 1057 1359 853 438 1395 294 312 1337 TX-DSHS-19-1309-A-001108 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B C D E F G H I J K L M Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming 39 294 19 4 66 24 32 36 11 35 357 59 2 52 24 18 42 15 35 469 176 1 60 50 20 51 65 46 422 83 5 92 40 13 44 181 40 173 31 5 60 49 18 38 8 30 220 6 4 67 76 18 16 12 28 210 5 6 86 60 13 25 6 54 136 9 10 96 33 29 37 3 60 1992 19 10 115 46 26 84 7 76 369 14 9 105 44 16 62 42 95 639 9 11 161 76 7 51 5 49 461 18 4 135 103 7 39 10 Territories American Samoa Puerto Rico U.S. Virgin Islands 711 0 711 0 2362 0 2362 0 779 0 779 0 4140 0 4140 0 919 0 919 0 2564 0 2564 0 10916 0 10916 0 1543 1 1542 0 6169 0 6027 142 9884 0 9710 174 5257 37 4802 418 305 0 281 24 14911 TX-DSHS-19-1309-A-001109 MBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 112 906 50 22 224 156 21 115 18 699 6648 498 93 1319 781 238 640 383 36911 133 35781 997 82460 171 80534 1755 TX-DSHS-19-1309-A-001110 MBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 A Reporting Area Total: United States (excluding territories) Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota B 2005 2006 2007 2008 G 2009 H 2004 C D E F 2010 I 2011 J 2012 K 2013 L 2014 M 2015 22527 22527 68 3 17 237 52 7 1384 347 16 75 103 0 11 110 39 51 12 24 7 226 1011 1639 29 1176 28 222 5 21 1 228 2715 3 5275 702 1 62 261 15 4016 339 92 9 26800 26800 79 5 38 198 102 9 1842 660 12 67 103 0 5 146 36 96 13 16 9 253 1383 2435 72 1130 18 224 3 16 3 269 3499 10 5885 711 4 83 322 7 4337 66 100 15 23770 23770 109 3 22 150 91 8 1825 525 63 61 77 0 22 169 36 103 12 14 9 352 1416 1492 64 1115 12 281 7 47 6 620 2589 18 4861 942 9 75 189 14 3270 341 69 6 31808 31808 124 11 15 220 86 6 3089 746 119 70 85 0 13 239 63 140 25 16 6 541 2679 3084 55 1609 21 582 5 34 15 898 3275 12 4523 779 12 46 311 12 4018 199 100 12 39993 39993 111 6 27 227 76 6 3943 829 80 119 133 0 12 253 52 117 18 21 10 927 2377 4709 98 1621 12 661 20 43 17 1623 3674 13 8176 601 14 88 398 45 3842 261 87 17 42649 42649 81 9 31 245 125 5 4179 1027 62 135 111 0 17 230 118 114 30 15 2 991 2099 5375 114 1914 15 436 15 24 14 1440 5210 7 6018 408 15 91 497 39 5780 278 64 6 34890 34890 104 7 20 205 148 8 3111 700 43 111 89 0 14 201 123 90 33 30 7 774 1705 3266 103 2708 32 442 8 20 3 1366 3904 7 3722 498 35 68 350 43 3827 224 55 12 40795 40795 113 11 96 656 112 6 3265 913 4 153 158 0 8 286 146 110 53 24 14 1043 1426 2868 117 3007 33 493 15 28 8 1348 4760 13 5338 520 35 91 471 51 5399 309 76 17 40119 40119 218 12 64 952 103 7 2922 717 2 177 154 0 10 411 147 174 90 110 18 1179 1707 5757 109 2103 29 572 12 33 11 1526 3994 6 3695 846 22 95 575 49 5105 393 107 11 46231 46231 294 15 97 690 141 7 3339 538 41 186 109 0 23 500 196 259 158 182 10 1512 1254 6063 179 3099 44 682 26 51 18 1811 4114 14 5784 701 43 134 370 49 5835 986 110 20 43654 43654 304 8 38 1118 94 21 2653 466 41 221 57 0 10 395 197 205 212 160 26 1651 1422 6498 138 1943 57 675 12 33 7 907 3649 7 4813 751 28 139 317 55 7529 1197 80 11 49825 49825 333 11 36 1122 119 59 2994 473 122 211 156 0 14 393 191 326 257 237 23 1450 1770 5466 164 2498 117 620 22 66 9 706 5409 10 5857 783 52 188 393 49 9102 1256 95 32 TX-DSHS-19-1309-A-001111 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 N O 2016 Total: 48610 48610 513 16 45 1074 159 18 2181 545 115 262 92 0 27 352 216 261 251 249 29 1957 1917 1582 251 2963 121 647 32 65 19 968 4786 8 5366 833 49 198 216 77 11550 1246 108 32 491671 491671 2451 117 546 7094 1408 167 36727 8486 720 1848 1427 0 186 3685 1560 2046 1164 1098 170 12856 22166 50234 1493 26886 539 6537 182 481 131 13710 51578 128 69313 9075 319 1358 4670 505 73610 7095 1143 200 TX-DSHS-19-1309-A-001112 TBDs 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 A B Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Territories American Samoa Puerto Rico U.S. Virgin Islands C 149 119 4 54 267 18 45 1222 10 — — — — D 177 108 3 54 408 22 73 1666 8 — — — 0 E 315 76 8 105 479 9 33 1639 12 — — — — F 226 169 16 139 1124 13 91 2115 20 — — — — G 344 244 20 404 1154 27 145 2276 15 — — — — H 321 319 10 411 1034 21 205 2934 8 — — — 0 I 425 184 8 358 1484 20 148 4043 4 — — — 0 J 383 132 19 632 1391 29 125 4476 14 — — — — K 811 157 14 534 1721 21 101 2529 7 — — — 0 L 674 175 25 949 1802 28 158 2731 5 — — — 0 M 678 150 22 672 1856 25 147 1955 4 — — — 0 717 128 21 864 1955 35 305 2586 23 — — — 46231 TX-DSHS-19-1309-A-001113 TBDs 0 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 N O 730 179 28 985 1779 32 388 3083 10 5950 2140 198 6161 16454 300 1964 33255 140 — — — — TX-DSHS-19-1309-A-001114 TBDs 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 A Reporting Area Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington B 2004 3 C 2005 1 3 D 2006 E F 2007 2008 2 1 G 2009 N H 2010 I 2011 J 2012 K 2013 L 2014 M 2015 2 2 1 8 1 4 1 1 4 1 1 1 4 8 5 1 6 2 1 1 1 2 1 1 2 4 2 4 2 1 TX-DSHS-19-1309-A-001115 Plague N 2016 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 4 — — — — — — — — — — — — — — — — O 1 Total: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 0 0 5 0 4 19 1 0 0 0 1 0 4 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 41 0 0 0 0 0 7 0 0 0 0 0 1 3 0 0 0 TX-DSHS-19-1309-A-001116 Plague 50 51 52 53 54 55 56 57 A West Virginia Wisconsin Wyoming American Samoa Puerto Rico U.S. Virgin Islands B — — — C — — — D — — — E — — — F — — — G — — — H — — — I — — — J — — — K — — — L — — — M — — — #N/A TX-DSHS-19-1309-A-001117 Plague — — — — — — N 1 18 Plague 120,000 100,000 80,000 60,000 40,000 20,000 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Sheet 23 TX-DSHS-19-1309-A-001119 60000 - 50000 40000 - 30000 20000 10000 0 2004 2005 2006 2007 ■ 2008 2009 2010 2011 2012 2013 2014 2015 2016 Reported tick-borne disease cases in US states ■ Reported mosquito-borne disease cases in US territories ■ Reported mosquito-borne disease cases in US states Sheet 24 TX-DSHS-19-1309-A-001120 Reported Cases of NationallyNotifiable Vector-BorneDiseases, 2004-2016 100000 80000 60000 40000 20000 0 -----,----- ---,----- ---,----- -----,--- -----,--- -----,--- 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - Total Vector-Borne Diseases Sheet 25 TX-DSHS-19-1309-A-001121 Reported Cases of NationallyNotifiable Tick-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 -- 2016 Total Tickborne Diseases Sheet 26 TX-DSHS-19-1309-A-001122 Reported Cases of NationallyNotifiable Mosquito-BorneDiseases, 2004-2016 60000 50000 40000 30000 20000 10000 0 ,------ -----,----------,----------,----------,----------,----------,----------,----------,----------,----------,----------,----2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 - 4842 6970 6610 9247 3609 4806 14505 4363 13990 14911 12719 5808 47500 Sheet 27 TX-DSHS-19-1309-A-001123 ReportedCases of NationallyNotifiableMosquito -Borne and TickborneDiseases by Vector, 2004-2016 60000 50000 40000 30000 20000 10000 0 2004 2005 -- 2006 2007 2008 2009 2010 2011 2012 Total Mosquito-Borne Diseases Sheet 28 -- 2013 2014 2015 2016 Total Tickborne Diseases TX-DSHS-19-1309-A-001124 2019 Epidemiology and Laboratory Capacity (ELC) Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Questions & Answers Vector-Borne Disease Webinar 3/20/19 Personnel 1. Should we assume that the FTE included could work on all three tiers? Do you want FTE time to be split between the H1 and H2 budget templates or just in the H1 template? 2. For Tier 1 does the FTE include 1 FTE equivalent epidemiologist and 1 FTE equivalent laboratorian, or 1 total? 3. Can jurisdictions ask for more than 1 FTE in Tier 1 if that is what's needed to accomplish both lab and epi requirements of Tier 1? Regarding the above three questions, contrary to what was stated in the vector-borne disease webinar (3/20), you CAN request more than 1.0 FTE to support Tier 1 activities, so long as the total request for Tier 1 does not exceed the $260,000 amount listed in the announcement. To the extent that personnel support Tier 2 and/or Tier 3 activities, please indicate this in your narrative and budget request. Budget 1. Is there additional funding attached to tier 2 beyond the $150,000-260,000 range mentioned? The NOFO language is: “In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities.” However, in the presentation it says the additional funding is only for Tier 3. The award funding range was based on historical funding for ELC vector-borne disease recipients amounts (without supplemental funding e.g. Zika). Please focus your funding request to match your activities as they relate to the tiers. Although we expect the majority of requests will fall within the range listed, jurisdictions CAN request funding above or below the award range listed if their work plan activities justify higher funding support. 2. In regards to preparing two different budgets, one for Tier 1 and one for Tiers 2 and 3, how should we submit this when our capacity is already much higher than just Tier 1? Please prepare two budgets, 1) the Tier 1 tab in the budget should cost out your needs for all required activities applicable to your jurisdiction 2) any additional activities required beyond the Tier 1 required activities should be included in the second budget tab covering Tiers 2 and 3. 3. Could we submit application for Tier 2 or Tier 3 activities in future budget period years or if we do not ask for it now we will not be able to apply for it later? TX-DSHS-19-1309-A-001125 Yes, you will have the opportunity in future years to request funding for Tier 2 and 3 activities even if you do not apply for them this year. 4. On the budget template, are columns H, I and J required for Tier 1 tab and Tier 2/3? Will you provide more guidance regarding this? Yes, information was including in supplementary guidance sent by ELC. Supplementary budget information for the vector-borne disease program can be found on page 19. It states: • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic 5. The Webinar mentioned preparing a budget for one year - in the narrative. Are we writing for 1-year, or laying out plans for the 5-year period? Your work plans should reflect your plans for the year one budget period only. Work Plan 1. Are the tier 2 and 3 activities likely to be maintained past one year, i.e. should we submit budgets for these activities for one year or multi-year? Yes – these are likely to be maintained past year 1. Please only propose one year of funding for the first budget period. 2. How would you like us to include progress in the upcoming ELC application? Because this is the first year of the new cooperative agreement, a report on progress from year 5 of the current cooperative agreement is not needed. Regarding performance measures, in past years, addressing performance measures was included in the application, but this is not included in the application for this year 1 budget period. More information regarding performance measures will be coming from the ELC Program office in Atlanta. Epidemiology 1. Can you provide an example of "expanded analysis and interpretation of VBD surveillance data" - the second bullet under tier 2? Expanded analysis and interpretation could include many activities beyond the basic aggregation of case data, including modeling, examination of trends or changes in trends, cluster analysis, etc. Whenever possible, it is important to publish findings to enrich the knowledge base in the public health community. 2. How should diseases with multiple modes of transmission (e.g. Q fever, brucellosis) be included? Section H guidance covers only vector-borne diseases. The primary mode of transmission for Q fever is not considered to be vector-borne, so this ELC program does not cover Q fever. Likewise, our guidance does not include brucellosis, as it is not vector-borne. TX-DSHS-19-1309-A-001126 3. Should surveillance of Babesiosis be included in Section N for parasitic activities or Section H of the ELC guidance? Babesiosis surveillance should be included in Section H. Laboratory 1. Can you discuss the capacity for performing serological testing for Anaplasma and Ehrlichia? We have relied on commercial testing for these pathogens for many years. Why is this capacity needed at public health laboratories? It is up to the jurisdiction to decide if this capacity relevant to your jurisdiction. Commercial testing is an appropriate alternative for jurisdictions as well. 2. How much detail would you like on the supply line? If we are asking for PPE or PCR Reagents – how specific should we be? Please associate supplies with a specific test or activity where possible, e.g., “PCR reagents for arboviral testing” or “PPE for tick surveillance activities.” 3. Can we submit budgets for equipment and supplies to be shipped out to other jurisdictions as needed for Tier 3? Must we account for this equipment once it is sent? Purchased equipment is usually the responsibility of the funding recipient for the life of the cooperative agreement. Additional information regarding the disposition of equipment will likely be included in your jurisdictions ELC Notice of Award. Ecology 1. For this new funding period, should 100% of mosquito data be entered into MosquitoNET now? CDC collects mosquito data in two systems, ArboNET and MosquitoNET. These systems collect different information (reporting to MosquitoNET does not replace reporting to ArboNET). • ArboNET: Reports of mosquito pools testing positive for arboviruses by county and date of collection (also called numerator data). Can also report county level data for numbers of mosquitoes collected and tested weekly by species (also called denominator data). • MosquitoNET: Detailed mosquito abundance data by specific geographic coordinates. MosquitoNET now covers all mosquito species. We are primarily interested in jurisdictions submitting surveillance data for all medically important mosquitos. Reporting of nuisance mosquitoes is optional. The system is also used to report insecticide resistance testing results. 2. If we request funding for some ecological surveillance activities, can we then subcontract local vector control districts or a university group to do them? Yes, subcontracting to vector-control districts or universities is OK. 3. Should any entomological surveillance that is conducted by our facility should be reported in Tier 2, and not Tier 1? TX-DSHS-19-1309-A-001127 Yes, entomological surveillance conducted by your facility should be reported in Tier 2. We make the following definitions regarding passive Tier 1 surveillance and active Tier 2 vector surveillance. • Passive: entomological surveillance activities already occurring in your jurisdiction, but not performed or coordinated by you. Examples could include, universities, or other state agencies, i.e. agriculture or veterinary • Active: entomological surveillance activities performed or coordinated by you. This could include collaborations with universities or local health departments/vector control agencies, or subcontracted to an outside group. Training 1. Are there any specific trainings for local health departments? Currently our Division has supported training initiatives through our national partners and the Vector-Borne Disease Centers of Excellence. Please see the websites below for additional information. • Midwest Regional COE at the University of Wisconsin in Madison http://mcevbd.wisc.edu/partners/university-of-wisconsin-madison • Northeast Regional COE at Cornell University http://neregionalvectorcenter.com/ • Pacific Southwest COE at the University of California – Davis and Riverside https://pacvec.us/ • Southeastern Gateway Regional COE at the University of Florida http://cdcsercoevbdflgateway.org/ • Western Gulf COE at the University of Texas Medical Branch in Galveston https://www.utmb.edu/wgcvbd • American Mosquito Control Association https://www.mosquito.org/page/training TX-DSHS-19-1309-A-001128 From: ZIKApregnancy (CDC) Sent: Friday, March 29, 2019 11:54 AM EDT To: Davidson, Sherri (CDC adph.state.al.us) ; McIntyre, Mary (CDC adph.state.al.us) ; Rachael.Montgomery@adph.state.al.us ; tobytha.powell@adph.state.al.us ; Brenda.Ryals@adph.state.al.us ; janice.smiley@adph.state.al.us ; Stevens, Kelly (CDC adph.state.al.us) ; amy.stratton@adph.state.al.us ; grace.thomas@adph.state.al.us ; PRAMS Alabama (CDC adph.state.al.us) ; mirwais.zhuben@adph.state.al.us ; evelyn.geeter@adph.state.al.us ; Castrodale, Louisa (CDC alaska.gov) ; Fearey, Donna (CDC alaska.gov) ; r.ropeti@doh.as ; Iugafono, Sunia (CDC doh.as) ; a.tufa@doh.as ; Dianna.contreras@azdhs.gov ; Timothy.Flood@azdhs.gov ; Lora.Andrikopoulos@azdhs.gov ; Rigler, Jessica (CDC azdhs.gov) ; irene.ruberto@azdhs.gov ; Joseph.Spadafino@azdhs.gov ; kara.tarter@azdhs.gov ; Venkat, Heather (CDC azdhs.gov) ; Villarroel, Lisa (CDC azdhs.gov) ; Joli.Weiss@azdhs.gov ; Hayley.Yaglom@azdhs.gov ; Haselow, Dirk (CDC arkansas.gov) ; RangelCF@archildrens.org ; Rupa.Sharma@arkansas.gov ; Lori.Simmons@arkansas.gov ; SmithHL@archildrens.org ; brandi.stricklin@arkansas.gov ; catherine.waters@arkansas.gov ; harit.agroia@cdph.ca.gov ; Olga.Barer@cdph.ca.gov ; Valorie.Eckert@cdph.ca.gov ; Aja.Griffin@cdph.ca.gov ; Richard.Olney@cdph.ca.gov ; Charsey.Porse@cdph.ca.gov ; Similoluwa.Sowunmi@cdph.ca.gov ; Barbara.Warmerdam@cdph.ca.gov ; Watt, James (CDC cdph.ca.gov) ; Eileen.Yamada@cdph.ca.gov ; ccroker@ph.lacounty.gov ; MIbrahim@ph.lacounty.gov ; along@ph.lacounty.gov ; clyu@ph.lacounty.gov ; Mascola, Laurene (CDC ph.lacounty.gov) ; vngo@ph.lacounty.gov ; SReynaldo@ph.lacounty.gov ; cvincentjones@ph.lacounty.gov ; Cchang@ph.lacounty.gov ; House, Jennifer (CDC state.co.us) ; Natalie.Marzec@state.co.us ; Cartter, Matthew (CDC ct.gov) ; karin.davis@ct.gov ; abdi.elmi@ct.gov ; brenda.esponda-morrison@ct.gov ; tabitha.fox@ct.gov ; zack.Fraser@ct.gov ; Claudia.gutierrez@ct.gov ; paula.eggers@state.de.us ; Davies-Cole, John (CDC dc.gov) ; Iyengar, Preetha (CDC dc.gov) ; PRAMS District of Columbia (CDC dc.gov) ; shreya.khuntia@dc.gov ; McGee, Sasha (CDC dc.gov) ; lbarrow@fsmhealth.fm ; EEdward@fsmhealth.fm ; cmasao@fsmhealth.fm ; anena@fsmhealth.fm ; jsarofalpiy@fsmhealth.fm ; BTaoTao-Wini@fsmhealth.fm ; ltaulung@fsmhealth.fm ; PVelasco@fsmhealth.fm ; rewaguk@fsmhealth.fm ; health@fsmhealth.fm ; blake.scott@flhealth.gov ; andrea.morrison@flhealth.gov ; Blackmore, Carina (CDC flhealth.gov) ; fdoh.grantsoffice@flhealth.gov ; Melissa.Jordan@flhealth.gov ; heather.lake-burger@flhealth.gov ; Mary.Hilton@flhealth.gov ; Danielle.Stanek@flhealth.gov ; Amanda.elmore@flhealth.gov ; jerusha.barton@dph.ga.gov ; skyler.brennan@dph.ga.gov ; Michael.Bryan@dph.ga.gov ; Cragan, Janet D. (CDC/DDNID/NCBDDD/DCDD) ; Drenzek, Cherie (CDC dph.ga.gov) ; julie.gabel@dph.ga.gov ; michele.mindlin@dph.ga.gov ; ashton.thompson@dph.ga.gov ; ada, Estelle (CDC dphss.guam.gov) ; Margaret.Bell@dphss.guam.gov ; margarita.gay@dphss.guam.gov ; O'Mallan, Josephine (CDC dphss.guam.gov) ; AnneMarie.Santos@dphss.guam.gov ; tommy.taitague@dphss.guam.gov ; William.Aakhus@doh.hawaii.gov ; nianest.alersbarreto@doh.hawaii.gov ; Jonathan.kimura@doh.hawaii.gov ; sylvia@hawaiigenetics.org ; sarah.park@doh.hawaii.gov ; Kris.Carter@dhw.idaho.gov ; Hahn, Christine G. (CDC dhw.idaho.gov) ; tengelse@dhw.idaho.gov ; Turner, Kathryn (CDC dhw.idaho.gov) ; Marcia.Witte@dhw.idaho.gov ; jane.fornoff@illinois.gov ; Debbie.Freeman@illinois.gov ; Kauerauf, Judy (CDC illinois.gov) ; Moritz, Erin (CDC illinois.gov) ; Jonathan.popovitch@illinois.gov ; theresa.sandidge@illinois.gov ; tiefu.shen@illinois.gov ; Arwady, Allison AA (CDC cityofchicago.org) ; Black, Stephanie SB (CDC cityofchicago.org) ; jennifer.levy@cityofchicago.org ; Toews, Karrie-Ann (CDC cityofchicago.org) ; Jessica.Wilkerson@cityofchicago.org ; MarAllen@isdh.IN.gov ; Brown, Jen (CDC isdh.in.gov) ; rchauhan1@isdh.in.gov TX-DSHS-19-1309-A-001129 ; aforkner@isdh.in.gov ; Pontones, Pamela (CDC isdh.in.gov) ; tastevens@isdh.in.gov ; julie.coughlin@idph.iowa.gov ; carrie-fall@uiowa.edu ; florence-foo@uiowa.edu ; Garvey, Ann (CDC idph.iowa.gov) ; nih@uiowa.edu ; oluwakemi.oni@idph.iowa.gov ; paul-romitti@uiowa.edu ; Kenneth.Sharp@idph.iowa.gov ; Farah.Ahmed@ks.gov ; Kelly.Gillespie@ks.gov ; Jamie.Kim@ks.gov ; hsmith@kdheks.gov ; stubach@kdheks.gov ; Tori.Amburgey@ky.gov ; Monica.Clouse@ky.gov ; martie.kupchinsky@ky.gov ; katie.myatt@ky.gov ; Robeson, Sara (CDC ky.gov) ; Teresa.Fields@ky.gov ; Matthew.Johnson@ky.gov ; Rachel.Zinner@ky.gov ; dimple.patel@ky.gov ; Edward.Holmberg@la.gov ; jenna.ibergjohnson@la.gov ; julie.johnston@la.gov ; Ratard, Raoult (CDC la.gov) ; christine.scott-waldron@la.gov ; sean.simonson@la.gov ; Sokol, Theresa (CDC la.gov) ; julius.tonzel@la.gov ; tri.tran@la.gov ; Farmer, Ann (CDC maine.gov) ; catie.peranzi@maine.gov ; Robinson, Sara (CDC maine.gov) ; Blythe, David (CDC maryland.gov) ; Brooks, Richard Benjamin (CDC/DDID/NCEZID/DHQP) ; Duwell, Monique MD (CDC maryland.gov) ; judie.hyun@maryland.gov ; McLean, Sandra (CDC maryland.gov) ; kristin.silcox@maryland.gov ; monika.piccardi@maryland.gov ; Catherine.Brown@state.ma.us ; alfred.demaria@state.ma.us ; Julie.e.dunn@state.ma.us ; cathleen.higgins@state.ma.us ; rebecca.liberman@state.ma.us ; matthew.a.osborne@state.ma.us ; kayleigh.sandhu@state.ma.us ; Sarah.Scotland@MassMail.State.MA.US ; susan.soliva@massMail.state.ma.us ; eileen.m.sullivan@state.ma.us ; mahsa.yazdy@MassMail.state.ma.us ; alversonG@michigan.gov ; ehrhardtj@michigan.gov ; Fussman, Chris (CDC michigan.gov) ; reikr@michigan.gov ; Signsk@michigan.gov ; simmonsl@michigan.gov ; Stobierski, Mary Grace (CDC michigan.gov) ; sook.ja.cho@state.mn.us ; Danila, Richard (CDC state.mn.us) ; barbara.frohnert@state.mn.us ; carolyn.hoel@state.mn.us ; michele.hort@state.mn.us ; erin.kough@state.mn.us ; david.neitzel@state.mn.us ; elizabeth.schiffman@state.mn.us ; paul.byers@healthyms.com ; gerri.cannonsmith@msdh.ms.gov ; Katherine.farrington@msdh.ms.gov ; Beryl.polk@msdh.ms.gov ; Alyce.Stewart@msdh.state.ms.us ; kathryn.taylor@msdh.ms.gov ; jennifer.hanson@msdh.ms.gov ; LaShunda.Williams@msdh.ms.gov ; Chana.Winder@msdh.ms.gov ; Molly.baker@health.mo.gov ; grants@health.mo.gov ; Alexandra.Berkley@health.mo.gov ; john.bos@health.mo.gov ; rose.kowieski@health.mo.gov ; qian.liu@health.mo.gov ; Loise.Wambuguh@health.mo.gov ; Erika.baldry@mt.gov ; debgibson@mt.gov ; Milhon, Karl (CDC mt.gov) ; Jeff.hamik@nebraska.gov ; samir.koirala@nebraska.gov ; Qu, Ming (CDC nebraska.gov) ; barker@snhdmail.org ; henri@snhdmail.org ; johnsonmi@snhdmail.org ; Larson, Sandra (CDC health.nv.gov) ; mehretu@SNHDMAIL.ORG ; mpeekbullock@health.nv.gov ; ramand@SNHD.ORG ; Zhang, Lei (CDC snhdmail.org) ; heather.barton@dhhs.nh.gov ; christine.bean@dhhs.nh.gov ; Suzann.Beauregard@dhhs.nh.gov ; carolyn.fredette@dhhs.state.nh.us ; Mathewson, Abigail (CDC dhhs.state.nh.us) ; paulette.valliere@dhhs.nh.gov ; eric.carlsson@doh.nj.gov ; Kim.Cervantes@doh.nj.gov ; Kristin.Garafalo@doh.nj.gov ; Sandra.Howell@doh.nj.gov ; Loletha.Johnson@doh.nj.gov ; Mary.Knapp@doh.nj.gov ; ahmed.muhammad@doh.nj.gov ; Joy.Rende@doh.nj.gov ; nancy.scotto-rosato@doh.nj.gov ; Tan, Christina CT (CDC doh.nj.gov) ; Karen.Worthington@doh.nj.gov ; Janis.gonzales@state.nm.us ; Krapfl, Heidi (CDC state.nm.us) ; Martina.Garcia@state.nm.us ; Aimee.Roth@state.nm.us ; nina.ahmad@health.ny.gov ; Blog, Debra (CDC health.ny.gov) ; laura.brady@health.ny.gov ; marilyn.browne@health.ny.gov ; Donna.DeLuca@healthresearch.org ; deb.fox@health.ny.gov ; Lisa.Jackson@health.ny.gov ; amanda.stolz@health.ny.gov ; nicole.longcore@health.ny.gov ; jennifer.white@health.ny.gov ; ccanary@health.nyc.gov ; mcasali1@health.nyc.gov ; Fine, Annie (CDC health.nyc.gov) ; miwamoto@health.nyc.gov TX-DSHS-19-1309-A-001130 ; mlash@health.nyc.gov ; elee4@health.nyc.gov ; tmcveigh@health.nyc.gov ; Paladini, Marc (CDC health.nyc.gov) ; fpoteat@health.nyc.gov ; sslavins@health.nyc.gov ; ttseyang@health.nyc.gov ; mvachon@health.nyc.gov ; swillis@health.nyc.gov ; awinters@health.nyc.gov ; ronna.chan@dhhs.nc.gov ; mandy.cohen@dhhs.nc.gov ; nina.forestieri@dhhs.nc.gov ; kristin.bergman@dhhs.nc.gov ; Maillard, Jean-Marie (CDC dhhs.nc.gov) ; lcronquist@nd.gov ; Miller, Tracy (CDC nd.gov) ; Luu, Ngoc Phuong NPL (CDC dph.gov.mp) ; Muña, Esther (CDC dph.gov.mp) ; margarita.aldan@dph.gov.mp ; warren.villagomez@gmail.com ; rosita.waldron@dph.gov.mp ; educator.dph@gmail.com ; deFijter, Sietske (CDC odh.ohio.gov) ; Kirstan.Duckett@odh.ohio.gov ; richard.gary@odh.ohio.gov ; Shelby.hale@odh.ohio.gov ; Kimberly.Machesky@odh.ohio.gov ; Mohr, Marika (CDC odh.ohio.gov) ; Norma.Ryan@odh.ohio.gov ; Anna.Starr@odh.ohio.gov ; BRANDI.TAYLOR@odh.ohio.gov ; lisarc@health.ok.gov ; KristinAO@health.ok.gov ; MikeT@health.ok.gov ; lisa.c.takeuchi@state.or.us ; kliu.basilius@palauhealth.org ; Elechuus, Brenice (CDC palauhealth.org) ; losii.samsel@palauhealth.org ; mindy.sugiyama@palauhealth.org ; tmong.udui@palauhealth.org ; jane.baker@phila.gov ; Rachel.Blumenfeld@Phila.gov ; Johnson, Caroline ( PHILA ) (CDC phila.gov) ; carol.larach@phila.gov ; Dana.Perella@phila.gov ; Sharon.Starr@phila.gov ; Trevor.Kanaskie@Phila.gov ; c-kihauser@pa.gov ; c-chowells@pa.gov ; Lind, Leah (CDC pa.gov) ; Long, Jonah (CDC pa.gov) ; Mariott, Chandra (CDC pa.gov) ; c-barmille@pa.gov ; lstubbs@pa.gov ; shawatkins@pa.gov ; camilledelgado@salud.pr.gov ; stephany.perez@salud.pr.gov ; mvalencia@salud.gov.pr ; mayabing@gmail.com ; Anzures, Edlen (CDC gmail.com) ; k.briand123@yahoo.com ; Aina.Garstang@gmail.com ; Rasnen Hansen ; wasejacklick@gmail.com ; Jill McCready ; Alexander-Scott, Nicole (CDC health.ri.gov) ; Bandy, Utpala (CDC health.ri.gov) ; Gosciminski, Michael (RI) (CDC health.ri.gov) ; daniela.quilliam@health.ri.gov ; St John, Kristen (CDC health.ri.gov) ; bridget.teevan@health.ri.gov ; samara.vinerbrown@health.ri.gov ; Bell, Linda (CDC dhec.sc.gov) ; Daguise, Virginie VD (CDC dhec.sc.gov) ; Drociuk, Dan (CDC dhec.sc.gov) ; henderdl@dhec.sc.gov ; LeedomVO@dhec.sc.gov ; Radcliffe, Rachel (CDC dhec.sc.gov) ; jan.bollock@state.sd.us ; chris.carlson@state.sd.us ; cassandra.deffenbaugh@state.sd.us ; Meghan.Marx@state.sd.us ; Carolina.Clark@tn.gov ; Cristina.alford@tn.gov ; Jacqueline.Johnson@tn.gov ; Katherine.Lolley@tn.gov ; morgan.mcdonald@tn.gov ; Laura.price@tn.gov ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Gaul,Linda (DSHS) ; Nickodem,Colette A (DSHS) ; Owens,Kamesha (DSHS) ; Sidwa,Tom (DSHS) ; Broussard,Kelly (DSHS) ; Canfield,Mark (DSHS) ; Garcia,Imelda M (DSHS) ; Langlois,Peter (DSHS) ; idaresit.umoh@dallascounty.org ; Kyoo.Shim@dallascounty.org ; wendy.chung@dallascounty.org ; Folasuyi.Richardson@dallascounty.org ; Tahani.Hamdan@houstontx.gov ; Amanda.Eckert@houstontx.gov ; Salma.Khuwaja@houstontx.gov ; McNeely, Wesley (CDC houstontx.gov) ; Tolulope.Olumuyiwa@houstontx.gov ; Kirstin.Short@houstontx.gov ; Yang, Biru (CDC houstontx.gov) ; steven.hinojosa@hchd.org ; connie.sanchez@hchd.org ; diana.cortes@mail.hchd.org ; leah.dewilde@doh.vi.gov ; Ellis, Esther (CDC doh.vi.gov) ; eleanor.johannes@doh.vi.gov ; cburnett@utah.gov ; jeason@utah.gov ; janejohnson@utah.gov ; aenance@utah.gov ; ddpeterson@utah.gov ; asteele@utah.gov ; Watkins, Shari A. (CDC utah.gov) ; peggy.brozicevic@vermont.gov ; Cook, Sally (CDC vermont.gov) ; paul.daley@vermont.gov ; brennan.martin@vermont.gov ; Nicolai, Laura Ann (CDC vermont.gov) ; lucia.orantes@vermont.gov ; shea.browne@vdh.virginia.gov ; katherine.crawford@vdh.virginia.gov ; liz.garrison@vdh.virginia.gov ; Kurkjian, Katie (CDC vdh.virginia.gov) ; Jennifer.Macdonald@vdh.virginia.gov ; TX-DSHS-19-1309-A-001131 elena.mircoff@vdh.virginia.gov ; elina.guralnik@vdh.virginia.gov ; mary.chan@doh.wa.gov ; Hanna.Oltean@doh.wa.gov ; melissa.a.baker@wv.gov ; Tara.L.Buckner@wv.gov ; kathy.g.cummons@wv.gov ; Ada.O.Okorie@wv.gov ; Sowmya.Adibhatla@dhs.wisconsin.gov ; amy.bittrich@dhs.wisconsin.gov ; DeSalvo, Traci (CDC dhs.wisconsin.gov) ; DHSGrantReview@wisconsin.gov ; Kimberly.Meinholz@dhs.wisconsin.gov ; christine.muganda@dhs.wisconsin.gov ; rebecca.osborn@dhs.wisconsin.gov ; Rohan, Angela (CDC dhs.wisconsin.gov) ; Wozniak, Ryan (CDC dhs.wisconsin.gov) ; katie.bryan@wyo.gov ; Vanhouten, Clay (CDC wyo.gov) CC: Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) ; King, Kellianne M. (CDC/DDNID/NCBDDD/DCDD) (CTR) ; Reynolds, Megan (CDC/DDNID/NCBDDD/DCDD) Subject: RE: Project W: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats Webinar Attachment(s): "CDC-RFA-CK19-1904_ Webinar for Project W.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning, Jurisdictional partners, Attached are the slides that were presented on the Webinar yesterday for Project W for the ELC grant. These slides will also be posted in REDCap, along with the recording from the webinar. We hope that this additional information is helpful when drafting your application. However, if you have any questions, please reach out to ELC at ELC@cdc.gov. As a reminder, the deadline to submit your completed application is Friday, May 10, 2019 at 11:59pm ET. Best, Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities -----Original Appointment----From: ZIKApregnancy (CDC); Sent: Monday, March 25, 2019 3:09 PM To: Subject: FW: Project W: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats Webinar When: Thursday, March 28, 2019 2:00 PM-3:00 PM (UTC-05:00) Eastern Time (US & Canada). Where: Skype and Conference Room 1204-B (for local staff only) Good afternoon, Jurisdictional partners, The below email invitations was sent out to all current ELC grantees. We recognize that many of you are on that email list, so apologize for the duplication, however wanted to make sure that everyone received notice. We hope that you will be able to join us for a webinar on Thursday, March 28, at 2:00pm ET, about ELC Project W. Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities -----Original Appointment----From: Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) Sent: Friday, March 22, 2019 4:50 PM Subject: Project W: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats Webinar TX-DSHS-19-1309-A-001132 When: Thursday, March 28, 2019 2:00 PM-3:00 PM (UTC-05:00) Eastern Time (US & Canada). Where: Skype and Conference Room 1204-B (for local staff only) The National Center of Birth Defects and Developmental Disabilities (NCBDDD) (ELC Project W) will host a webinar that will cover: · · · Overview and Intention of the Project Funding and Award Plans Questions and Answers Questions regarding this webinar should be directed to Tineka Yowe-Conley,tay7@cdc.gov. ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (770) 488-3600 (Chamblee Dial-in Conference Region) (855) 644-0229 (Chamblee Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 21182383 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... TX-DSHS-19-1309-A-001133 National Center on Birth Defects and Developmental Disabilities Overview of 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904: Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats March 2019 TX-DSHS-19-1309-A-001134 Agenda I Overview of the Project I Next Steps I Questions and Answers 135 M2  W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Managed and funded by CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD), Division of Congenital and Developmental Disorders (DCDD) TX-DSHS-19-1309-A-001136 Funding Strategy ■ Number of Awards: 4 - 9 ■ Award Amounts: $200,000 and $425,000 Utilize Funding For: ■ Personnel - (e.g., A Jurisdictional-Level Coordinator) ■ Travel ■ Equipment ■ Supplies ■ Contractual Support TX-DSHS-19-1309-A-001137 Award Criteria ■ Quality of Application ■ Number of Births Per Year ■ Estimates of Exposure to Emerging Infections and Other Health Threats ■ Public Health Importance of the Emerging Health Threat ■ Prior "M" funding is not required ~4 ~4 <> TX-DSHS-19-1309-A-001138 Supplementary Information      A Comparison of ELC NOFOs Application Development Tips Submission Process and Tools Materials from the ELC Kick-off and Budget Webinars Frequently Asked Questions (FAQs) – Project W: Pages 85–86 TX-DSHS-19-1309-A-001139 Objectives and Supported Activities ■ USZPIR Databases (Utilize and/or Adapt) NOTE: Applications can Address Zika AND/OR Other Emerging Threat ■ Collaborate with State, Local, and Territorial Health Departments ■ Work with Clinical Experts and Clinical Professional ■ Develop and Disseminate Clinical Guidance and Health Communications Materials TX-DSHS-19-1309-A-001140 Surveillance Model to Monitor Emerging Threats Identify emerging threat Use surveillance system to monitor effects of threat among pregnant women and infants Collect information on poor health effects during pregnancy to identify which outcomes to monitor Infant follow up surveillance to collect information about babies Ensure followup of children and screenings as information emerges Use data to develop recommendations for clinical care and plan for services needed by families affected by emerging threats TX-DSHS-19-1309-A-001141 Strategies and Activities ■ Project W will Address 2 of the 3 Core Strategies Area A: Surveillance, Detection and Response • Enhanced Workplace Capacity • Enhanced Case Investigations • Improved Surveillance • Strengthened Partnerships and Collaborations • Advanced Innovative IT Strategies Area C: Communications, Coordination and Partnerships • Information Sharing and Collaboration TX-DSHS-19-1309-A-001142 Outcomes ■ Improve Epidemiological Capacity ■ Improve Completeness and Timeliness of Reporting ■ Improve Monitoring of Infants and Children ■ Translation of Public Health Data TX-DSHS-19-1309-A-001143 Evaluation and Performance Measurement ■ Outcome Measures will be Based on: - Proportion of Cases Among Infants - Completeness of Reporting of Variables TX-DSHS-19-1309-A-001144 Collaborations ■ National Center on Birth Defects and Developmental (NCBDDD) ■ State, local and territorial ■ American Academy of Pediatrics (AAP) ■ American College of Obstetricians ■ American Board of Obstetrics and Gynecology (ABOG) ■ Society for Maternal ■ American Nurses Association (ANA) ■ Association of Clinical Nurse Midwives (ACNM) ■ Other Professional Groups Disabilities Health Departments and Gynecologists (ACOG) Fetal Medicine (SMFM) TX-DSHS-19-1309-A-001145 Next Steps ■ Coordinate your Proposal ■ Awareness of Internal Deadlines TX-DSHS-19-1309-A-001146 A Session 147 Additional Questions?  Q/A Document  Main POC for Questions: Tineka Yowe-Conley, MPA (tay7@cdc.gov)  Other Contacts: – Dana Meaney-Delman, MD, MPH, FACOG (vmo0@cdc.gov) Chief, Prevention Research and Translation Branch – Nicole Fehrenbach, MPP (ekk5@cdc.gov) Deputy, Division of Congenital and Developmental Disorders – Peggy Honein, PHD, MPH (mrh7@cdc.gov) Director, Division of Congenital and Developmental Disorders TX-DSHS-19-1309-A-001148 From: Aldridge,Tiffany (DSHS) Sent: Friday, March 29, 2019 12:40 PM EDT To: Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) CC: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: RE: TX Year 4 Carry Over of M2 - Zika Pregnancy Registry Funds Attachment(s): "Cover letter.pdf","Federal Financial Report.pdf","SF424A Budget Summary.pdf","No Cost Extension Budget narrative.pdf","Indirect Cost Rate.pdf","GrantSolutions - Read Only.pdf" Good Afternoon, The No-Cost Extension for Texas for Year 4 has been submitted in GrantSolutions (see attached). Please let me know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Zion, Karen (CDC/OCOO/OFR/OGS) [mailto:wvf8@cdc.gov] Sent: Friday, March 1, 2019 9:47 AM To: Aldridge,Tiffany (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) Cc: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: RE: TX Year 4 Carry Over of M2 - Zika Pregnancy Registry Funds WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi Tiffany, I just wanted to let you know that I returned the request to you to allow you to change it to an extension. Zika funds cannot be carried over, however, they can be extended. Please resubmit using the PPHF Extension as the amendment type. Also, please talk with your Project Officer to find out if there is a bona fide need for the Zika Coordinator to attend this years ELC grantee meeting in April. Thanks, Karen. From: Aldridge,Tiffany (DSHS) Sent: Thursday, February 28, 2019 6:17 PM To: Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) Cc: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: TX Year 4 Carry Over of M2 - Zika Pregnancy Registry Funds Good Afternoon, Attached is TX Year 4 M2 Zika Pregnancy Registry Carry Over of funds request and a copy of the submission to GrantSolutions. Please let us know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 TX-DSHS-19-1309-A-001149 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-001150 TEXAS Texas Department ofStateHealth Services HealthandHuman Services JohnHellerstedt,M.D. Commisslontr March 29, 2019 Karen Zion, Grants Management Specialist Centers for Disease Control and Prevention Office of Grants Services Infectious Disease Service Branch, Team I 2920 Brandywine Road, MS E-15 Atlanta, GA 30341 DSHS Doc.# 1918-04-AP-08 • Reference: Award Number : 6NUS0CK000378-04 CK14-1401, Building and Strengthen ing Epidemiology, Laboratory, and Health Information Systems Capacity in State and Local Health Departments Prior Approval : No-Cost Extension of Year 4 Zika 2017 Funds Dear Ms. Zion: The Texas Department of State Health Services (DSHS) requests a no-cost extension of the Zika 2017 component budget and project per iod end date from July 31, 2018 to July 31, 2019to utilize unexpended funds of $136,672 for the referenced Award Number as listed above. In Year 4, DSHS hired a contracted Zika Pregnancy Registry (ZPR) Coordinator; however , the position became vacant after a few weeks. A new ZPR Coordinator was hired at the end of Year 4 and has been comp leting the activities of the position since this time. Per discussions with Center for Disease Control and Prevention (CDC), the recommendation was to request a no-cost extension to offset funding for this contractor through the end of the project period in order for the ZPR Coordinator to complete the data compilation and technical assistance for the Local Health Departments (LHDs). The CDC hired contracted ZPR Coordinators throughout the regions in Texas. The coordinators provide education and outreach to health care providers in their P.O. Box 149347 • Austin, Te> sooo ... ,, .~C"--,,_j HJI .Cll 1, 10112111• 11)112D11 so~ - .... .. 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"'°""'' H_, EuwoUOfl0. 1• .. .,._,_ si..-111 ~.,,,,.,_...,.,._.., ~ ,.._ ... ,,_,._..,~,.,..,- .. ,........, .. ....,.,._.,. .. u.,....,.,, .. ou11c..,,.i- ......a-.-S'd...-lrqN_,ol_,.-, ,..,_.......,....,"" ...-Dl......._b---~..... tf"ll•l5""'1Wra... ...-..-,-11 __ ,Cll4Ctali11Y--DIDC-.J ~ 0).18-0C&I IG/l 112011 JIM .... ....,,.,, .... 11.,...,0..a__ lot,_,. ............ .._ .._,.. ..._ -•,..,__,_,,_ ■sllO Sent: Friday, March 29, 2019 3:53 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Attachment(s): "Supplementary Information for ELC FY 2019_v2.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please find the updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 2) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks and we look forward to seeing many of you next week! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 21, 2019 6:04:53 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Supplementary Information for 2019 Good afternoon, Please find the Supplementary Information for Applying to 2019 ELC NOFO document attached here, and also located in REDCap in the file repository. As mentioned in previous communications, this document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • • • • describe the new ELC structure and contrast it with previous project periods, offer tips for developing effective work plans, milestones, and budgets, provide additional information about the submission process and tools that may aid applicants, illustrate materials from the ELC and partner program webinars, including a compilation of frequently asked questions for applicants to reference, and instructions on how to download the recorded ELC webinars. PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Thank you, ELC Team TX-DSHS-19-1309-A-001164 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) March 2019 VERSION 2 TX-DSHS-19-1309-A-001165 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 19 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 20 ELC Data Management Plan (DMP) Checklist ......................................................................................... 21 5. Submission Process ................................................................................................................................. 23 Submission Checklist ............................................................................................................................... 23 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 23 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 28 7. Program-Specific Frequently Asked Questions and Guidance.................................................................... Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance................................................... Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond .................................................................................................................................. Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-001166 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Yellow highlighted sections are new additions to this document, since the first version was shared on March 21, 2019. Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-001167 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-001168 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 19-1904 CK 14-1401 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-001169 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-001170 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-001171 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-001172 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-001173 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-001174 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-001175 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-001176 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-001177 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Three other related programs and projectsin this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases • G. Hospital-acquired infections and antimicrobial resistance • O. Vaccine preventable diseases To simplify the application process, for those three specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-001178 through the program-specific activity (i.e., Activity F, G, or O); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those three activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. H. Vector-borne Diseases (p. 156) Clarification to text found in the Funding Strategy section (p.157). The third bullet states: • Estimated average award amount: Approximately $266,000. The average award will depend upon the project activities (tiers) in which a jurisdiction participates. In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities. These jurisdictions must document capacity at lower tiers to be granted higher tier funding. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the text is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-001179 support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. I. Mycotics: Detecting and Preventing Fungal Infections (p. 167) Supplementary guidance was provided via webinar to applicants on March 28, 2019. Webinar slides are located in ELC’s REDCap file repository. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-001180 • expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this • Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. o Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-001181     Prepare a report identifying the populations and outlining strategies to improve coverage. Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities. Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks. Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission. Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. • Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-001182 of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-001183 • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-001184 ELC Data Management Plan (DMP) Checklist While the Data Management Plan requirements in the 2019 ELC NOFO specifically pertains to collection of public health data related to ELC-funded activities, we strongly encourage that efforts be made to make the DMPs as complete as possible. 1. Description of ELC Data - Describe types of data collected (e.g., performance measure data, financial data, success stories). Things to think about: • What data will be generated through programmatic activities? • What data types will you be creating or capturing? • How will you capture or create the data? • If you will be using existing data, how will you acquire it? 2. Period of data retention - Describe plans for archiving data or explanation of why that is not necessary. Things to think about: • How long will the data collector retain the right to use the data before opening it up to wider use? • Explain details regarding data retention periods. 3. Data format – Describe general data formatting standards. Things to think about: • Which file formats will you use for your data, and why? • What transformations to more shareable formats will be necessary to prepare data for preservation and/or data sharing? • What contextual details (metadata) are needed to make the data you capture or collect meaningful? • How will you create or capture these details? 4. Data dissemination – Describe how data will be disseminated and how other parties gain access. Things to think about: • How and when will you make the data available after data collection? (Include the resources needed to make the data available: equipment, systems, expertise, etc.) • Who gets access to data specifically? • How will data are to be shared and managed with partners and other major stakeholders? • What other types of information should be shared regarding the data, e.g., the way it was generated, analytical and procedural, information? • What is the process for gaining access to the data? • Will any permission restrictions need to be placed on the data? • Are there ethical and privacy issues? If so, how will these be resolved? • How will you manage data with sensitive information? Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-001185 5. Data storage and preservation of access – Describe long-term strategy for storing, archiving and preserving data. Things to think about: • What is the long-term strategy for maintaining, curating and archiving the data? • Which archive/repository/database have you identified as a place to deposit data? • How long will/should data be kept beyond the life of the budget/project period? • What data will be preserved for the long-term and why? • What documentation will be submitted alongside the data or created for archival in order to make the data reusable? Centers for Disease Control and Prevention 22 TX-DSHS-19-1309-A-001186 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 23 TX-DSHS-19-1309-A-001187 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method will be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDFfrom .Eile... ~ PDF from .S.canner f'~ PDFfrom Web Page... Saveas Otner EJcporlTo Shift+Ctr l+O f'e,PDFfrom .Clipboard ~ J.!➔..I ~:!!I Combine Filesinto a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF£ortfolio ... ~ udget.pdf PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001188 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF,click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-001190 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.pdl ~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.pdf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDF and save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001191 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q: Where can I locate the FY19 NOFO? A: The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A: The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A: The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q: What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: AwardsMade ELC NOFO Published Budget Webinar Appl ications Due 2014-20 18 Closeout Report & 2018 Perform ance Measures Due ELC Kick-Off Webi nar Feb 28 2019 HAI/AR Perform ance Measures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toRrnca y Aue 1 Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-001192 Q: What is the application due date? A: The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A: Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q: When should we submit our Close-Out Reports? A: A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-001193 FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q: Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Q: Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q: Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o • Performance measures will NOT be collected with application. o • Enter these narratives on “approach” tab in each template. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-001194 • • • • Therefore, the activities names are hard coded. Work plan details are not pre-populated, as this is the first of a five year period of performance Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q .Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. What are some of the new ELC Budget Template Features? A: There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-001195 funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-001196 A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users - Q. In which program or project should I request support for cross-cutting training and peer-to-peer travel? A. It is recommended that any training/travel request in the budget relates to an activity in the work plan. Travel and training requests made in the Cross-cutting Epi & Lab Program should link to crosscutting outcomes. For trainings and travel specific to a program/project, please include these requests in the specific program/project application template. For the ELC Annual Meeting: • If the request if for the ELC Governance Team members to attend the ELC Annual Meeting, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For specific trainings or conferences, such as CSTE, Public Health Informatics, APHL, etc. • If the request is for cross-cutting epi &/or lab staff travel to travel to a specific conference, it may be requested in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For Peer-to-Peer Site Visits • If the Peer-to-Peer request is for cross-cutting epi &/or lab staff to visit another jurisdiction to either learn or share best practices, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. Submitting Your Applications Questions Q: Where do I submit my completed application? A: Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-001197 Q: Are recipients still required to submit applications to GrantSolutions? A: No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q: How do I gain access to REDCap A: In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Q. What should we submit via REDCap? A: The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q: What resources will be available for recipients to complete applications? A: The ELC will release the following resources to assist recipients with completing and submitting their grant application: Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. Centers for Disease Control and Prevention 34 TX-DSHS-19-1309-A-001198 • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com. Centers for Disease Control and Prevention 35 TX-DSHS-19-1309-A-001199 7. Program-Specific Frequently Asked Questions and Guidance Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 36 TX-DSHS-19-1309-A-001200 2019 ELCSectionF: equentlyAskedQuestio General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE Food Net Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSSEnhanced OHHABSand GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov ; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov ; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvQ2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov ; 404.718.4155) Amy Kirby (agkl@cdc.gov ; 404.718.3161) Mia Mattioli (kuk9@cdc.gov ; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhg5@cdc.gov ; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov ; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814) Jared Reynolds (uvz6@cdc.gov ; 404.639.3519) Erin Stokes (ykt3@cdc.gov ; 404.718.1175) Aron Hall (esg3@cdc.gov ; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evll(a)cdc.gov ; 404.718.4871) Aron Hall (esg3@cdc.gov ; 404.639.1869) Virginia Roberts (evll@cdc.gov ; 404.718.4871) Jonathan Yoder (jey9@cdc.gov ; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov ; 404.639.0704 ), Efrain Ribot (eyr4@cdc.gov ; 404.639.3521) Template-related questions 1. What happened to the 'other' option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an 'other' option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELCNOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001201 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 3. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 4. What we if have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001202 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity (p 100-101) 5. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. **HL7 Transmission of case surveillance data 6. Variations of this activity are found in Strategy 1a, Strategy 1c, and Strategy 1h. Can you clarify how we can respond to these? Should they be treated independent of each other, or should be addressed as a unit? Activity I (pages 99-100) addresses integrating data elements into existing surveillance systems and working with informatics staff to enable transmission of data elements. Activity IV (pages 102-103) addresses collecting and transmitting national case surveillance data, but does not specify sending via HL7. Activity IX (page 107) very specifically and in detail describes sending condition-specific data/national case surveillance data via HL7. Strategy 1a is focused on the workforce capacity needed to develop internal capacity for, and complete or continue implementation of HL7 messages for the data elements specified in Generic Version 2 (GenV2) and the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Responses should include identification of any additional staff or training needed to complete the sub-activities listed. Additional staff may include epidemiologists needed to provide temporary capacity during the labor-intensive onboarding process activities. - Strategy 1c is focused on the processes of data collection, reporting, and data cleaning, independent of the data transmission method. Responses for part B should include descriptions of the questionnaires, or when no questionnaire is available, the data elements collected for each of the conditions indicated. Additional information for these conditions can be found in Project F Appendix 1. Strategy 1h is focused on advancing and modernizing information exchange. Responses should indicate if the jurisdiction is planning to implement all or a portion of the FDD MMG. If a jurisdiction is not able to implement the entire guide, they are able to subset the guide into 2 four condition sections and implement one section in the budget period. The response should specify which four condition tabs will be implemented. For the remaining four condition tabs the jurisdiction should indicate if electronic tabular format or traditional mechanisms will be used. (Can we somehow reference the previously provided FAQs here as well?) The response should also include activities related to incorporating all condition-specific data elements in the FDD MMG into data management systems. **PulseNet and NARMS Funding 7. Should requests for WGS funding be separated by type or pathogen between PulseNet and NARMS? Requests for WGS personnel, supplies, and equipment for enteric/foodborne pathogens should be combined for PulseNet and NARMS in the Food and Water laboratory capacity budget (F2). It is no longer necessary to specify requests by PulseNet and NARMS, as was done in the previous ELC cycle. Please be sure to continue to requests funds specifically for shipping NARMS routine surveillance and outbreak isolates to CDC for antimicrobial susceptibility testing. 8. How much per isolate should we factor in for sequencing supplies? You should use $125/isolate as an average cost for sequencing supplies. 3 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001203 9. Will PulseNet award funds for serotyping? No, neither PulseNet nor NARMS will provide funds for traditional or molecular serotyping. 10. Will PulseNet fund any PFGE? PulseNet will no longer fund PFGE activities. **Waterborne (General) 11. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 12. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 13. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. - 14. For Activity III (b.iii, page 102), what are some examples of other water related issues? Hurricanes? Flooding? Water-related emergencies like floods or droughts are good examples; health risks that are not necessarily waterborne disease outbreaks. CryptoNet 15. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) 4 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001204 • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) Great Lakes Restoration Initiative (GLRI) 16. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. **Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 17. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System 5 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001205 (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 18. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-disease-reporting-table.html. 19. For activity IV (e), what is NORS looking for in terms of data completeness? For example, a jurisdiction is entering all details for all foodborne, waterborne, animal contact, and environmental outbreaks but only those “P-t-P” outbreaks for which there is decent data. Would they rather have all “P-t-P” outbreaks even if the data quality is lower for the majority of those? Only five variables are required to report an outbreak in NORS: the state-assigned outbreak ID (or state ID), date first ill, estimated number of primary ill, state of exposure, and the primary mode of transmission. We encourage all states to report all foodborne, waterborne, and other enteric illness outbreaks even if that is all the information available to them. We strongly encourage additional information to be reported if available but we fully recognize that state and local health departments may not have access to detailed information for all outbreaks. Measures listed in Section F, pages 123124, might be helpful for reporting sites that are trying to prioritize improvements related to outbreak reporting completeness. These pages describe the measures that CDC NORS staff will be calculating and providing back to each reporting site next year. This includes targets for the number of finalized outbreaks per 1,000,000 persons per year by each mode of transmission, and measures of completeness for specific areas of the NORS forms (e.g., case characteristics, etiology, setting information). 20. For activity IV (e), what does environmental contamination mean? Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). 21. For activity IV (e.iii), what does preventative measures refer to? This refers to the prevention measure question in the animal contact section (pg. 4 of the NORS 52.13 form) which asks states to report any prevention measures or recommendations (e.g., handwashing) that were used to help stop the outbreak and prevent additional infections. **Activity IX: Advance electronic information exchange implementation (p 107) 22. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? 6 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001206 The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 23. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. 24. For activity IX(b. iv) page 107, for cryptosporidiosis, does this mean we should transmit data for all cases submitted for subtyping, then outbreak-associated cases, then sporadic cases? Or does it mean all cases submitted for subtyping AND outbreak-associated cases, then sporadic cases? The second example is the intended activity; if HL7 transmission is not feasible then please assess feasibility to send electronic data following this prioritization: 1) each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet AND for each outbreak-associated case 2) sporadic cases for which a Cryptosporidium specimen has not been submitted to CryptoNet. **Activity X: Implement health promotion strategies 25. For activity X (a and b) page 107-108, these aren't really in the day-to-day responsibilities for food and waterborne epidemiologists. Is the expectation that epidemiology staff should be doing this, or should we be reporting on meeting with our communications teams to achieve these goals? The intention is to be working with health communications group to make sure that food and water prevention messages are available to their constituents. Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. 26. For activity X (d) page 108, we're aware of the MAHC and reference it on occasion, we rely heavily on EH partners to implement the details. Should we report here on partnerships with EH or are we expected to spend more time on this? Reporting on partnerships with EH on the MAHC is acceptable. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. 7 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001207 **Environmental Microbiology 1. For activity XIX (a.i), p111 and XX (a.i), p112, would it be acceptable to respond with environmental testing for Legionella here? What are some of the other environmental waterborne diseases to test for under each of these activities? Legionella sampling alone is not sufficient to meet this strategy. Legionella testing activities are included in other sections of the NOFO. The Section F, Tier 2: Environmental Microbiology activities cover other waterborne infections. Our most common pathogens for environmental testing are Cryptosporidium, E. coli, and Norovirus, though there are others that could fall under this strategy. FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks 8 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001208 that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #16 for more information about how to apply for GLRI funding). Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 4. What are the minimum activities for a CoE? 9 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001209 Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate 10 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001210 the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. 11 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001211 o Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). 6. Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). 7. Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. 8. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. 9. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children 12 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001212 • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 13 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001213 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-001214 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-001215 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-001216 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-001217 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-001218 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-001219 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-001220 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-001221 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-001222 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-001223 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-001224 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001225 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001226 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001227 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-001228 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-001229 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-001230 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-001231 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-001232 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-001233 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-001234 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-001235 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-001236 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-001237 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-001238 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-001239 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-001240 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-001241 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-001242 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-001243 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-001244 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-001245 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-001246 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-001247 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001248 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001249 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001250 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-001251 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-001252 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-001253 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-001254 Interim Guidance for Whole Genome Se uencin of HAl7AR Patho ens Supplemental guidance includes: 1. Priorities: Selection of isolates for sequencing 2. Platforms: lllumina MiSeq (paired-end) for all sequencing; other lllumina platforms that can produce paired-end reads are acceptable 3. Protocols: Please refer to protocols used for PulseNet. Job aids and best practices for additional technical assistance (i.e., Gram positives, Pseudomonas, etc.) will be available 4. Sequence Data Quality Metrics and Processing: QuAISAR-H pipeline provide an easy, all-in-one tool for initial processing and analyses of raw sequence data 5. Data Sharing Methods: Multiple avenues to accommodate 6. Posting to NCBI: DHQP-hosted umbrella "CDC HAI-Seq"; include SRA number in LIMS as link to WGS data 7. Metadata Guidelines: Non-identifiable isolate information different systems and capacities will accompany sequence data TX-DSHS-19-1309-A-001255 Priorities for Sequencing at State/Local/Regional Labs   Untenable to sequence every HAI or MDRO pathogen Priorities for sequencing are as follows: 1. Sequencing that supports outbreak investigations (CRE, CRPA CRAB) 2. All CRAB isolates 3. CRE and CRPA that may carry novel carbapenemase genes • Carbapenemase-producing (e.g., mCIM- or CarbaNP-positive) but PCR negative for KPC, NDM, OXA-48-like, VIM, and IMP • Note: Exclude isolates with resistance profiles that explain carbapenemase production – Enterobacter that are cefotaxime, ceftriaxone, and ceftazidime resistant but cefepime susceptible (indicates high levels of AmpC beta-lactamase) – Serratia that are resistant to carbapenems and susceptible to 3rd generation cephalosporins (indicates presence of SME gene) 4. Non-KPC isolates • Resistance to any beta-lactam above meropenem (e.g., aztreonam-avibactam; ceftazadime-avibactam; meropenem-vabrobactam) unless AST and RT-PCR suggest KPC TX-DSHS-19-1309-A-001256 Platforms  State and local public health labs should use the Illumina MiSeq (pairedend) for all sequencing.  Other Illumina platforms that can produce paired-end reads are acceptable. TX-DSHS-19-1309-A-001257 Protocols   Please refer to protocols used for PulseNet (with minor exceptions – see below) (https://www.cdc.gov/pulsenet/pdf/PNL32-MiSeq-Nextera-XT.pdf) Recommended adjustments to protocol – HAI pathogen WGS runs may be of higher diversity than those typically seen for PulseNet activities • Consider a slightly higher phiX spike-in for runs of higher diversity (~2-5% is generally appropriate) – To plan sequencing runs with maximum efficiency and data quality, please use our pooling job-aid calculator tool (forthcoming) – If sites need further technical assistance, (for example, for gram positives) – DHQP is working to provide job aids/best practices • Pseudomonas aeruginosa are difficult to sequence and should be sequestered to their own Pseudomonas-only runs as much as possible. Alternatively, a small number (<5) of Pseudomonas can be included in non-Pseudomonad sequencing runs. • DHQP working on a QMS version of a calculator tool for planning sequencing runs of diverse organisms and other job aids TX-DSHS-19-1309-A-001258 Sequence Quality Metrics and Processing: QuAISAR-H Pipeline  Pipeline for Quality control, Assembly, species Identification, Sequence typing, Annotation, and Resistance mechanisms for Healthcare-associated pathogens  Automates routine evaluation and provides an easy, all-in-one tool for initial processing and analyses of raw sequence data  Available for sites that want to run it locally – Command line available now – GUI-like application on CDC AMD Portal currently in beta-testing • Available to external partners via SAMS credentialing TX-DSHS-19-1309-A-001259 QuAISAR-H Pipeline       QuAISAR-H iX, Quality control steps trim reads, remove PhiX, check for contaminants using two bioinformatics tools, Kraken and Gotcha Genomes are assembled by SPAdes Classified using publically available MLST schemes Annotated using Prokka Species verified with Average Nucleotide Identity Antimicrobial resistance genes are identifiedd using c-SSTAR to apply non-redundant ResFinder and ARG-ANNOT databases ( C Trimmomatic Assesment Kraken ( SRST2 ) Gottcha ) SPAdes plasmidSPAdes ( Kraken ) Trim contigs Trim contigs ( C-SSTAR ) )-----1 ( plasmid Finder, ___ 16s1D) ___. ~ QUality control Assembly Identification plasmid Finder ( BUSCO) Resistance mechanisms Healthcare TX-DSHS-19-1309-A-001260 Sequence Quality Metrics    Quality Metrics – Aim for 60X coverage • No lower than 40X (quality concerns) • No higher than 100X (cost, more than quality concerns) – Species ID should match expected ID from traditional laboratory methods, using QuAISAR-H pipeline – 200 contigs or less, using QuAISAR-H pipeline – Assembled genome ratio should be between 0.6-1.4, using QuAISAR-H pipeline To ensure quality metrics are met, sites should send their first sequencing run to DHQP for confirmation before proceeding with further sequencing Note: Data must pass quality checks prior to uploading to NCBI TX-DSHS-19-1309-A-001261 Data Sharing  All WGS data will be shared by states with DHQP for centralized analyses  Options for sharing data directly with DHQP – BaseSpace – Secure CDC Sharefile (similar to Box) – MMB secure FTP – Additional options under consideration  Working toward developing capacity for direct NCBI upload is important TX-DSHS-19-1309-A-001262 Posting to NCBI    DHQP will host an NCBI umbrella, “CDC HAI-Seq” – For bioprojects and sequence data generated by CDC and other public health laboratories related to healthcare-associated infections – Can include any data format, including raw reads and/or assemblies – Broad BioProjects for NTM, Staph, Cdiff, Gram negatives, etc. For outbreaks: – Delays between the completion of sequencing and submission to CDC/DHQP should be minimized. – Internal analyses by state health departments should not be prioritized if it will compromise the speed with which data are shared with DHQP so that data can be evaluated from across the outbreak. – DHQP will post a representative sample(s) to NCBI as a reference and to support data sharing and improved public health response. Ideally, states communicates NCBI ID (SRA number) to DHQP via LIMS, HL7 messaging, or other mechanism; not spreadsheet/emails TX-DSHS-19-1309-A-001263 Plan for Metadata on NCBI  Setting conservative limits to the metadata included across all HAI/AR activities – Time: Specimen collection year – Type: Specimen type (human, animal, environmental, other) – Location: Specimen collection location (United States) – Source: Specimen source (blood, urine, device, surface, etc.) – Organism: Genus, species – ID: Isolate identifier (unique ID assigned to isolate by organization who sequenced it; cannot be linked readily to original ID without master) • Isolate ID must be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically • Follow CDC guidance for assigning WGS IDs TX-DSHS-19-1309-A-001264 Plan for Metadata on NCBI  Suggested WGS ID (under development) – YYYYLC-00000, where • YYYY=year sequenced • LC = Location code for where sequencing was performed (code assigned by and key retained at DHQP) • 00000=Consecutive numbers assigned by the sequencing lab  Again: Isolate ID should be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically TX-DSHS-19-1309-A-001265 Questions? Alison Laufer Halpin, PhD vif0@cdc.gov Lead, Metagenomics and Molecular Biology, Division of Healthcare Quality Promotion Allison Cory Brown, PhD MPH iyk6@cdc.gov Lead, AR Capacities and Special Studies, Division of Healthcare Quality Promotion For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-001266 2019 Epidemiology and Laboratory Capacity (ELC) Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Frequently Asked Questions Personnel 1. Can jurisdictions ask for more than one FTE or FTE equivalent in Tier 1 if that is what is needed to accomplish Tier 1 activities in our jurisdiction? Yes, you CAN request more than 1.0 FTEto support Tier 1 activities; however, the accompanying narrative must justify that this personnel time is required. To the extent that the same personnel support Tier 2 and/or Tier 3 activities, please indicate this in your narrative and budget request. 2. How do I ask for funding for staff that works on both Tier 1 and Tier 2 activities? If we split their time between tier 1 and tier 2, what happens if I do not get the funding fortier 2? Staff funding is tied to the activities the staff person supports. Under the proposed scenario, if Tier 2 activities are funded, funding for staff supporting those activities could be supported. In contrast, if Tier 2 activities are not funded, funding for staff supporting those activities may not be supported. Please see the answer in #1 of this section as well. 3. I rely on contractors to complete activities. Are they considered the same as FTEs,as noted in your webinar and Q&A document, if they are performing the same activities? Contractors would be considered the same as FTEstaff. 4. Several positions have been historically funded by ELCto complete ELCactivities. Can I still ask for funding for this position in the new competitive cycle? What about historical positions that are currently vacant? Yes, applying for funding to support these positions is appropriate under the new competitive cycle. Budget 1. Is there additional funding attached to tier 2 beyond the $150,000-260,000 range mentioned? The NOFO language is: "In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities." Please clarify this NOFO language. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the NOFO language is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on TX-DSHS-19-1309-A-001267 historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. 2. In regards to preparing two different budgets, one for Tier 1 and one for Tiers 2 and 3, how should we submit this when our capacity is already much higher than just Tier 1? We acknowledge that many jurisdictions may already have vector-borne disease capacity that goes beyond Tier 1. Regardless, please prepare the two budget tabs to differentiate between “core” and “enhanced” VBD capacity and associated funding needs. The Tier 1 tab in the budget should include your needs to be successful in all required Tier 1 activities as applicable to your jurisdiction. Budget needs for additional (optional) enhanced activities beyond Tier 1 should be included in the second budget tab, covering Tiers 2 and 3. 3. Could we submit an application for Tier 2 or Tier 3 activities in future budget period years? Will we be able to apply for it later if we do not ask for it now? Yes, you will have the opportunity in future years to request funding for Tier 2 and 3 activities even if you do not apply for them this year. 4. The Webinar mentioned preparing a budget for one year. In our narrative, are we writing for 1-year, or laying out plans for the 5-year period? Your work plans should reflect your plans for the year one budget period only. 5. My jurisdiction has staff positions funded from the Zika supplemental. We would like to keep these positions for this next competitive ELC cycle since they are essential to our vectorborne disease program. How do we do this? Applying for funding to support these positions is appropriate under the new competitive cycle. As the positions described in this scenario were funded using supplemental funding in previous years, we cannot guarantee these positions will be supported under this new competitive cycle for ELC. Work Plan 1. Are the tier 2 and 3 activities likely to be maintained past one year, i.e. should we submit budgets for these activities for one year or multi-year? Yes – these are likely to be maintained past year 1. Please only propose one year of funding for the first budget period. Epidemiology 1. Can you explain activity “identify and report non-nationally notifiable VBD cases to CDC”? If non-nationally notifiable diseases are captured in the state, how are these reported to ArboNET? Is it the same mechanism? Non-notifiable arboviruses are reported to ArboNET using the same mechanism for notifiable diseases. Please see the Table 1 at the end of the FAQ for a list of notifiable and non-notifiable TX-DSHS-19-1309-A-001268 arboviral disease conditions. For non-arboviral conditions, please contact the respective point of contract listed in the Program H guidance. Laboratory 1. How much detail would you like on the supply line? For example, if we are asking for PPE or PCR Reagents – how specific should we be? Please associate supplies with a specific test or activity where possible, e.g. “PCR reagents for arboviral testing” or “PPE for tick surveillance activities.” 2. My jurisdiction is interested in becoming a regional reference lab for testing. Are we allowed to do outreach to other states to see if they have a need? Are we allowed to share our letters of support to DVBD during this application period? In this scenario, it is up to the jurisdiction to determine if and how they would do outreach to other states to gain support. Unfortunately, we have no mechanism to accept letters of support for this application. Jurisdictions could note established collaborations or memorandums of understanding with other jurisdictions in the narratives sections. 3. How should collaborations with universities be handled to make sure that they are not crossing the line of “research.” If ELC is strictly non-research, what activities with universities are expected and encouraged? As you likely know, CDC cannot fund research activities under the ELC cooperative agreement. However, CDCs Vector-Borne Program does support a domestic research program through other funding opportunities, including under the Emerging Infections Program and the VectorBorne Disease Centers of Excellence cooperative agreements. In certain situations, jurisdiction staff can participate in CDC or other funded research activities if their time is not fully funded by ELC. For example, if laboratory staff are funded 50% by ELC and 50% by other sources, they may be able to support collaborative research under the 50% time covered by other support. Additionally, ELC-funded staff could collaborate with partners to help determine and prioritize research needs, participate in trainings, or host fellowship or graduate students. 4. Can we request support for maintenance agreements for laboratory equipment? Yes, requesting support maintenance agreements for laboratory equipment is appropriate if the equipment supports testing for vector-borne diseases. Cost-sharing measures should be used if the maintenance agreement supports testing for other programs as well. Ecology 1. Can you please clarify the difference between ArboNET and MosquitoNET reporting CDC collects mosquito data in two systems, ArboNET and MosquitoNET. These systems collect different information (reporting to MosquitoNET does not replace reporting to ArboNET). • ArboNET: Reports of mosquito pools testing positive for arboviruses by county and date of collection (also called numerator data). Can also report county level data for numbers of mosquitoes collected and tested weekly by species (also called denominator data). TX-DSHS-19-1309-A-001269 • MosquitoNET: Detailed mosquito abundance data by specific geographic coordinates. MosquitoNET now covers all mosquito species. We are primarily interested in jurisdictions submitting surveillance data for all medically important mosquitoes. Reporting of nuisance mosquitoes is optional. The system is also used to report insecticide resistance testing results. 2. If we request funding for some ecological surveillance activities, can we then subcontract local vector control districts or a university group to do them? Yes, subcontracting to local vector-control districts or universities is acceptable. 3. Can you clarify the difference between “passive” (Tier 1) and “active” (Tier 2) surveillance for vectors? We make the following definitions regarding passive Tier 1 surveillance and active Tier 2 vector surveillance. • Passive: entomological surveillance activities already occurring in your jurisdiction, but not performed or coordinated by you. Examples could include, universities, or other state agencies, e.g. agriculture or veterinary agencies • Active: entomological surveillance activities performed or coordinated by you. This could include collaborations with universities or local health departments/vector control agencies, or subcontracted to an outside group. 4. Will CDC support funding for tick surveillance of Dermacentor or other non-Ixodes tick species? Tick surveillance requests that relate to Ixodes species and align with the new surveillance guidance will be prioritized over other non-Ixodes tick surveillance funding requests. 5. If a jurisdiction passively receives vectors from partners, but actively conducts pathogen testing at their public health laboratory, where would this jurisdiction submit their activity request – in Tier 1 or Tier 2? Under this scenario, this activity would be consider Tier 2 if receiving mosquitoes for testing at the jurisdiction laboratory and Tier 3 if performing pathogen testing in ticks. 6. My jurisdiction currently sends collected ticks to CDC for pathogen testing. Which activity would this best align? We consider sending ticks to CDC for pathogen testing a Tier 2 activity. It best aligns with NOFO Strategy 1c, c) Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET). TX-DSHS-19-1309-A-001270 Table 1: Arboviral Condition Codes Condition Code Condition Name Nationally Notifiable 10058 Cache Valley virus disease, neuroinvasive No 10066 Cache Valley virus disease, non-neuroinvasive No 11718 California encephalitis virus disease Yes 10054 California serogroup virus diseases, neuroinvasive Yes 10061 California serogroup virus diseases, non-neuroinvasive Yes 10073 Chikungunya virus diseases Yes 10093 Colorado tick fever virus disease No 10680 Dengue Yes 11705 Dengue, severe Yes 11704 Dengue-like illness Yes 10053 Eastern equine encephalitis virus disease, neuroinvasive Yes 10062 Eastern equine encephalitis virus disease, non-neuroinvasive Yes 50237 Flavivirus disease, not otherwise specified No 10078 Jamestown Canyon virus disease, neuroinvasive Yes 10079 Jamestown Canyon virus disease, non-neuroinvasive Yes 10059 Japanese encephalitis virus disease, neuroinvasive No 10068 Japanese encephalitis virus disease, non-neuroinvasive No 11712 Keystone virus disease Yes 10081 La Crosse virus disease, neuroinvasive Yes 10082 La Crosse virus disease, non-neuroinvasive Yes 10072 Other arboviral disease, not otherwise specified (Alkhurma virus, Barmah Forest virus, Bourbon virus, Heartland virus, Highlands J virus, Kyasanur Forest virus, Mayaro virus, Murray Valley encephalitis virus, O'nyong-nyong virus, Oropouche virus, Rift Valley Fever virus, Rocio virus, Ross River virus, Sindbis virus, Tahyna virus, Toscana virus, Usutu virus, Other Arbovirus) No 10057 Powassan virus disease, neuroinvasive Yes 10063 Powassan virus disease, non-neuroinvasive Yes 11734 Snowshoe hare virus disease Yes 10051 St. Louis encephalitis virus disease, neuroinvasive Yes 10064 St. Louis encephalitis virus disease, non-neuroinvasive Yes 10074 Tick-borne encephalitis viruses No 11724 Trivittatus virus disease Yes 10055 Venezuelan equine encephalitis virus neuroinvasive disease No 10067 Venezuelan equine encephalitis virus non-neuroinvasive disease No 10056 West Nile virus disease, neuroinvasive Yes 10049 West Nile virus disease, non-neuroinvasive Yes 10052 Western equine encephalitis virus disease, neuroinvasive Yes 10065 Western equine encephalitis virus disease, non-neuroinvasive Yes 10660 Yellow fever Yes 50224 Zika virus disease, congenital Yes 50223 Zika virus disease, non-congenital Yes TX-DSHS-19-1309-A-001271 50222 Zika virus infection, congenital Yes 50221 Zika virus infection, non-congenital Yes TX-DSHS-19-1309-A-001272 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-001273 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. TX-DSHS-19-1309-A-001274 From: ZIKApregnancy (CDC) Sent: Monday, April 01, 2019 11:15 AM EDT To: Yowe-Conley, Tineka (CDC/DDNID/NCBDDD/DCDD) ; King, Kellianne M. (CDC/DDNID/NCBDDD/DCDD) (CTR) ; Reynolds, Megan (CDC/DDNID/NCBDDD/DCDD) ; Baez Santiago, Madelyn (CDC/DDNID/NCBDDD/DCDD) (CTR) Subject: Updated supplementary ELC information 4_1_2019 Attachment(s): "CK19-1904_ Webinar for Project W_FINAL.pdf","Supplementary Information for ELC FY 2019_v2.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning Jurisdictional Partners, We have updated information from ELC that we would like to share with you. On Friday, we emailed the presentation slides for Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” webinar that occurred on March 28. Please disregard those slides and refer to the correct version attached in this email. We also plan to share the recording of this webinar to our partners once it becomes available. ELC also updated their supplementary information for applying to 2019 Notice of Funding opportunity, which is included as an attachment as well. If you have any questions regarding any of these items, please reach out to ELC atELC@cdc.gov. As a reminder, the deadline to submit your completed application is Friday, May 10, 2019 at 11:59pm ET. Best Regards, Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities ZIKApregnancy@cdc.gov TX-DSHS-19-1309-A-001275 National Center on Birth Defects and Developmental Disabilities Overview of 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904: Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats March 2019 TX-DSHS-19-1309-A-001276 Agenda I Overview of the Project I Next Steps I Questions and Answers W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Managed and funded by CDC’s National Center on Birth Defects and Developmental Disabilities (NCBDDD), Division of Congenital and Developmental Disorders (DCDD) TX-DSHS-19-1309-A-001278 Funding Strategy ■ Estimated Number of Awards: 4- 9 ■ Estimated Award Amounts: $200,000 and $425,000 ■ Estimated Average Award Amount: $320,000 Utilize Funding For: ■ Personnel - (e.g., A Jurisdictional-Level Coordinator) ■ Travel ■ Equipment ■ Supplies ■ Contractual Support TX-DSHS-19-1309-A-001279 Award Criteria ■ Quality of Application ■ Number of Births Per Year ■ Estimates of Exposure to Emerging Infections and Other Infectious Disease Threats ■ Public Health Importance of the Emerging Health Threat ■ Prior ELC-funded work on the US Zika Pregnancy and Infant Registry is not a requirement for funding consideration Reminder: This ELCNOFO is for non-research projects and research projects will not be considered or funded TX-DSHS-19-1309-A-001280 Supplementary Information      A Comparison of ELC NOFOs Application Development Tips Submission Process and Tools Materials from the ELC Kick-off and Budget Webinars Frequently Asked Questions (FAQs) – Project W: Pages 85–86 TX-DSHS-19-1309-A-001281 Objectives and Supported Activities ■ USZPIR Databases (Utilize and/or Adapt) NOTE:Applications can AddressZika AND/OR Other EmergingInfectious Disease ■ Collaborate with State, Local, and Territorial Health Departments ■ Work with Clinical Experts and Clinical Professional ■ Develop and Disseminate Clinical Guidance and Health Communications Materials TX-DSHS-19-1309-A-001282 Surveillance Model to Monitor Emerging Infectious Disease Identify emerging infectious diseases Use surveillance system to monitor effects of threat among pregnant women and infants Collect information on poor health effects during pregnancy to identify which outcomes to monitor Infant follow up surveillance to collect information about babies Ensure followup of children and screenings as information emerges Use data to develop recommendations to inform public health action and to plan for services needed by families affected by an emerging infectious disease TX-DSHS-19-1309-A-001283 Strategies and Activities ■ Project W will Address 2 of the 3 Core Strategies Area A: Surveillance, Detection and Response • Enhanced Workplace Capacity • Enhanced Case Investigations • Improved Surveillance • Strengthened Partnerships and Collaborations • Advanced Innovative IT Strategies Area C: Communications, Coordination and Partnerships • Information Sharing and Collaboration TX-DSHS-19-1309-A-001284 Outcomes ■ Improve Epidemiological Capacity ■ Improve Completeness and Timeliness of Reporting ■ Improve Monitoring of Infants and Children ■ Translation of Public Health Data TX-DSHS-19-1309-A-001285 Evaluation and Performance Measurement ■ Outcome Measures will be Based on: - Proportion of Cases Among Infants - Completeness of Reporting of Variables TX-DSHS-19-1309-A-001286 Collaborations ■ National Center on Birth Defects and Developmental (NCBDDD) ■ State, local and territorial ■ American Academy of Pediatrics (AAP) ■ American College of Obstetricians ■ American Board of Obstetrics and Gynecology (ABOG) ■ Society for Maternal ■ American Nurses Association (ANA) ■ Association of Clinical Nurse Midwives (ACNM) ■ Other Professional Groups Disabilities Health Departments and Gynecologists (ACOG) Fetal Medicine (SMFM) TX-DSHS-19-1309-A-001287 Next Steps ■ Coordinate your Proposal ■ Awareness of Internal Deadlines TX-DSHS-19-1309-A-001288 A Session Additional Questions?     Q/A Document Contact your ELC PI Project W Main POC: Tineka Yowe-Conley, MPA (tay7@cdc.gov) Other Contacts: – Dana Meaney-Delman, MD, MPH, FACOG (vmo0@cdc.gov) Chief, Prevention Research and Translation Branch – Nicole Fehrenbach, MPP (ekk5@cdc.gov) Deputy, Division of Congenital and Developmental Disorders – Peggy Honein, PHD, MPH (mrh7@cdc.gov) Director, Division of Congenital and Developmental Disorders For general questions, please send your email to the ELC mailbox (ELC@cdc.gov) TX-DSHS-19-1309-A-001290 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) March 2019 VERSION 2 TX-DSHS-19-1309-A-001291 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 19 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 20 ELC Data Management Plan (DMP) Checklist ......................................................................................... 21 5. Submission Process ................................................................................................................................. 23 Submission Checklist ............................................................................................................................... 23 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 23 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 28 7. Program-Specific Frequently Asked Questions and Guidance.................................................................... Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance................................................... Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond .................................................................................................................................. Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-001292 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Yellow highlighted sections are new additions to this document, since the first version was shared on March 21, 2019. Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-001293 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-001294 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 19-1904 CK 14-1401 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-001295 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-001296 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-001297 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-001298 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-001299 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-001300 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-001301 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-001302 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-001303 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Three other related programs and projectsin this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases • G. Hospital-acquired infections and antimicrobial resistance • O. Vaccine preventable diseases To simplify the application process, for those three specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-001304 through the program-specific activity (i.e., Activity F, G, or O); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those three activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. H. Vector-borne Diseases (p. 156) Clarification to text found in the Funding Strategy section (p.157). The third bullet states: • Estimated average award amount: Approximately $266,000. The average award will depend upon the project activities (tiers) in which a jurisdiction participates. In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities. These jurisdictions must document capacity at lower tiers to be granted higher tier funding. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the text is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-001305 support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. I. Mycotics: Detecting and Preventing Fungal Infections (p. 167) Supplementary guidance was provided via webinar to applicants on March 28, 2019. Webinar slides are located in ELC’s REDCap file repository. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-001306 • expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this • Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. o Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-001307     Prepare a report identifying the populations and outlining strategies to improve coverage. Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities. Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks. Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission. Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. • Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-001308 of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-001309 • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-001310 ELC Data Management Plan (DMP) Checklist While the Data Management Plan requirements in the 2019 ELC NOFO specifically pertains to collection of public health data related to ELC-funded activities, we strongly encourage that efforts be made to make the DMPs as complete as possible. 1. Description of ELC Data - Describe types of data collected (e.g., performance measure data, financial data, success stories). Things to think about: • What data will be generated through programmatic activities? • What data types will you be creating or capturing? • How will you capture or create the data? • If you will be using existing data, how will you acquire it? 2. Period of data retention - Describe plans for archiving data or explanation of why that is not necessary. Things to think about: • How long will the data collector retain the right to use the data before opening it up to wider use? • Explain details regarding data retention periods. 3. Data format – Describe general data formatting standards. Things to think about: • Which file formats will you use for your data, and why? • What transformations to more shareable formats will be necessary to prepare data for preservation and/or data sharing? • What contextual details (metadata) are needed to make the data you capture or collect meaningful? • How will you create or capture these details? 4. Data dissemination – Describe how data will be disseminated and how other parties gain access. Things to think about: • How and when will you make the data available after data collection? (Include the resources needed to make the data available: equipment, systems, expertise, etc.) • Who gets access to data specifically? • How will data are to be shared and managed with partners and other major stakeholders? • What other types of information should be shared regarding the data, e.g., the way it was generated, analytical and procedural, information? • What is the process for gaining access to the data? • Will any permission restrictions need to be placed on the data? • Are there ethical and privacy issues? If so, how will these be resolved? • How will you manage data with sensitive information? Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-001311 5. Data storage and preservation of access – Describe long-term strategy for storing, archiving and preserving data. Things to think about: • What is the long-term strategy for maintaining, curating and archiving the data? • Which archive/repository/database have you identified as a place to deposit data? • How long will/should data be kept beyond the life of the budget/project period? • What data will be preserved for the long-term and why? • What documentation will be submitted alongside the data or created for archival in order to make the data reusable? Centers for Disease Control and Prevention 22 TX-DSHS-19-1309-A-001312 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 23 TX-DSHS-19-1309-A-001313 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method will be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDFfrom .Eile... ~ PDF from .S.canner f'~ PDFfrom Web Page... Saveas Otner EJcporlTo Shift+Ctr l+O f'e,PDFfrom .Clipboard ~ J.!➔..I ~:!!I Combine Filesinto a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF£ortfolio ... ~ udget.pdf PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001314 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF,click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-001316 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.pdl ~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.pdf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDF and save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001317 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q: Where can I locate the FY19 NOFO? A: The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A: The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A: The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q: What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: AwardsMade ELC NOFO Published Budget Webinar Appl ications Due 2014-20 18 Closeout Report & 2018 Perform ance Measures Due ELC Kick-Off Webi nar Feb 28 2019 HAI/AR Perform ance Measures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toRrnca y Aue 1 Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-001318 Q: What is the application due date? A: The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A: Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q: When should we submit our Close-Out Reports? A: A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-001319 FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q: Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Q: Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q: Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o • Performance measures will NOT be collected with application. o • Enter these narratives on “approach” tab in each template. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-001320 • • • • Therefore, the activities names are hard coded. Work plan details are not pre-populated, as this is the first of a five year period of performance Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q .Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. What are some of the new ELC Budget Template Features? A: There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-001321 funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-001322 A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users - Q. In which program or project should I request support for cross-cutting training and peer-to-peer travel? A. It is recommended that any training/travel request in the budget relates to an activity in the work plan. Travel and training requests made in the Cross-cutting Epi & Lab Program should link to crosscutting outcomes. For trainings and travel specific to a program/project, please include these requests in the specific program/project application template. For the ELC Annual Meeting: • If the request if for the ELC Governance Team members to attend the ELC Annual Meeting, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For specific trainings or conferences, such as CSTE, Public Health Informatics, APHL, etc. • If the request is for cross-cutting epi &/or lab staff travel to travel to a specific conference, it may be requested in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For Peer-to-Peer Site Visits • If the Peer-to-Peer request is for cross-cutting epi &/or lab staff to visit another jurisdiction to either learn or share best practices, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. Submitting Your Applications Questions Q: Where do I submit my completed application? A: Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-001323 Q: Are recipients still required to submit applications to GrantSolutions? A: No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q: How do I gain access to REDCap A: In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Q. What should we submit via REDCap? A: The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q: What resources will be available for recipients to complete applications? A: The ELC will release the following resources to assist recipients with completing and submitting their grant application: Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. Centers for Disease Control and Prevention 34 TX-DSHS-19-1309-A-001324 • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com. Centers for Disease Control and Prevention 35 TX-DSHS-19-1309-A-001325 7. Program-Specific Frequently Asked Questions and Guidance Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 36 TX-DSHS-19-1309-A-001326 2019 ELCSectionF: equentlyAskedQuestio General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE Food Net Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSSEnhanced OHHABSand GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov ; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov ; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvQ2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov ; 404.718.4155) Amy Kirby (agkl@cdc.gov ; 404.718.3161) Mia Mattioli (kuk9@cdc.gov ; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhg5@cdc.gov ; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov ; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814) Jared Reynolds (uvz6@cdc.gov ; 404.639.3519) Erin Stokes (ykt3@cdc.gov ; 404.718.1175) Aron Hall (esg3@cdc.gov ; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evll(a)cdc.gov ; 404.718.4871) Aron Hall (esg3@cdc.gov ; 404.639.1869) Virginia Roberts (evll@cdc.gov ; 404.718.4871) Jonathan Yoder (jey9@cdc.gov ; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov ; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov ; 404.639.0704 ), Efrain Ribot (eyr4@cdc.gov ; 404.639.3521) Template-related questions 1. What happened to the 'other' option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an 'other' option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELCNOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001327 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 3. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 4. What we if have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001328 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity (p 100-101) 5. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. **HL7 Transmission of case surveillance data 6. Variations of this activity are found in Strategy 1a, Strategy 1c, and Strategy 1h. Can you clarify how we can respond to these? Should they be treated independent of each other, or should be addressed as a unit? Activity I (pages 99-100) addresses integrating data elements into existing surveillance systems and working with informatics staff to enable transmission of data elements. Activity IV (pages 102-103) addresses collecting and transmitting national case surveillance data, but does not specify sending via HL7. Activity IX (page 107) very specifically and in detail describes sending condition-specific data/national case surveillance data via HL7. Strategy 1a is focused on the workforce capacity needed to develop internal capacity for, and complete or continue implementation of HL7 messages for the data elements specified in Generic Version 2 (GenV2) and the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Responses should include identification of any additional staff or training needed to complete the sub-activities listed. Additional staff may include epidemiologists needed to provide temporary capacity during the labor-intensive onboarding process activities. - Strategy 1c is focused on the processes of data collection, reporting, and data cleaning, independent of the data transmission method. Responses for part B should include descriptions of the questionnaires, or when no questionnaire is available, the data elements collected for each of the conditions indicated. Additional information for these conditions can be found in Project F Appendix 1. Strategy 1h is focused on advancing and modernizing information exchange. Responses should indicate if the jurisdiction is planning to implement all or a portion of the FDD MMG. If a jurisdiction is not able to implement the entire guide, they are able to subset the guide into 2 four condition sections and implement one section in the budget period. The response should specify which four condition tabs will be implemented. For the remaining four condition tabs the jurisdiction should indicate if electronic tabular format or traditional mechanisms will be used. (Can we somehow reference the previously provided FAQs here as well?) The response should also include activities related to incorporating all condition-specific data elements in the FDD MMG into data management systems. **PulseNet and NARMS Funding 7. Should requests for WGS funding be separated by type or pathogen between PulseNet and NARMS? Requests for WGS personnel, supplies, and equipment for enteric/foodborne pathogens should be combined for PulseNet and NARMS in the Food and Water laboratory capacity budget (F2). It is no longer necessary to specify requests by PulseNet and NARMS, as was done in the previous ELC cycle. Please be sure to continue to requests funds specifically for shipping NARMS routine surveillance and outbreak isolates to CDC for antimicrobial susceptibility testing. 8. How much per isolate should we factor in for sequencing supplies? You should use $125/isolate as an average cost for sequencing supplies. 3 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001329 9. Will PulseNet award funds for serotyping? No, neither PulseNet nor NARMS will provide funds for traditional or molecular serotyping. 10. Will PulseNet fund any PFGE? PulseNet will no longer fund PFGE activities. **Waterborne (General) 11. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 12. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 13. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. - 14. For Activity III (b.iii, page 102), what are some examples of other water related issues? Hurricanes? Flooding? Water-related emergencies like floods or droughts are good examples; health risks that are not necessarily waterborne disease outbreaks. CryptoNet 15. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) 4 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001330 • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) Great Lakes Restoration Initiative (GLRI) 16. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. **Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 17. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System 5 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001331 (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 18. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-disease-reporting-table.html. 19. For activity IV (e), what is NORS looking for in terms of data completeness? For example, a jurisdiction is entering all details for all foodborne, waterborne, animal contact, and environmental outbreaks but only those “P-t-P” outbreaks for which there is decent data. Would they rather have all “P-t-P” outbreaks even if the data quality is lower for the majority of those? Only five variables are required to report an outbreak in NORS: the state-assigned outbreak ID (or state ID), date first ill, estimated number of primary ill, state of exposure, and the primary mode of transmission. We encourage all states to report all foodborne, waterborne, and other enteric illness outbreaks even if that is all the information available to them. We strongly encourage additional information to be reported if available but we fully recognize that state and local health departments may not have access to detailed information for all outbreaks. Measures listed in Section F, pages 123124, might be helpful for reporting sites that are trying to prioritize improvements related to outbreak reporting completeness. These pages describe the measures that CDC NORS staff will be calculating and providing back to each reporting site next year. This includes targets for the number of finalized outbreaks per 1,000,000 persons per year by each mode of transmission, and measures of completeness for specific areas of the NORS forms (e.g., case characteristics, etiology, setting information). 20. For activity IV (e), what does environmental contamination mean? Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). 21. For activity IV (e.iii), what does preventative measures refer to? This refers to the prevention measure question in the animal contact section (pg. 4 of the NORS 52.13 form) which asks states to report any prevention measures or recommendations (e.g., handwashing) that were used to help stop the outbreak and prevent additional infections. **Activity IX: Advance electronic information exchange implementation (p 107) 22. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? 6 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001332 The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 23. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. 24. For activity IX(b. iv) page 107, for cryptosporidiosis, does this mean we should transmit data for all cases submitted for subtyping, then outbreak-associated cases, then sporadic cases? Or does it mean all cases submitted for subtyping AND outbreak-associated cases, then sporadic cases? The second example is the intended activity; if HL7 transmission is not feasible then please assess feasibility to send electronic data following this prioritization: 1) each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet AND for each outbreak-associated case 2) sporadic cases for which a Cryptosporidium specimen has not been submitted to CryptoNet. **Activity X: Implement health promotion strategies 25. For activity X (a and b) page 107-108, these aren't really in the day-to-day responsibilities for food and waterborne epidemiologists. Is the expectation that epidemiology staff should be doing this, or should we be reporting on meeting with our communications teams to achieve these goals? The intention is to be working with health communications group to make sure that food and water prevention messages are available to their constituents. Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. 26. For activity X (d) page 108, we're aware of the MAHC and reference it on occasion, we rely heavily on EH partners to implement the details. Should we report here on partnerships with EH or are we expected to spend more time on this? Reporting on partnerships with EH on the MAHC is acceptable. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. 7 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001333 **Environmental Microbiology 1. For activity XIX (a.i), p111 and XX (a.i), p112, would it be acceptable to respond with environmental testing for Legionella here? What are some of the other environmental waterborne diseases to test for under each of these activities? Legionella sampling alone is not sufficient to meet this strategy. Legionella testing activities are included in other sections of the NOFO. The Section F, Tier 2: Environmental Microbiology activities cover other waterborne infections. Our most common pathogens for environmental testing are Cryptosporidium, E. coli, and Norovirus, though there are others that could fall under this strategy. FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks 8 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001334 that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #16 for more information about how to apply for GLRI funding). Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 4. What are the minimum activities for a CoE? 9 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001335 Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate 10 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001336 the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. 11 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001337 o Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). 6. Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). 7. Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. 8. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. 9. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children 12 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001338 • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 13 ELC NOFO FAQ: Section F (ver. 03/25/2019) TX-DSHS-19-1309-A-001339 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-001340 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-001341 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-001342 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-001343 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-001344 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-001345 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-001346 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-001347 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-001348 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-001349 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-001350 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001351 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001352 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001353 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-001354 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-001355 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-001356 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-001357 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-001358 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-001359 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-001360 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-001361 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-001362 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-001363 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-001364 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-001365 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-001366 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-001367 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-001368 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-001369 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-001370 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-001371 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-001372 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-001373 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001374 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001375 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001376 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-001377 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-001378 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-001379 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-001380 Interim Guidance for Whole Genome Se uencin of HAl7AR Patho ens Supplemental guidance includes: 1. Priorities: Selection of isolates for sequencing 2. Platforms: lllumina MiSeq (paired-end) for all sequencing; other lllumina platforms that can produce paired-end reads are acceptable 3. Protocols: Please refer to protocols used for PulseNet. Job aids and best practices for additional technical assistance (i.e., Gram positives, Pseudomonas, etc.) will be available 4. Sequence Data Quality Metrics and Processing: QuAISAR-H pipeline provide an easy, all-in-one tool for initial processing and analyses of raw sequence data 5. Data Sharing Methods: Multiple avenues to accommodate 6. Posting to NCBI: DHQP-hosted umbrella "CDC HAI-Seq"; include SRA number in LIMS as link to WGS data 7. Metadata Guidelines: Non-identifiable isolate information different systems and capacities will accompany sequence data TX-DSHS-19-1309-A-001381 Priorities for Sequencing at State/Local/Regional Labs   Untenable to sequence every HAI or MDRO pathogen Priorities for sequencing are as follows: 1. Sequencing that supports outbreak investigations (CRE, CRPA CRAB) 2. All CRAB isolates 3. CRE and CRPA that may carry novel carbapenemase genes • Carbapenemase-producing (e.g., mCIM- or CarbaNP-positive) but PCR negative for KPC, NDM, OXA-48-like, VIM, and IMP • Note: Exclude isolates with resistance profiles that explain carbapenemase production – Enterobacter that are cefotaxime, ceftriaxone, and ceftazidime resistant but cefepime susceptible (indicates high levels of AmpC beta-lactamase) – Serratia that are resistant to carbapenems and susceptible to 3rd generation cephalosporins (indicates presence of SME gene) 4. Non-KPC isolates • Resistance to any beta-lactam above meropenem (e.g., aztreonam-avibactam; ceftazadime-avibactam; meropenem-vabrobactam) unless AST and RT-PCR suggest KPC TX-DSHS-19-1309-A-001382 Platforms  State and local public health labs should use the Illumina MiSeq (pairedend) for all sequencing.  Other Illumina platforms that can produce paired-end reads are acceptable. TX-DSHS-19-1309-A-001383 Protocols   Please refer to protocols used for PulseNet (with minor exceptions – see below) (https://www.cdc.gov/pulsenet/pdf/PNL32-MiSeq-Nextera-XT.pdf) Recommended adjustments to protocol – HAI pathogen WGS runs may be of higher diversity than those typically seen for PulseNet activities • Consider a slightly higher phiX spike-in for runs of higher diversity (~2-5% is generally appropriate) – To plan sequencing runs with maximum efficiency and data quality, please use our pooling job-aid calculator tool (forthcoming) – If sites need further technical assistance, (for example, for gram positives) – DHQP is working to provide job aids/best practices • Pseudomonas aeruginosa are difficult to sequence and should be sequestered to their own Pseudomonas-only runs as much as possible. Alternatively, a small number (<5) of Pseudomonas can be included in non-Pseudomonad sequencing runs. • DHQP working on a QMS version of a calculator tool for planning sequencing runs of diverse organisms and other job aids TX-DSHS-19-1309-A-001384 Sequence Quality Metrics and Processing: QuAISAR-H Pipeline  Pipeline for Quality control, Assembly, species Identification, Sequence typing, Annotation, and Resistance mechanisms for Healthcare-associated pathogens  Automates routine evaluation and provides an easy, all-in-one tool for initial processing and analyses of raw sequence data  Available for sites that want to run it locally – Command line available now – GUI-like application on CDC AMD Portal currently in beta-testing • Available to external partners via SAMS credentialing TX-DSHS-19-1309-A-001385 QuAISAR-H Pipeline       QuAISAR-H iX, Quality control steps trim reads, remove PhiX, check for contaminants using two bioinformatics tools, Kraken and Gotcha Genomes are assembled by SPAdes Classified using publically available MLST schemes Annotated using Prokka Species verified with Average Nucleotide Identity Antimicrobial resistance genes are identifiedd using c-SSTAR to apply non-redundant ResFinder and ARG-ANNOT databases ( C Trimmomatic Assesment Kraken ( SRST2 ) Gottcha ) SPAdes plasmidSPAdes ( Kraken ) Trim contigs Trim contigs ( C-SSTAR ) )-----1 ( plasmid Finder, ___ 16s1D) ___. ~ QUality control Assembly Identification plasmid Finder ( BUSCO) Resistance mechanisms Healthcare TX-DSHS-19-1309-A-001386 Sequence Quality Metrics    Quality Metrics – Aim for 60X coverage • No lower than 40X (quality concerns) • No higher than 100X (cost, more than quality concerns) – Species ID should match expected ID from traditional laboratory methods, using QuAISAR-H pipeline – 200 contigs or less, using QuAISAR-H pipeline – Assembled genome ratio should be between 0.6-1.4, using QuAISAR-H pipeline To ensure quality metrics are met, sites should send their first sequencing run to DHQP for confirmation before proceeding with further sequencing Note: Data must pass quality checks prior to uploading to NCBI TX-DSHS-19-1309-A-001387 Data Sharing  All WGS data will be shared by states with DHQP for centralized analyses  Options for sharing data directly with DHQP – BaseSpace – Secure CDC Sharefile (similar to Box) – MMB secure FTP – Additional options under consideration  Working toward developing capacity for direct NCBI upload is important TX-DSHS-19-1309-A-001388 Posting to NCBI    DHQP will host an NCBI umbrella, “CDC HAI-Seq” – For bioprojects and sequence data generated by CDC and other public health laboratories related to healthcare-associated infections – Can include any data format, including raw reads and/or assemblies – Broad BioProjects for NTM, Staph, Cdiff, Gram negatives, etc. For outbreaks: – Delays between the completion of sequencing and submission to CDC/DHQP should be minimized. – Internal analyses by state health departments should not be prioritized if it will compromise the speed with which data are shared with DHQP so that data can be evaluated from across the outbreak. – DHQP will post a representative sample(s) to NCBI as a reference and to support data sharing and improved public health response. Ideally, states communicates NCBI ID (SRA number) to DHQP via LIMS, HL7 messaging, or other mechanism; not spreadsheet/emails TX-DSHS-19-1309-A-001389 Plan for Metadata on NCBI  Setting conservative limits to the metadata included across all HAI/AR activities – Time: Specimen collection year – Type: Specimen type (human, animal, environmental, other) – Location: Specimen collection location (United States) – Source: Specimen source (blood, urine, device, surface, etc.) – Organism: Genus, species – ID: Isolate identifier (unique ID assigned to isolate by organization who sequenced it; cannot be linked readily to original ID without master) • Isolate ID must be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically • Follow CDC guidance for assigning WGS IDs TX-DSHS-19-1309-A-001390 Plan for Metadata on NCBI  Suggested WGS ID (under development) – YYYYLC-00000, where • YYYY=year sequenced • LC = Location code for where sequencing was performed (code assigned by and key retained at DHQP) • 00000=Consecutive numbers assigned by the sequencing lab  Again: Isolate ID should be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically TX-DSHS-19-1309-A-001391 Questions? Alison Laufer Halpin, PhD vif0@cdc.gov Lead, Metagenomics and Molecular Biology, Division of Healthcare Quality Promotion Allison Cory Brown, PhD MPH iyk6@cdc.gov Lead, AR Capacities and Special Studies, Division of Healthcare Quality Promotion For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-001392 2019 Epidemiology and Laboratory Capacity (ELC) Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Frequently Asked Questions Personnel 1. Can jurisdictions ask for more than one FTE or FTE equivalent in Tier 1 if that is what is needed to accomplish Tier 1 activities in our jurisdiction? Yes, you CAN request more than 1.0 FTEto support Tier 1 activities; however, the accompanying narrative must justify that this personnel time is required. To the extent that the same personnel support Tier 2 and/or Tier 3 activities, please indicate this in your narrative and budget request. 2. How do I ask for funding for staff that works on both Tier 1 and Tier 2 activities? If we split their time between tier 1 and tier 2, what happens if I do not get the funding fortier 2? Staff funding is tied to the activities the staff person supports. Under the proposed scenario, if Tier 2 activities are funded, funding for staff supporting those activities could be supported. In contrast, if Tier 2 activities are not funded, funding for staff supporting those activities may not be supported. Please see the answer in #1 of this section as well. 3. I rely on contractors to complete activities. Are they considered the same as FTEs,as noted in your webinar and Q&A document, if they are performing the same activities? Contractors would be considered the same as FTEstaff. 4. Several positions have been historically funded by ELCto complete ELCactivities. Can I still ask for funding for this position in the new competitive cycle? What about historical positions that are currently vacant? Yes, applying for funding to support these positions is appropriate under the new competitive cycle. Budget 1. Is there additional funding attached to tier 2 beyond the $150,000-260,000 range mentioned? The NOFO language is: "In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities." Please clarify this NOFO language. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the NOFO language is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on TX-DSHS-19-1309-A-001393 historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. 2. In regards to preparing two different budgets, one for Tier 1 and one for Tiers 2 and 3, how should we submit this when our capacity is already much higher than just Tier 1? We acknowledge that many jurisdictions may already have vector-borne disease capacity that goes beyond Tier 1. Regardless, please prepare the two budget tabs to differentiate between “core” and “enhanced” VBD capacity and associated funding needs. The Tier 1 tab in the budget should include your needs to be successful in all required Tier 1 activities as applicable to your jurisdiction. Budget needs for additional (optional) enhanced activities beyond Tier 1 should be included in the second budget tab, covering Tiers 2 and 3. 3. Could we submit an application for Tier 2 or Tier 3 activities in future budget period years? Will we be able to apply for it later if we do not ask for it now? Yes, you will have the opportunity in future years to request funding for Tier 2 and 3 activities even if you do not apply for them this year. 4. The Webinar mentioned preparing a budget for one year. In our narrative, are we writing for 1-year, or laying out plans for the 5-year period? Your work plans should reflect your plans for the year one budget period only. 5. My jurisdiction has staff positions funded from the Zika supplemental. We would like to keep these positions for this next competitive ELC cycle since they are essential to our vectorborne disease program. How do we do this? Applying for funding to support these positions is appropriate under the new competitive cycle. As the positions described in this scenario were funded using supplemental funding in previous years, we cannot guarantee these positions will be supported under this new competitive cycle for ELC. Work Plan 1. Are the tier 2 and 3 activities likely to be maintained past one year, i.e. should we submit budgets for these activities for one year or multi-year? Yes – these are likely to be maintained past year 1. Please only propose one year of funding for the first budget period. Epidemiology 1. Can you explain activity “identify and report non-nationally notifiable VBD cases to CDC”? If non-nationally notifiable diseases are captured in the state, how are these reported to ArboNET? Is it the same mechanism? Non-notifiable arboviruses are reported to ArboNET using the same mechanism for notifiable diseases. Please see the Table 1 at the end of the FAQ for a list of notifiable and non-notifiable TX-DSHS-19-1309-A-001394 arboviral disease conditions. For non-arboviral conditions, please contact the respective point of contract listed in the Program H guidance. Laboratory 1. How much detail would you like on the supply line? For example, if we are asking for PPE or PCR Reagents – how specific should we be? Please associate supplies with a specific test or activity where possible, e.g. “PCR reagents for arboviral testing” or “PPE for tick surveillance activities.” 2. My jurisdiction is interested in becoming a regional reference lab for testing. Are we allowed to do outreach to other states to see if they have a need? Are we allowed to share our letters of support to DVBD during this application period? In this scenario, it is up to the jurisdiction to determine if and how they would do outreach to other states to gain support. Unfortunately, we have no mechanism to accept letters of support for this application. Jurisdictions could note established collaborations or memorandums of understanding with other jurisdictions in the narratives sections. 3. How should collaborations with universities be handled to make sure that they are not crossing the line of “research.” If ELC is strictly non-research, what activities with universities are expected and encouraged? As you likely know, CDC cannot fund research activities under the ELC cooperative agreement. However, CDCs Vector-Borne Program does support a domestic research program through other funding opportunities, including under the Emerging Infections Program and the VectorBorne Disease Centers of Excellence cooperative agreements. In certain situations, jurisdiction staff can participate in CDC or other funded research activities if their time is not fully funded by ELC. For example, if laboratory staff are funded 50% by ELC and 50% by other sources, they may be able to support collaborative research under the 50% time covered by other support. Additionally, ELC-funded staff could collaborate with partners to help determine and prioritize research needs, participate in trainings, or host fellowship or graduate students. 4. Can we request support for maintenance agreements for laboratory equipment? Yes, requesting support maintenance agreements for laboratory equipment is appropriate if the equipment supports testing for vector-borne diseases. Cost-sharing measures should be used if the maintenance agreement supports testing for other programs as well. Ecology 1. Can you please clarify the difference between ArboNET and MosquitoNET reporting CDC collects mosquito data in two systems, ArboNET and MosquitoNET. These systems collect different information (reporting to MosquitoNET does not replace reporting to ArboNET). • ArboNET: Reports of mosquito pools testing positive for arboviruses by county and date of collection (also called numerator data). Can also report county level data for numbers of mosquitoes collected and tested weekly by species (also called denominator data). TX-DSHS-19-1309-A-001395 • MosquitoNET: Detailed mosquito abundance data by specific geographic coordinates. MosquitoNET now covers all mosquito species. We are primarily interested in jurisdictions submitting surveillance data for all medically important mosquitoes. Reporting of nuisance mosquitoes is optional. The system is also used to report insecticide resistance testing results. 2. If we request funding for some ecological surveillance activities, can we then subcontract local vector control districts or a university group to do them? Yes, subcontracting to local vector-control districts or universities is acceptable. 3. Can you clarify the difference between “passive” (Tier 1) and “active” (Tier 2) surveillance for vectors? We make the following definitions regarding passive Tier 1 surveillance and active Tier 2 vector surveillance. • Passive: entomological surveillance activities already occurring in your jurisdiction, but not performed or coordinated by you. Examples could include, universities, or other state agencies, e.g. agriculture or veterinary agencies • Active: entomological surveillance activities performed or coordinated by you. This could include collaborations with universities or local health departments/vector control agencies, or subcontracted to an outside group. 4. Will CDC support funding for tick surveillance of Dermacentor or other non-Ixodes tick species? Tick surveillance requests that relate to Ixodes species and align with the new surveillance guidance will be prioritized over other non-Ixodes tick surveillance funding requests. 5. If a jurisdiction passively receives vectors from partners, but actively conducts pathogen testing at their public health laboratory, where would this jurisdiction submit their activity request – in Tier 1 or Tier 2? Under this scenario, this activity would be consider Tier 2 if receiving mosquitoes for testing at the jurisdiction laboratory and Tier 3 if performing pathogen testing in ticks. 6. My jurisdiction currently sends collected ticks to CDC for pathogen testing. Which activity would this best align? We consider sending ticks to CDC for pathogen testing a Tier 2 activity. It best aligns with NOFO Strategy 1c, c) Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET). TX-DSHS-19-1309-A-001396 Table 1: Arboviral Condition Codes Condition Code Condition Name Nationally Notifiable 10058 Cache Valley virus disease, neuroinvasive No 10066 Cache Valley virus disease, non-neuroinvasive No 11718 California encephalitis virus disease Yes 10054 California serogroup virus diseases, neuroinvasive Yes 10061 California serogroup virus diseases, non-neuroinvasive Yes 10073 Chikungunya virus diseases Yes 10093 Colorado tick fever virus disease No 10680 Dengue Yes 11705 Dengue, severe Yes 11704 Dengue-like illness Yes 10053 Eastern equine encephalitis virus disease, neuroinvasive Yes 10062 Eastern equine encephalitis virus disease, non-neuroinvasive Yes 50237 Flavivirus disease, not otherwise specified No 10078 Jamestown Canyon virus disease, neuroinvasive Yes 10079 Jamestown Canyon virus disease, non-neuroinvasive Yes 10059 Japanese encephalitis virus disease, neuroinvasive No 10068 Japanese encephalitis virus disease, non-neuroinvasive No 11712 Keystone virus disease Yes 10081 La Crosse virus disease, neuroinvasive Yes 10082 La Crosse virus disease, non-neuroinvasive Yes 10072 Other arboviral disease, not otherwise specified (Alkhurma virus, Barmah Forest virus, Bourbon virus, Heartland virus, Highlands J virus, Kyasanur Forest virus, Mayaro virus, Murray Valley encephalitis virus, O'nyong-nyong virus, Oropouche virus, Rift Valley Fever virus, Rocio virus, Ross River virus, Sindbis virus, Tahyna virus, Toscana virus, Usutu virus, Other Arbovirus) No 10057 Powassan virus disease, neuroinvasive Yes 10063 Powassan virus disease, non-neuroinvasive Yes 11734 Snowshoe hare virus disease Yes 10051 St. Louis encephalitis virus disease, neuroinvasive Yes 10064 St. Louis encephalitis virus disease, non-neuroinvasive Yes 10074 Tick-borne encephalitis viruses No 11724 Trivittatus virus disease Yes 10055 Venezuelan equine encephalitis virus neuroinvasive disease No 10067 Venezuelan equine encephalitis virus non-neuroinvasive disease No 10056 West Nile virus disease, neuroinvasive Yes 10049 West Nile virus disease, non-neuroinvasive Yes 10052 Western equine encephalitis virus disease, neuroinvasive Yes 10065 Western equine encephalitis virus disease, non-neuroinvasive Yes 10660 Yellow fever Yes 50224 Zika virus disease, congenital Yes 50223 Zika virus disease, non-congenital Yes TX-DSHS-19-1309-A-001397 50222 Zika virus infection, congenital Yes 50221 Zika virus infection, non-congenital Yes TX-DSHS-19-1309-A-001398 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-001399 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. TX-DSHS-19-1309-A-001400 From: Electronic Data Exchange (CDC) Sent: Tuesday, April 02, 2019 11:57 AM EDT To: Electronic Data Exchange (CDC) CC: Amsterdam, Leota (CDC/DDID/NCEZID/DPEI) (CTR) ; Hall, Christopher (Jason) (CDC/DDID/NCEZID/DPEI) ; Patel, Kelsey (CDC/DDID/NCEZID/DPEI) (CTR) ; Light, Megan (CDC/DDID/NCEZID/DPEI) ; Pinner, Robert W. (CDC/DDID/NCEZID/OD) ; Hoover, Michele (CDC/DDPHSS/CSELS/DHIS) Subject: ELC HIS Application Supplemental Information Attachment(s): "ELC HIS Application Supplemental Information - Final 2019.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, We’ve attached the supplemental information to assist with completing the ELC Health Information Systems grant application. Please let us know if you have any additional questions. Thanks, ELR Implementation Support and Monitoring Team Team Member: Leota Amsterdam CDC edx@cdc.gov TX-DSHS-19-1309-A-001401 ELC Health Information Systems Application Information The following information is provided to help jurisdictions complete the ELC HIS application. Please reach out to edx@cdc.gov for any questions regarding the ELC HIS application. The application templates this year are similar to last year. Please note: 2018/Budget Period 5 (BP5) activity-level progress reports and BP5 performance measures will not be collected with the new NOFO application, and will be collected in close-out reports in late October 2019. The application template for the FY19 NOFO includes four tabs (sections): 1) Home Page 2) Approach 3) BP1 Work Plan and 4) Guidance. An updated Budget Template will be used this year. Home Page The Home Page, as shown below, provides instructions on how to complete, print and PDF your application template, and provides space for contact information for the person completing the application template. Select a Jurisd iction) First Name : Last Name : Email: Phone : Posit ion/ T"itle : Project lead 's Contact tnrormatlon Alternate POCContact tnro (Optlonal) Instructio ns.: Please proc eed to the Approac h a nd then BPl Work Pla n ta bs to complet e all a ct ivities and fields . Printi ng or Uploading t o Grant Solutions : Use the button to t he right o expo rt the oo l o a PDF. Once in PDF orm at, you may pr int, or sa ve and upload , s ect ions o th e to ol by s pecifying th e des ired pag e numbe rs during prin ·ng. Depending on the version of Microsoft Excelyo u are using, you may ob ta in bd t u results by print ing to the "Microsoft Print to PDF" printer item (under File, Print) . Make PDF Spell Check: Use the follow ing bu tton to run s~ ll check ac ros s th e ent ire documen t. Note tha th e fo rm may freeze if spe llc heck process is inter ru pted or ca nceled befo re complet ion. Spell Check Submission : Please refer to i:uidance provided by the ElC team for subminion of application templates to Grants.gov and REDCapELCApplication and Monitoring Portal. Supporting Documentation Documents can be included to support information in the application (e.g., document with the name and address of hospitals/facilities identified to be onboarded for syndromic surveillance, organizational charts, workflow diagrams). You may upload documents to the supporting documentation section of the ELC Application and Monitoring Portal 2019–2020 REDCap project located at the bottom of the Completed Application Templates page. Update to HIS Tier 1 Requirements in NOFO NOTE: There is a typo in the Tier 1 summary listed for Project C (page 52 of the NOFO). It should reflect the required activities listed in the Project C section. Specifically: 1 TX-DSHS-19-1309-A-001402    Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. 2018 Application Work Plan vs 2019 Application Work Plan The differences between the information requested in the previous and the new ELC HIS application are listed in the following chart. Although Strategy 1, Enhance Health Information Systems Workforce, is no longer a strategy, ELC HIS is committed to providing cross-cutting flexible IT/informatics personnel to accomplish the strategies and activities. BP5 (2018-2019) I: Enhance Health Information Systems Workforce a. Designate a public health information systems specialist with flexible responsibilities… b. Develop and sustain core personnel needed to support integrated surveillance systems… c. Develop and sustain personnel resources to support and advance electronic data exchange… d. Increase public health informatics and information technology skills…through training… II. Advance Electronic Information Exchange Implementation a. Increase the percentage of lab reports received through ELR. b. Automate the use of all ELR. c. Increase ELR based on Meaningful Use (MU) standards. d. Increase public health laboratory capacity for electronic data exchange. e. Participate in the ELC Health Information Systems Implementation Support and Monitoring effort f. Implement new HL7 NNDSS Case Notification Messages. BP1 (2019-2020) No longer a separate strategy for HIS. See guidance below for including personnel and workforce in Applicant Capacity I. Strategy 1h: Advance Electronic Data Exchange… I.a.i. Maintain existing ELR transmissions (required) I.a.ii. (Required for jurisdictions below 75%) Increase ELR… I.a.iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way I.a.iv. Develop or enhance ELR data quality assurance processes No longer included as a separate activity I.c. Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. I.d. Advance electronic data exchange for Public Health Laboratories. No longer a separate activity for HIS. See guidance below in Applicant Capacity. I.b.i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (required) 2 TX-DSHS-19-1309-A-001403 g. Implement electronic case reporting (eCR). h. Create the capacity to transfer ELR messages and eCR messages between jurisdictions… III. Sustain and/or enhance integrated surveillance information systems I.e.i. Implement electronic case reporting (eCR) I.f. Advance electronic information exchange between jurisdictions II. Strategy 1i: sustain and enhance information systems… II.a. Maintain existing information systems… a. Maintain existing surveillance information including the personnel and operating system. environment/supporting software (required) b. Implement (if appropriate) a new/replacement II.b. Implement (if appropriate) new/replacement integrated surveillance information system. information systems. c. Enhance existing integrated surveillance II.c.i. Enhance existing information system(s) by information system(s) by adding or improving adding or improving functionality for Integrated functionality… surveillance information system; II.c.ii. LIMS; II.c.iii. Syndromic surveillance information system d. Move, or explore the efficiencies of moving, II.d. Implement additional innovative an existing or new integrated surveillance enhancements that improve analysis, enable labinformation system to a cloud-based/hosted epi collaboration, or increase the sustainability or environment. efficiency of systems… e. STD surveillance II.c.i.b. Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. II.c.i.c. Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. II.d. Innovative enhancements that improve analysis, enable lab-epi collaborations or increase sustainability or efficiencies of systems. II.e. Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. Approach The Approach tab (new) is designed to capture how the applicant will address the public health needs for their jurisdiction and/or the population they serve by clearly stating the problem, providing justification on how your jurisdiction will address the identified problem through activities, outlining the resources that will be used to address this problem through the suggested activities and how this entire plan will be evaluated for the current year. Under the Approach tab, you have fields for the Problem Statement, Justification, Applicant Capacity, and Evaluation Plan 2019. Additional information is provided below to assist with the Applicant Capacity and the Evaluation Plan for 2019 sections. Applicant Capacity Applicant capacity should include information to address the jurisdiction’s current capacity to successfully implement the proposed strategies and activities including staff and infrastructure in place that will be sustained or enhanced. This section should include staff for supporting flexible IT resources, to support electronic data exchange and integrated surveillance (previously included in Strategy 1) to 3 TX-DSHS-19-1309-A-001404 implement, maintain, or enhance integrated surveillance information systems, and the infrastructure and support to advance electronic data exchange (e.g., ELR, case notifications, syndromic surveillance, eCR). Supporting documentation (e.g., organizational chart, pictures or graphics of system processes) may be included to support the narrative. Be sure to also include information to support the following cooperative agreement requirements (page 83 of ELC NOFO) in this section:  Designate a person with overall responsibility for HIS activities (i.e., lead public health information systems specialist) and personnel responsible for each activity. This should include key personnel resources in IT, public health informatics, surveillance, and public health laboratories responsible for the implementation, enhancement, and maintenance of:  Integrated surveillance system  Electronic Laboratory Reporting  Syndromic Surveillance  Participate in ELC HIS implementation, support, and monitoring efforts.  Participate in Technical Assistance consultation assessment to identify priorities.  Work with CDC to measure key aspects of implementation (e.g., ELR volume at least once during the project period, HL7 case notifications sent to CDC, emergency departments (EDs) onboarded and sending data to CDC BioSense).  Participate in efforts to define consistent ways to link surveillance data to laboratory findings from public health labs and CDC labs for all conditions. Evaluation Plan for 2019 Describe the plan and the ability to collect the necessary data to report on each of the performance measures associated with the proposed activities (see table below, information in red is required) and the cooperative agreement requirements for measuring key aspects of implementation (e.g., percentage of ELR volume, HL7 case notifications sent to CDC, Emergency Departments onboarded and sending data to CDC BioSense). Activity Maintain and enhance Electronic Laboratory Reporting (ELR). Implement New NNDSS Case Notification Messages Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED)…. Establish electronic test ordering and reporting (ETOR) using HL7 messages with 1 or more hospitals or public health labs. Performance Measure Percent of lab report volume received through ELR Percent of conditions for both state reportable and nationally notifiable conditions that use the new HL7 format Percent of emergency departments (EDs) sending HL7 Promoting Interoperability (formerly MU) compliant syndromic surveillance messages to the health department and BioSense Platform1 Number of hospitals and public health labs with established electronic ordering and reporting (ETOR). 1 Required if funded for Syndromic Surveillance. If jurisdiction is only using CDC BioSense, health departments do not need to receive the messages directly. 4 TX-DSHS-19-1309-A-001405 Enhance systems to automated processing and use of ELR Percentage of STD case investigations (e.g., Chlamydia, Gonorrhea) auto-created from ELR. For the first year of the cooperative agreement, there is not a separate tab for your Progress Report. The progress report and performance measures will be captured later in the year in a closeout report. Highlights and additional information to describe proposed activities, including baseline information, can be included in each activity’s Implementation Plan under the BP 1 Work Plan. ELR volume will be collected once during the 5 year cooperative agreement for jurisdictions above 75% ELR. For jurisdictions below 75% ELR, volume will be collected annually as it has been in the past. CDC reserves the right to request ELR volume during the cooperative agreement as necessary for inquiries and funding justifications. CDC would provide guidance and ample notice in the event of a request. We recommend documentation of the volume calculation methodology at your jurisdiction to ensure that a volume request would be completed accurately and within the needed time frame. BP (Budget Period) 1 Work Plan The BP1 Work Plan section of the application template is where the applicant will outline the proposed activities, implementation plans, and milestones for Budget Period 1 (BP1). The BP1 Work Plan section is very similar to last year. Key differences include all activities are built into the template (no drop-down option to select activities), and all activity sections are expandable/collapsible for easy navigation. All required activities need to be included in the application. All other activities included in the application should be based on jurisdiction need and capacity. All implementation plans for each area should highlight successes, how barriers and challenges will be addressed, and how achieving identified milestones improve performance. Additional information to assist with completing the application for selected activities is listed below. NOTE: All activities or implementation milestones may not be included in the examples of implementation plan or milestones (i.e., development of process to enhance ELR data quality and assurance, etc.). Strategy 1h: Advance Electronic Data Exchange Electronic Laboratory Reporting a.) Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. i. (Required) Maintain existing ELR transmissions ii. (Required for jurisdictions below 75%) Increase ELR - propose and execute a plan to increase the volume and percentage of lab reports received through ELR over the next year iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way (vs. re-keying or manually uploaded). iv. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. Implementation Plan may include: i. Plans to maintain ELR, including baseline and target percentage of ELR volume a. Jurisdictions above 75%: Continue to establish ELR with labs, as appropriate 5 TX-DSHS-19-1309-A-001406 ii. iii. iv. Jurisdictions below 75%: Propose and execute a plan for the next year to increase the volume of ELR to reach 75%, move to next quartile (i.e., 50%), or have a minimum increase of 10%. The plan should include: a. Highlights and successes with onboarding over the past year b. High level summary of labs to be onboarded including estimated increase in ELR volume c. How barriers and challenges will be addressed Enhanced processes for ELR to be entered into surveillance system in an automated way. a. This may include efforts for accepting CDC ELR. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. a) Maintain and enhcnce Electronic Laboratory Reporting (ELR}to enable public health agencies to rece ive reports from labo rator ies in a more efficient electronic format. Hide A:t ivity Expand Act ivity BP Imp lem ent at ion Plan 11000 char) The goa l for BP1 is to increase the a nnu a l ELR percentage from 6~% to 75 %. Act ivit ies inc lude va lida t ing the str ucture a nd conter t of messages . a nd pr ovid ing t ime ly a nd acc ura te feed bac k for message refinement. We success fu lly onboa d ed La bcorp with min ima l iss ues a nd our la rgest hos p ita l system cons ist ing of SO fac ilit ies . We a re ta rget ing bet.veen 4 a nd 5 systems to move from Accepta r ce Tes t ing to Prod uct ion for eac h qua rt er. ELR vo lume percentage will be s ign ifica nt ly impac ted by Ques t a nd tva yo go ing live. Ques t a nd Ma yo contr ibute a ppr oxima te ly 10% of report s se nt to the sta te hea lth depa rtm ent Mos t of the rema in ing hos p ita l systems ha ve outsta nd ing cha llenges . Cha llenges inc lude incorr ect message structure. vendo r incons istenc ies . miss ing res ults. a nd LIS upgrades or switches . Co n t inu ed ELC H IS f:'-PPOrt for t h e !:t a ff w h o !:u pp o rt ELR o n b oa r d ·n s a n d m a in t en a n ce if: c r it ica l t o br in g onboa rd ing goa ls to fru it ion. The fo llowing sta ff ma nage a nd coord ina te ELR onboa rd ing tas ks: John Smith • ELR coo rd ina tor for our jur isd ict ion Jaso n Ha ll • Message Va lida tor Miche le Hoo ver • Surve illa nce System ma nage r Milestones:     List of specific facilities that you plan to onboard. Examples of how to complete that would be: o Facilities per quarter on each row o Facilities by lab type (e.g., hospitals/hospital systems on 1 row, large reference lab on the next row, etc.) o Hospital systems per row You do not have to list each facility individually per row, there are options of how to relay this information as listed above. Enhancing ELR data quality and assurance processes, as applicable. Jurisdictions above 75% should continue to onboard new labs, as appropriate, to improve volume of ELRs received. 6 TX-DSHS-19-1309-A-001407 BP Mile:stones1255char) Our ju ri sd i cti on w ill mov e t he a ll ow i ng h os pit a l syst e ms ro m t est to pro d ucti on : Bapt i st Hea lt h Chil d re n's Hea lt hca re HCA Hamil to n Hosp,it a l Syst em These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,erce nt age by S p ercent age po i nt s. Our ju ri sd i cti on w ill mov e t he a ll ow i ng re ere n ce l ahs i nto pro du cti o n: Quest Di ag nost i cs Mayo Cli n i c Dept . o Lab Med Pat h ol ogy These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,er-ce nta ge hy 10 percent age po i nt s. Our ju ri sd i cti on w ill cont i nu e to mo nitor ELR da t a q ua li ty vi a -custom a b l ea u das hbo ards a nd mo nt h ly a udit i ng re port s. W e w ill add ress da t a q ua li ty iss ues see n i n ,curre nt o nbo arded f eeds . W e w ill cont i nu e to e nsure t h at ELRs are de li ve red a utom at i-ca ll y to ou r i nt egrat ed surve ill ance syst e m. PersonResponsible ELR Coo rd i nator Message Va li da tor Surve ill a nce Syst em Ma nage r Achieveby Date July2020 ELR Coor d i nator Message Va li da tor Surve ill ance Syst em Ma nage r Febr ua ry 2020 Surve ill a nce Syst em ma nage r July 2020 I Surve ill a nce Syst em ma nage r July 2020 r.;- NNDSS Case Notifications b.) Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (a) Extract, translate and transmit the data for conditions contained in 5 additional finalized HL7 Nationally Notifiable Message Mapping Guides using the new HL7 case notification structure and retire the corresponding legacy formatted transmissions. (b) Use the CDC NNDSS onboarding process to receive approval for the new HL7-based case notifications before production transmissions are initiated or legacy transmissions are retired. Implementation Plan may include:   List of MMGs previously onboarded and in progress. Plans to implement and onboard at least 5 additional new HL7 Message Mapping Guides including: o Highlights and successes with onboarding o High level summary of MMGs to be onboarded in Yr01 o Description of barriers and challenges and how they will be addressed A list of finalized MMG and Artifacts and event codes (included under MMG Related Documentation) are available at NNDSS HL7 Case Notification Resource Center. Additional resources and information to request technical assistance are available at the NMI Technical Assistance and Training Resource Center. 7 TX-DSHS-19-1309-A-001408 b) Suppo rt CDC'sabilit y to monit or, cont rol, and preven t diseases and ot he r healt h t hreat s by standa rdizing the repo rt ing of surveill'ance dat a (requi red fo r all repo rt ing ju risdictions). Hi de Act iv ity Expand Act iv ity BP Implementa t ion Plan (1000 char) W e p l a n t o i mp l ement case n ot i i cat i o ns o r 5 i nal i zed HL7 Nat i o na ll y Not i i ab l e MM Gs: M ump s, Pert uss i s, Va r i cell a, Hepat it i s, S. D an d Co ngen it a l Sy p h ili s. Gen v 2 and Ar b ov i r a l 1.3 w ere on boa rded an d dat a i s bei ng t ra nsmitt ed success u ll y to CDC. Key pro cesses l ea d i ng u p to on bo ard i ng i ncl u de i na li zat i o n of t he MM G (so me a re i n p il ot st age). ga p an a ly si s a nd page devel opm ent , da t a port i ng , a n d da t amart dev el opm ent. he l att er i s p a i red wit h d i sease-s pecif i c mo d u l e i mp lement at i o n to ensu re da t a av a il abili ty . Each MM G i s est i mat ed to t a ke 3 mo nt h s rom ga p a na ly si s t o HL7 on boa rd i ng. As new MM Gs a re-read y fo r p il ot t est i ng, t he Su rv eill an ce Sy st em M an ager w ill o rga ni ze t he pr oj ect t ea m a nd ma nage t he ov era ll i mpl ement at i o n sc hed u l e. S.ig ni i ca nt new w or k d u r i ng t h i s per i od w ill be needed to mo d ify o u r su rv eill an ce sy st em t o co mp l et e-MM G i mp l ement at i on . MM G i mp l ement at i o n w ill be-p r i ma r il y managed by t he su rv eill an ce sy st em manager . Milestones:   Guides in progress. Examples of how to complete that would be: o Each line can be its own MMG along with steps for implementation o Grouping prioritized MMGs per row o Grouping MMGs by quarter These are not the only options, only examples of how it can be done based on your jurisdiction’s preference. BP Milesto11es(255 cl1art Ach.ieve by Date Perso11Respomi.ble I mp l ement M ump s, Pert uss i s and Var i cell a MM Gs Surv eill ance Sy st em manager Oct ober 20 19 I mp l ement Hepat it i s MM G Surv eill ance Sy st em manager Janu ary 2020 I mpl ement S D and Congenit al Sy phili s MM Gs Surv eill ance Sy st em manager Apr il 2020 Ensure our surv eill ance sy st em has t he req ui r ed updat es Surv eill ance Sy st em m anager July 20 20 to i mp lement add it i ona l MM Gs. Att end ongo i ng eSHARE webi nar s and st ay up t o dat e w it h Surv eill ance Sy st em manager July 20 20 MM G nat i onal pro gr ess v i a NM I Not es Syndromic Surveillance Note: All ELC recipients are eligible to apply for syndromic surveillance activities. c.) Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. i. Increase coverage and number of facilities submitting syndromic surveillance data to the BioSense Platform according to jurisdictional needs (a) (Required for any jurisdiction applying for Syndromic Surveillance funding) Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED) and urgent care facilities with messages that include the NSSP priority 1 and 2 data elements. ii. (Required for any jurisdiction applying for Syndromic Surveillance funding) Participate in the NSSP Community of Practice and other efforts to strengthen syndromic surveillance practice and use. This may include participation in meetings, workshops, and trainings; development of collaborative projects; increase use cases and practical applications by public health 8 TX-DSHS-19-1309-A-001409 programs; share lessons learned and best practices, and providing feedback on the BioSense Platform. (a) Develop or enhance data quality control and assurance processes (b) Enhance timeliness of messages sent to jurisdiction systems and to NSSP BioSense Platform. iii. Enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements. iv. Develop or enhance syndrome monitoring and response protocols. v. Develop at least two collaborative projects (one with a CDC program) where syndromic surveillance can be used to address health department surveillance data needs. Projects done in collaboration with CDC should include sharing the syndromic data with the CDC program through the BioSense Platform. Implementation Plan should include: i. ii. iii. iv. v. If currently sending data to the NSSP Platform: Propose and execute a plan to maintain or onboard new emergency department (ED) or urgent care facilities and send data to the NSSP BioSense Platform, with a focus on HIDTA counties. Include: a. Successes with onboarding facilities in the past year. b. High level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal to submit additional information as needed regarding facilities. c. How barriers and challenges to onboarding will be addressed. If currently not sending data to the NSSP BioSense Platform: Develop and execute a plan to onboard new or existing facilities data to the BioSense Platform, with a focus on HIDTA counties. Include: a. Current facilities sending data to the jurisdiction system. b. As appropriate, high level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal as needed to submit additional information regarding facilities. c. How barriers and challenges for onboarding will be addressed. Plans to enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements, including data elements and the facilities/systems who will be contacted to address issues. Plans to enhance timeliness of messages sent to jurisdiction systems and NSSP BioSense data, including identification of facilities/system identified who will be contacted to address issues. Identify specific syndrome monitoring and response protocols that will be developed or enhanced. Development of at least two collaborative projects (one with a CDC program). Collaborative projects include:  Working with any public health partners including local health departments, other state health departments, and program areas (e.g., injuries, hepatitis, HIV, other infectious diseases, opioids).  Potential projects could include using syndromic surveillance data to assist with: o Public health investigation o Providing information to provide communications for decision makers, health providers, media, etc. o Development of additional specific surveillance activities based on syndromic data 9 TX-DSHS-19-1309-A-001410 o Identification of need for public health intervention See https://www.cdc.gov/nssp/success-stories.html for examples of collaborative projects. Hide Act ivity Expand Act ivity BP Implementation Plan (1000 char) Our j urisd ict ion has be-en us ing syndrom ic s urveill a nce (SyS) s ince 2009 a nd a re a mem ber of t he NS.SP Commun ity of Prac t ice. We curr ent ly se nd t o BioSense a nd have 25 eme rge ncy de pa rt ments a nd 10 urge nt ca re centers s ubmitt ing syndrom ic s urveill a nce da t a t o our HIE (se,e s upp leme nt a l info rma t ion or t he list of on boa rded fac ilit ies ). We will priorit ize increas ing t he nu mber of bot h eme rge ncy de pa rt me nt s a nd urge nt ca re centers t hat s ubmit syndrom ic s urveilla nce da t a t o t hough t he st at e HIE a nd will oc us efforts on high intens ity drug tr a fficking a rea (HIDTA) co unt ies . As mo re ac ilit ies a re onboa rded , we a nt icipat e increas ing our coverage . As a co lla borat ive project. we pla n t o increase s urveill a nce of ILi by working wit h t he de pa rt ment o ed uca t ion t o obta in data t o tr ac k sc hoo l a bse nte,eism . Milestones:      Identify which facilities to be onboarded including name and address of facility and how targeted facilities will increase coverage once onboard Specific data elements and facilities/systems identified to address issues with data quality Specific syndrome monitoring and response protocols that will be developed or enhanced Ensure/improve timeliness of reporting to BioSense platform Key milestones for collaborative projects BP Milestones (255 char) Perwn Responsible On boa rd 5 eme,rge ncy depa rt me nt s a nd 5 urge nt ca re Sy nd rom ic s urveill a nce Achieve by Date ce,nt ers (se,e de t a il ed li st o t a rge,t ed ac ilit ie,s in coo rd in at o r July 2020 s u pp leme nt a l info rma t io n) W ork wit h Best Hea t h Ca re syst em t o add ress da t a Sy nd rom ic s urveill a nce q ua lity iss ues ide nt i ied us ing a b lea u das h boa rd (see coo rd in at o r July 2020 s u pp leme nt a l infor ma t io n for li st of da t a e leme nt s ) Ens u re all da t a a rr ives at j u risd ict io na nd NS.SP Biose nse Synd rom ic s urveill a nce p la orm wit h in 8 ho urs . o rece ipt a t st at e hea lt h coo rd in at o r M arch 2020 depa rt me nt Cont inu e t o pa rt icip-at e in SS-re lat ed tr a in ings , Sy nd rom ic s urveill a nce w o rks ho ps a nd nat io na l web in a rs coo rd in at o r Ens u re rece ipt of sc hoo l abse nt ee ism da t a wit h 3 la rges t Sy nd rom ic s urveill a nce sc hoo l d ist ricts in o u r j urisd ict io n July 2020 December 20 19 coo rd in at o r Public Health Laboratories d.) Advance electronic data exchange for Public Health Laboratories. i. Create and send ELR based on Promoting Interoperability [formerly Meaningful Use (MU)] standards for all reportable conditions to or within the public health department. ii. Map local test, result, and specimen source codes to LOINC and SNOMED standards. iii. Establish electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. 10 TX-DSHS-19-1309-A-001411 Implementation and Milestones:    This section is for enhancing electronic data exchange for Public Health Laboratories including: o Plans for working to send PHL ELR messages for all reportable conditions. o Mapping local codes to LOINC and SNOMED standards o Establishing electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. This section is for HL7 messaging for ETOR activities. o If ETOR is proposed using a web portal, that activity should be included in Strategy 1i, activity C. This activity can include regional labs and state public health labs, but does not include CDC Labs. LIMS activities and milestones should not be included in this activity. LIMS enhancements should be included under Strategy 1i, Sustain and enhance information systems. d) Advance electronic data exchange for Public Health Laboratories . Hide Activity Expand Activity BP Implementation Plan (1000 char) Develop and im ple m ent an ETORinterfa ce wit h a loca l hosp ita l syste m, which se nt nea rly 3,000 STD repo rts to t he state public hea lt h lab in 2018. This will improve data qua lity , efficiency, and a llow t he state lab to de live r ELRsto our integ rated surv eillance syste m . We will also deve lop a pub lic hea lt h lab networ k wit hin ou r juri sdict ion's 12 reg ional pub lic hea lt h labs to improve electro nic data excha nge. Update t he LIS wit h new test codes and map t he m to LOINC codes fo r HL7 2.5 .1 trans miss ion pur poses . New test codes shall be ma ed wit hin 14 da softest code u date . BP Milestones (255 char) Person Responsible Develop and imp leme nt ETORinterface with loca l hospita l PHL Ma nage r s ste m wit h hi h vo lume of STD re orts Map new test codes to LOINCstandards PHL Ma nage r Achieve by Date July 2020 July 2020 (Select Date] [Select Date] (Select Date] Electronic Case Reporting e.) Advance electronic information exchange between electronic health records and public health. i. Implement electronic case reporting (eCR) (a) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for conditions published in the Reportable Condition Trigger Tables and use Reportable Conditions Knowledge Management System (RCKMS) for public health reporting decision support. (b) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for Chlamydia and Gonorrhea. Technical guidance on electronic case reporting for Gonorrhea and Chlamydia is available in a document named “Advancing ECR of STIs: Technical Guidance for Public Health Departments.” This document allows jurisdictions to choose different technical architecture of implementation while providing consistent guidance on the science of STI reporting. ii. Participate in national efforts by engaging in the: 1) discussion and development of eCR standards by participating in the HL7 Public Health Working Group; and 2) development and 11 TX-DSHS-19-1309-A-001412 updates to default reporting specifications and trigger codes by participating in the CSTE RCKMS vetting process iii. Participate in the RCKMS to author jurisdictional reporting criteria and maintain reporting specifications Implementation Plan and Milestones:  Describe a plan that includes details on partners and vendors and the data format that will be   used to send eCR (includes i.a. and i.b.). Plans for participation in national efforts High level overview of which conditions will be authored in RCKMS. e) Advance electronic information exchange between electronic health records and public health Hide Activity Expand Activity BP Im lementation Plan 1000 char Our ju risdict ion will part icipate in national eCR efforts. For 2018-19, our ju risdict ion part icip ated in RCKMS author ing for at least one set of RCKMSdisease-specific report ing specificat ions. This occurred with the establishment of Jurisdiction Adm i ni strator(s) , RCKMS accounts for relevant authors , and RCKMS tra ini ngs. We have selected 2 pi lot facili t ies and the ir respect ive EHRvendors (Epic and Sunquest ) who are exp lor ing the ir abili t ies to use tr igger codes . These pil ot sites are high volume faciliti es that have successfull y onboarded for ELRin the past. Our j urisdict ion inte nds to util ize the AIMS Hub to rece ive elCRs, whi ch with we have already estab li shed a connection. Our surveillance system will be enhanced to consume elCR , which is planned for the 3rd quarter of the BPl . We will cont inu e to stay up to date on national eCR progress and participate in the monthly eCR workgroup led by another ELCapp lic ant. BP Milestones 255 char Ensure necessary survei ll ance system enh ancements are comp leted to consume elCR formats Work wi th 2 pil ot facili t ies to send test elCRs to our surve ill ance system . Move 1 pilot facili ty into production for elCRsto be sent for STDcond it ions. Person Res nsible Surveillance System Manager Achieve b Date December 2019 Surveillance System Manager April 2020 Continue to part icip ate i n eCR workgroup meet in gs and w eb in ars. Stay up to date on nat iona l eCR efforts and Digital Bridge pilot project. Surveillance System Manager July 2020 Author at least 1 rule in RCKMS Surveill ance System Manager July 2020 Ensure stab ili ty of app licat ion where facili t ies can register Surveillance System Manager their int ent to send elCRs to the health dept . July 2020 Electronic Information Exchange between Jurisdictions. f.) Advance electronic information exchange between jurisdictions. i. Create the capacity to transfer ELR messages and eCR messages between jurisdictions. These transfers refer to the electronic sending of ELR and case data between two jurisdictions for a lab report or a case that was reported to one jurisdiction but belongs to another jurisdiction. Implementation and Milestones should include:   Partnering states, bidirectional/unidirectional, via AIMS or direct connection o Although the example given does not specify which partner will collaborate on interstate data exchange, be specific about who you’re proposing to work with. This activity is strictly referring to interstate (state to state) exchange and not intrastate (e.g., city to state). If you need assistance with intrastate exchange, you can submit an ELR Technical Assistance request. 12 TX-DSHS-19-1309-A-001413 f) Advance electronlc informa ,tion exchange between juris-dlctlons. Hi de Act ivi ty Expand Act ivity BP Implementation Plan 11000 char) ·w e w ill cont i nu e to , w ork w ith ne ighb or i ng sta t es t o exp l ore exchange o both ELRs and eCRs. W e have an esta bli shed mechani sm w ith t he AIMS hub , so i partn ers are w illi ng, w e are ab l e speci i c to ELRs. We have esta bli shed a bi di rect i ona l ELR ee d w ith 1 neighb ori ng ju ri sd i cti on vi a AIMS. Est abli shi ng th ese i nte rf aces w ill repl ace paper report s bei ng hand-e nt ered i nto our surveill ance syst em, and w ill i ncrease our ELR percent age. BP Milestones 1255 char) W ork w ith 2 neighb ori ng ju ri sd i cti on s t o se nd and receive ELRs vi a AIMS Monit or th e onb oa rd ed ELR eed al read y esta bli shed w ith a neighb ori ng ju ri sd i cti on Person Responsible Achieve by Date ELR Coordi nator Febr uary 2O:ID ELR Coor di nator Ju ly 2020 Strategy 1i: Sustain and Enhance info systems Maintain Information Systems a.) Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Implementation Plan and Milestones should include:  Maintenance needs for surveillance system, LIMS, syndromic surveillance system, and any supporting software. a) Maintain existing information systems , including the pers-onneland operating environment/supporting s-oftware necessary for them to function. Hi de Activi ty Expand Activity BP Implementation Plan (1000 char) W e w ill cont i nu e our mont hly meet i ngs w ith our surveil ance syst em cont racto r t o tr ack de li verabl es, and to revi ew and pr i or it i ze w ork. We w ill cont i nu e month ly i n-house devel opm ent meet i ngs, te chn i cal t ea m meet i ngs, use r group meet i ngs, and tr ai ni ngs . Mai nt enance o our syst em i ncl udes se rver and sof tw are upgrades . We w ill need to mai nt ai n un di ng or our surveill ance syst em cont racto r as w ell as our softw are li cense or th e too l s th at make usi ng t hese syste ms se cure and sust ai nabl e. Due t o exi st i ng i ssues w ith t he t rai ni ng portal, th e surveill ance syst em t ea m pl ans to rebu il d th e use r app li cat i o,n and dat ab,ase . An up dated tr ai ni ng envi ronment w ill p-rovi de a bett er un de rst andi ng o t he syst em and dat a quali ty expectat i on s. ·w e have st arted a pr ocess to docum ent_, eval uat e, and i mp rove th e oll ow i ng pr ocesses : use r tr ai ni ng, enr oll ment , access mo di i cat i on, dea ctivat i on, and BP Milestones (255 char) Mai nt ai n surveill ance syst em vendo r cont racts Mai nt ai n t rai ni ng port al ·or syst em use rs b,y up dat es use r ap,pli cat i on and data base Mai nt ai n i nteg rat i on engi ne and tr ansport i nt erf aces (SF P and PHINl'v1S eeds ) Mai nt ai n LIMS Mai nt ai n syndro mi c surveill ance syst em Person Responsible Achieve by Date Surveill ance Syste m Manage r Surveill ance Syste m Manage r July 2020 Ma rch 2020 Surveill ance Syst em Manage r July 202!0 Surveill ance Syste m Manage r and PHL manager Surveill ance Syste m manage r and Syndromic Surveill ance coor di nator July 202!0 July 202!0 13 TX-DSHS-19-1309-A-001414 b.) Implement (if appropriate) new/replacement information systems. Implementation Plan and Milestones should include:    Justification for transitioning to a new system Detailed work plan of requirements for replacement system How the plan for replacement will impact the particular program or jurisdiction 1:1)Implement (if appropriate) new/replacement information sy~ems . Hi de Activi ty Expand Act ivi ty BP Implementation Plan (1000 char) Our ju ri sd ict i on w ill exp l o-re th e po ss i b•ili ty o, repl ad ng our current Lead surveill ance syst em w ith a modul e w ith i n our i nt egrat ed surveill ance syst em. Our current syst em i s i ncapabl e o, p,rocess i ng HL7 messages and i s over 2Dyea rs ol d. Like many oth er ju ri sd i cti ons, Lead i s a high vol ume condit i o-n and tr ansit i oni ng to , th e i nt eg rat ed syst em w ill pos it ively i mpact da t a proc ess i ng, t i meli ness and BP Milestones (255 char) S.ch ed ul e at l eas t 4 de mos or th e Lead pro gram t o Achieveby Date PersonResponsible Lead Prog ram and S.urveill ance November 2019 get a th oro-ugh un de rst andi ng o, oth er surveill ance S.yst em Manage r syst em opt i ons and capabili t i es Com pl et e RFP pr ocess Lead Prog ram and S.yste m Manage r Deve l op, and t est Lead m odul e Lead Prog ram and S.yst em Manage r Go li ve w it h repl a-cem ent Lead mod ul e Lead Prog ram and S.yst em Manage r Po,st -pro ducti on bu g ix es and syste m eval uat i on Lead Prog ram and S.yst em Manage r S.urveill ance December 2019 S.urveill ance April 20 2:0 S.urveill ance June 20 2:0 S.urveill ance July 2:020 Enhancing Information Systems c.) Enhance existing information system(s) by adding or improving functionality. Prioritized enhancements are listed below, but other enhancements may be requested. i. Integrated surveillance information system: (a) Enhance systems to enable the automated processing and use of eCR (and if desired, Reportability Response) documents. (b) Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. (c) Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. If using a standalone CS database, migrate CS surveillance into an existing integrated information system. States using NBS version 5.3 or newer should use CS module available within the system. (d) Enhance systems to enable the automated processing and use of ELR, including complete susceptibility findings. ii. LIMS (a) Enhance system to enable the automated processing and use of HL7 electronic test orders. (b) Consult with CDC to evaluate options for implementing and integrating a web portal to support electronic test ordering and reporting (ETOR). iii. Syndromic surveillance information system 14 TX-DSHS-19-1309-A-001415 (a) Explore, evaluate, and incorporate new data sources at your jurisdiction that can enhance syndromic surveillance. Implementation Plan and Milestones should include: For the integrated information system  Provide a high level overview of plans to enable automated processing and use of eCR documents.  Describe a plan for transitioning STD, including legacy data, into an existing or replacement system and how the plan will impact the STD program.  Describe how the jurisdiction will transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. Hard copies of congenital syphilis case report forms will no longer be accepted by CDC’s STD program.  Describe a plan for being able to automatically process and use full ELR, including complete susceptibility findings. For LIMS  Include LIMS maintenance and upgrade activities or LIMS replacement plans.  Provide a high level overview of plans to enable the automated processing and use of HL7 electronic test orders.  Prior to the development of a new web portal to support electronic test ordering and reporting (ETOR), plan to include a consultation with CDC to evaluate options. For Syndromic Surveillance  Develop a plan to identify additional data sources to be added to the jurisdiction data system and how they will be used. c) Enhance existing information system(s) by adding or improving functionality. Hide Act ivi ty Exp and Act iv ity BP Im lementation Plan 1000 char Our j urisdiction is curr ent ly on t he lat est v ersion release of ou r int egrat ed surve ill ance syst em . Enhancemen t act ivit ies w ill be focused on t est ing and imp leme nt at ion of surve ill ance sy st em upg rades; and upda t es and dev elopme nt of Tableau dashbo ards. The surve ill ance syst em manageme nt t eam is curr ent ly w orking on dat a ro ut ing en hancemen t s w ill aut oma t e curr ent manua l assignmen t s, facili t at ing dail y inclusion of ne w codes and fac ili t at ing qua lity assurance on all exist ing code comb inat ions . Toget her t hese efforts w ill imp rove f unct iona li ty and dat a qua li ty fo r ou r use rs, and improve pub lic healt h response and analysis.The nex t ve rsion release wi ll ensu re t hat elCRsand ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em . The curr ent STD surve ill ance syst em is no longe r supp orted by CDCso plans w ill be made t o m igrat e STD surve ill ance int o ou r int egrat ed surve ill ance syst em . The PHL LIMS syst em w ill be upg raded t o t he lat est ve rsion w it h t he assist ance of t he PHL vendo r. BP Milestones 2!.5 char Upgrade t o t he lat est ve rsion release fo r int egrat ed surve ill ance syst em ; Cont inue t o ensu re all ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em Person Res nsible Surve ill ance Syst em Manage r M igrat e STD surve ill ance from legacy syst em t o t he int egrat ed surve ill ance syst em Upgrade PHL LIMS t o lat est ve rsion Enhance synd rom ic surve ill ance syst em t o inco rpo rat e ne w dat a sou rces Transit ion any rema ining hard cop ies of congen it al syph il is case report fo rms t o an electron ic f eed STD Prog ram and Surve ill ance Syst em Manage r PHL Manage r Syndrom ic Surve ill ance Coordinat or STD Program and Surve ill ance Syst em Manage r Achieve b Date January 2020 July 2020 July 2020 July 2020 December 2019 15 TX-DSHS-19-1309-A-001416 Innovative Enhancements to Improve Collaborations with Lab and Epi data. d.) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Illustrate projects: i. Enable lab-epi collaboration by identifying and implementing a universal case identifier (or similar linking variable) to include with laboratory and case data transmission (e.g., patient identifier that links data from health systems; identifier to link PulseNet data to case reports). ii. Develop systems or tools for public release of public health data. iii. Explore the efficiencies of moving an existing or new information system to a cloudbased/hosted environment. iv. Identify software or platforms that enable the integration and visualization of surveillance and laboratory data. v. Identify solutions to integrate AMD data with surveillance data for analysis or visualization. Implementation Plan and Milestones should include:  Any other projects or enhancements that promote collaboration or efficiency. For example, universal patient IDs, moving a surveillance information system to a cloud-based/hosted environment, data sharing/release, epi-lab data integration, or data visualization. d) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Hide Act iv ity Expand Act iv ity BP Im lementation Plan 1000 char Our j urisdiction needs modern and af fo rdable t echno logy solut ions t o de li ve r produ cts and serv ices t o ou r prog rams. We have been w orking w it h Amazon on t he Amazon Cloud Com put ing (AWS) dat a cent er m igrat ion . We w ill com plet e a proo f of conce pt , m igrat ing in t est mode a num ber of app li cat ions . Our surve ill ance syst em , int egrat ion eng ine and ot he r supp ort ing infras t ructu re t echno logies w ill be moved t o AWS. This w ork w ill requ ire us t o exam ine and add ress any surve ill ance syst em security concerns , and updat e curr ent processes and archit ectu re t hat won 't be supp orted in AWS. BP Milestones 255 char Deve lopmen t of M igrat ion Plan t o Amazon Web Service (AWS) Cloud and com plet e m igrat ion Im pleme nt updat es t o ELR Tableau dash boards on a quarte rly basis Achieve b Date Person Res nsible Surve ill ance Syst em Manage r July 2020 Surve ill ance Syst em Manage r and prog ram leads July 2020 [Select Date ) Advanced Molecular Detection (AMD) Technical Infrastructure e.) Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. i. Implement management and analytic software ii. Increase network bandwidth and computing power and/or use cloud infrastructure to support AMD initiatives This section is focused on providing support for the technical infrastructure needed to support AMD. It does not include diagnostic equipment, sequencers, testing supplies, or personnel using the data. All laboratories that submit reportable lab findings to public health via ELR should submit reportable antimicrobial resistance (AR) laboratory findings via ELR, with messages conforming to nationally 16 TX-DSHS-19-1309-A-001417 accepted standards, validated for accuracy and completeness of content and structure when sent or received. Laboratories that are not currently reporting via ELR are encouraged to do so, especially as electronic reporting of AR is a compelling reason to develop this capacity. Additional information is available through the CSTE’s Best Practices for Surveillance of Antimicrobial Resistance via Electronic Laboratory Reporting and the Antimicrobial Resistance Surveillance Task Force Year 2 Report and Recommendations. Implementation Plan and Milestones may include:     Procuring Cloud Infrastructure (e.g., cloud storage, computing processing) Increased bandwidth for network infrastructure Specialized software to assist in using AMD data with epi data Increase in-house computing processing and storage e) Increase HIS capacity to support Advanced Molecu lar Detection (AMD) activities. Hide Act ivi ty Expand Act ivi ty BP Im lementation Plan 1000 char In ou r wo rkplan t o t ransit ion t o t he AWS (see prev iou s activ ity ), w e w ill inclu de clou d procu rem ent fo r st orage of AMD dat a. BP Milestones 255 char Wo rk w it h procu rem ent t o acquire add it iona l st orage fo r AMD dat a Person Res nsible Surve ill ance Syst em Man ager Achieve b Date .luly 2020 [Select [Select [Select [Select Date ) Date ) Date ) Date ) Guidance The Guidance tab of the application template provides a link which will open the respective FY19 NOFO Guidance section, for applicant reference. The link should open a PDF in a new window on your desktop, that might appear behind the Excel template file. Additional Budget Information The FY19 Budget Template is similar to last year with some key enhancements and new columns including:   Instructions Tab: Provides instructions for all fields within the ELC Budget Template New SF-424 Feature: Section B of this form automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This tab will autopopulate as applicants complete their detailed budgets, and can be printed and submitted directly to Grants.gov to satisfy the SF-424 requirement. 17 TX-DSHS-19-1309-A-001418 Budget Requests for Personnel Budget requests to support cross-cutting health information personnel can be requested in multiple area of the ELC application. The major areas where flexible IT and health/laboratory informatics personnel may be included are in one or a combination of the following: • A: Cross-Cutting Epidemiology and Laboratory Capacity • Personnel supporting cross-cutting epidemiology and laboratory informatics activities • B: ELC Leadership, Management, and Administration • Leadership and Management positions assist in the leadership, management, coordination and administration of the ELC Cooperative Agreements, including integration of epidemiology, laboratory, and health informatics activities. • C: Health Information Systems Capacity • Personnel who only work on ELC HIS activities In the budget justification, applicants should indicate the areas of the application where the same personnel are being requested in multiple areas as a safeguard. This will avoid duplication of funding. Budget Requests for Training, Meeting Participation, and Peer-to-Peer Travel If travel to conferences/meetings and participation in trainings is requested for ELC Governance Team members, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If travel to conferences/meetings and participation in trainings is requested for HIS staff, not the HIS person of contact on the Governance Team, then the request would should be included in the Health Information Systems Capacity (Project C in the ELC NOFO) budget. Similar to the conference travel and training requests, if Peer-to-Peer travel is a request for epi or lab staff to visit another jurisdiction to either learn or share best practices, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If Peer-to-Peer travel is a request for HIS staff to visit another jurisdiction, then the request would need to be entered on the Health Information Systems Capacity budget. 18 TX-DSHS-19-1309-A-001419 Notes and Q + A from 3/20 ELC HIS Application Guidance Webinar: ETOR:       Using a web portal with an LIS system is another way to implement ETOR without using HL7 messaging Letters of support from hospitals for ETOR work is not necessary, but can be included in the application in the supplemental Q: Does ETOR through state HIE count as one connection with a hospital? A: Yes Examples of ETOR: If you are receiving HL7 format and it’s going into LIMS system, it counts as ETOR. If data is being keyed in and transformed into HL7 and then going into LIMS system, it also counts as ETOR. Try to limit ETOR connections to hospitals and “other” type labs. Public health clinics do count as ETOR, but we are trying to limit the field for ETOR connections. Q: If ETOR is already up and running and we want to sustain that connection, should we list this work as a project in the application? A: Yes, include this work in the application or include it in the measures. Syndromic Surveillance:      The Syndromic Surveillance activities are NOT required. However, if you do apply for Syndromic Surveillance activities, there are some activities that are required. All previous NSSP funding will be moved into ELC. We are hoping for level funding and should have additional 1-year dollars to help with syndromic surveillance activities. All ELC grantees can apply for syndromic funding Q: Can you elaborate on the collaborative projects activity in the syndromic surveillance section? o ESOOS is a requirement for funding on the syndromic side (NCIP Co-Ag side), so it does NOT count as a collaborative project on the ELC side. o There are additional examples of collaborative projects above. The syndromic surveillance measure mentions emergency departments (EDs), but urgent care facilities can also be counted eCR:   RCKMS is needed for eCR work: o Activity e, ia is a broad eCR project and requires triggering through RCKMS o Activity e, ib is STD-specific and builds off a pilot already in place. Triggers are implemented at the EHR, therefore RCKMS is not needed. To clarify, there will be no additional work for RCKMS in the new 5 year Co-Ag. Any RCKMS activities that are mentioned in the guidance are the ones that currently exist. RCKMS authoring will eventually expand from the initial 6 conditions. NMI: 19 TX-DSHS-19-1309-A-001420   CDC is currently working with the FDD guide and other larger guides to determine the best strategy to make it more equitable because some guides have several conditions included and some have only one. The FDD guide will count as 2 MMGs if you implement half of the conditions at a time. If you take on all conditions (entire guide at one time) then it would count as 3 MMGs In terms of jurisdictions implementing 5 MMGs, as long as folks are working towards implementation of as many guides as possible, the NMI team is maintaining expectations on how many guides can realistically implemented for each jurisdiction. General Application:    Each activity has 5 milestones hard coded in, they are not expandable. 5 is the limit number of milestones, you don’t have to use all 5 for each activity. If there is no character limit for a section, please try to be as concise as possible AMD:  This AMD activity is about technical support, cloud procurement, increased bandwidth for network infrastructure, specialized software for analysis, etc... It is NOT about sequencers, diagnostic equipment, testing supplies, or staff (i.e. bioinformaticians used to analyze the data). Miscellaneous:     We are using 2018 ELR volume estimates to determine the >75% ELR cutoff for each jurisdiction. Those who are below 75% ELR will continue to provide ELR volume estimates every year in the grant cycle. Q: For advanced electronic data exchange between jurisdictions, is there a preference for push or pull? A: If interested, there are existing mechanisms supported through APHL to assist with transmission but CDC does not have a preference for push or pull options. Q: What does automation of STD ELRs mean? A: STD initiation of investigations from STD ELRs that come in. The system automatically creates investigation bases on ELR details rather than someone manually having to create the investigation. There is an activity referencing PulseNet (under Strategy 1i, activity d: implement additional innovative enhancements that improve analysis…) in the NOFO. Although PulseNet is in the process of being replaced, it is used in the guidance as an example here to help people think through projects that identify a universal case identifier to include with laboratory and case data transmission. 20 TX-DSHS-19-1309-A-001421 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, April 05, 2019 8:17 AM EDT Subject: ELC Annual Meeting Survey WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, Thank you for attending the 2019 ELC Annual Meeting. In order to continue to provide a beneficial meeting to you each year, we are asking you to complete the following survey https://is.gd/elcannualmeeting2019. Please complete this survey by Friday, April 19, 2019. Again, thank you for attending the 2019 ELC Annual Meeting and your feedback is greatly appreciated. Thank you, The ELC Team TX-DSHS-19-1309-A-001422 From: Phippard, Alba (CDC/DDID/NCEZID/DGMQ) Sent: Wednesday, April 10, 2019 12:38 PM EDT To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) ; Komatsu, Kenneth (CDC azdhs.gov) ; Brady, Shane (CDC azdhs.gov) ; Santibanez, Margarita@CDPH ; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov) ; Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us) ; DOH ; Shuford,Jennifer (DSHS) ; Banicki,Allison (DSHS) ; Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD) ; Mcconnell, Michelle (HHS/OS/OGA) ; Waterman, Steve (CDC/DDID/NCEZID/DVBD) ; Escotto, Dianne A. (CDC/DDID/NCEZID/DGMQ) ; Villarino, Elsa (CDC/DDID/NCEZID/DGMQ) ; Fonseca-Ford, Maureen (CDC/DDID/NCEZID/DGMQ) ; Contreras, Sonia (CDC/DDID/NCEZID/DGMQ) ; Montiel, Sonia (CDC/DDID/NCEZID/DGMQ) (CTR) ; Arrouzet, Cory (CDC/DDID/NCEZID/DGMQ) ; Clements, Crystal (CDC/DDID/NCEZID/DGMQ) ; Goryoka, Grace (CDC/DDID/NCEZID/OD) ; Angelo, Kristina (CDC/DDID/NCEZID/DGMQ) ; Borntrager, Denise (CDC/DDID/NCEZID/DGMQ) ; Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR) ; Tyler,Carla (DSHS) ; Sidwa,Tom (DSHS) ; Frieda Adams (Freida.Adams@state.nm.us) ; Olivia.Arizmendi@cdph.ca.gov ; Torres,David (DSHS) ; Delossantos,Rosy (DSHS) ; April Fernandez (april.fernandez@cdph.ca.gov) ; Kozo, Justine ; Paula Kriner ; Maria Fierro ; Robert Guerrero (robert.guerrero@azdhs.gov) ; Mariana Casal (mariana.casal@azdhs.gov) ; Corona Luevanos,Adriana (DSHS) ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Eugene Livar ; McConnell, Michelle S (Mexico City) ; Pezzi, Clelia (CDC/DDID/NCEZID/DGMQ) ; Ledezma,Elvia (DSHS) ; Travis.Leyva@state.nm.us ; Cass, Anne (CDC cdph.ca.gov) ; Lee,Yihua (DSHS) ; Martinez,Angelica (DSHS Contractor) ; Foy,Elizabeth (DSHS) ; Vaaler,Margaret (DSHS) ; Rodriguez,MariaG (DSHS) ; Ruiz,Mauro (DSHS) ; Prot,Emilie (DSHS) ; Wendorf, Kristen (CDPH-CID-DCDC-TCB) ; Shah, Neha (CDC cdph.ca.gov) ; Perez,Alberto (DSHS) ; Rosenbluth,Lauren (DSHS) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) ; Paddock, Christopher (CDC/DDID/NCEZID/DVBD) ; Peterson, Amy (CDC/DDID/NCEZID/DVBD) ; Armstrong, Paige A (CDC/DDID/NCEZID/DVBD) ; Barrera, Roberto (CDC/DDID/NCEZID/DVBD) ; Hemme, Ryan Russell (CDC/DDID/NCEZID/DVBD) ; Adams, Laura E. (CDC/DDID/NCEZID/DVBD) ; Reyes, Monica (OS/OGA) ; Baker, Nicole (OS/OGA) Subject: RE: Southern Land Border Disease Prioritization Follow-Up Call on Aedes-transmitted diseases and Rickettsioses Attachment(s): "Next_Steps_Discussion_Guide_for_Disease_Prioritization_4.10.19.pptx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi All, Here are the slides that are being presented now on the screen for the sykpe call. Sorry for the delay. -----Original Appointment----From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) Sent: Friday, March 15, 2019 10:34 AM To: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR); Komatsu, Kenneth (CDC azdhs.gov); Brady, Shane (CDC azdhs.gov); Santibanez, Margarita@CDPH; Esmeralda Iniquez-Stevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov); Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us); DOH; Shuford,Jennifer (DSHS); Banicki,Allison (DSHS); Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD); Mcconnell, Michelle (HHS/OS/OGA); Waterman, Steve (CDC/DDID/NCEZID/DVBD); Escotto, Dianne A. (CDC/DDID/NCEZID/DGMQ); Villarino, Elsa (CDC/DDID/NCEZID/DGMQ); Fonseca-Ford, Maureen (CDC/DDID/NCEZID/DGMQ); Contreras, Sonia (CDC/DDID/NCEZID/DGMQ); Montiel, Sonia (CDC/DDID/NCEZID/DGMQ) (CTR); Arrouzet, Cory (CDC/DDID/NCEZID/DGMQ); Clements, Crystal (CDC/DDID/NCEZID/DGMQ); Goryoka, Grace (CDC/DDID/NCEZID/OD); Angelo, Kristina (CDC/DDID/NCEZID/DGMQ); Borntrager, Denise (CDC/DDID/NCEZID/DGMQ); Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR); Carla.tyler@dshs.texas.gov; Tom (DSHS; Frieda Adams (Freida.Adams@state.nm.us); Olivia.Arizmendi@cdph.ca.gov; Torres,David (DSHS); Delossantos,Rosy (DSHS); April Fernandez (april.fernandez@cdph.ca.gov); Kozo, Justine; 'Paula Kriner'; Maria Fierro; Robert Guerrero (robert.guerrero@azdhs.gov); Mariana Casal (mariana.casal@azdhs.gov); Corona Luevanos,Adriana (DSHS); Aldridge,Tiffany (DSHS); Gamez,Monica (DSHS); Eugene Livar; McConnell, Michelle S (Mexico City); Pezzi, Clelia (CDC/DDID/NCEZID/DGMQ); elvia.ledezma@dshs.texas.gov; Travis.Leyva@state.nm.us; Cass, Anne (CDC cdph.ca.gov); Lee, Yihua (CDC dshs.texas.gov); Martinez, Angelica (CDC dshs.texas.gov); Foy,Elizabeth (DSHS); Vaaler,Margaret (DSHS); Rodriguez, Maria (CDC dshs.texas.gov); Ruiz,Mauro (DSHS); Prot,Emilie (DSHS); Wendorf, Kristen (CDPH-CID-DCDC-TCB); Shah, Neha (CDC cdph.ca.gov); Perez,Alberto (DSHS); Rosenbluth, Lauren (CDC dshs.texas.gov); Moser, Kathleen (CDC/DDID/NCEZID/DGMQ); Phippard, Alba (CDC/DDID/NCEZID/DGMQ); Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ); Paddock, Christopher (CDC/DDID/NCEZID/DVBD); Peterson, Amy (CDC/DDID/NCEZID/DVBD); Armstrong, Paige A (CDC/DDID/NCEZID/DVBD); Barrera, Roberto (CDC/DDID/NCEZID/DVBD); Hemme, Ryan Russell (CDC/DDID/NCEZID/DVBD); Adams, Laura E. (CDC/DDID/NCEZID/DVBD); Reyes, Monica (OS/OGA); Baker, Nicole (OS/OGA) Subject: Southern Land Border Disease Prioritization Follow-Up Call on Aedes-transmitted diseases and Rickettsioses When: Wednesday, April 10, 2019 9:00 AM-10:30 AM (UTC-08:00) Pacific Time (US & Canada). Where: Skype Meeting TX-DSHS-19-1309-A-001423 PLEASE SEE BELOW FOR SKYPE INFORMATION Attached you will find the latest version of the Disease Prioritization general recommendations as well as the next steps that we have decided at this point. Please forward this invitation to any aedes-transmitted/rickettsioses disease subject matter experts in your state that you would like to have participate. Thank you, Tom Gray ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 8059272 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... TX-DSHS-19-1309-A-001424 [ In~ ~~• r Engagement altflhe IJJJS , SotrtffiemLand Bonier lifl!ll:fijtwiiselJkti~ We will start promptly at 9~00a._m ..(fRIJ). Please put your pt\one on mute. TX-DSHS-19-1309-A-001425 1 ,_ ~ /Pti1JlitttatiwffN! lfllulb]u-Engage,nent as_Soutflflrn r a;tt1tla ILa,r,JlBvKlkn TX-DSHS-19-1309-A-001426 2 Disease Prioritization Goals • To prioritize endemic and emerging infectious diseases of particular concern in the US southern border region, identify common U.S. federal and state priorities, and determine how to jointly address them. These include diseases that can be introduced and amplified, or cause an outbreak, due to the movement of people, products, or animals between the US and Mexico; and • To develop plans to address gaps in surveillance, response, or other relevant activities for the prioritized diseases. TX-DSHS-19-1309-A-001427 3 Agenda Welcome, Agenda, and Logistics 5 minutes General Recommendations 10 minutes Handout: DP_ GeneraLRecommendatons_NexL Steps_DRAFT_ 3.25.19 Discuss Next Steps for Aedes-transmitted diseases and rickettsioses 50 minutes Handout: Preparing_for_ApriL 10_Disease_Prioritization_ Ca/L 3.25.19_b Discuss Health Education, Promotion and Capacity Building 15 minutes Wrap-Up and Next steps 5 minutes TX-DSHS-19-1309-A-001428 4 Logistics ... • Please mute your phone when not speaking; • Please do not place this call on hold - many of our phone systems have hold music; and • Please state your name each time you speak. TX-DSHS-19-1309-A-001429 5 General Recommendations for Prioritized Diseases The general recommendations were proposed at the disease prioritization workshop and then discussed on our previous two calls. Edits have been made to: • Increase clarity; • Eliminate redundancy; and • Ensure proper placement as a next step or general recommendation. TX-DSHS-19-1309-A-001430 6 Next Steps for AedesTransm itted Diseases and Rickettsioses Handout: Preparing_for_ApriL 10_Disease_Prioritization_ Ca/L3.25.19_b TX-DSHS-19-1309-A-001431 7 Surveillance Next Steps for AedesTransmitted Disease and Rickettsioses Handout: Preparing_for_ApriL 10_Disease_Prioritization_ Ca/L3.25.19_b TX-DSHS-19-1309-A-001432 8 REVIEW: Next Steps for Aedes-Transmitted Diseases and Rickettsioses RECOMMENDATION • Strengthen surveillance for prioritized vector-borne diseases and vector presence in the border region through active surveillance approaches. PROPOSED NEXT STEPS • Discuss feasibility of implementing syndromic sentinel surveillance for acute febrile illness with confirmatory testing at key sites in the border region. • Convene key border agency partners to explore and further operationalize participatory surveillance for vector-borne diseases and vector presence for the border region. TX-DSHS-19-1309-A-001433 9 REVIEW: Next Steps for Aedes-Transmitted Diseases and Rickettsioses RECOMMENDATION • Prioritize identification of binational outbreaks/clusters of the priority diseases. • Engage community healthcare providers to ensure surveillance and reporting mechanisms are in place for monitoring infectious diseases among mobile populations. TX-DSHS-19-1309-A-001434 10 Laboratory Next Steps for Aedes-Transmitted Diseases and Rickettsioses Identify Additional Next Steps TX-DSHS-19-1309-A-001435 11 Next Steps for Aedes-Transmitted Diseases and Rickettsioses General Recommendations Laboratory • Review and implement approaches to strengthen surveillance and laboratory practices for antimicrobial resistance in the border region. • Ensure that culture-independent diagnostic testing does not reduce high quality public health surveillance in the border region. TX-DSHS-19-1309-A-001436 12 Next Steps for Aedes-Transmitted Diseases and Rickettsioses Laboratory Discussion Questions • Are there major laboratory gaps for Aedes-transmitted diseases and Rickettsioses that should be addressed in the border region? • Are there additional next steps that should be added that are specific to Aedes-transmitted diseases and Rickettsioses? TX-DSHS-19-1309-A-001437 13 Outbreak Response and Preparedness Next Steps for Aedes-Transmitted Diseases and Rickettsioses Identify Additional Next Steps TX-DSHS-19-1309-A-001438 14 Preparedness Discussion for Aedes-Transmitted Diseases and Rickettsioses Discussion Question • Are there major gaps in preparedness for clusters/outbreaks of Aedes-transmitted diseases and Rickettsioses in the border region that have not yet been discussed? TX-DSHS-19-1309-A-001439 15 Preparedness Discussion for Aedes-Transmitted Diseases and Rickettsioses Recommendation • Improve description of the geographic distribution of Aedes mosquitoes and where transmission is more likely to occur. Discussion Question • What are the challenges in understanding where transmission is more likely to occur in the border region? TX-DSHS-19-1309-A-001440 16 Preparedness Discussion for Aedes-Transmitted Diseases and Rickettsioses Recommendations • Enhance follow-up of patients or contacts that cross the border or who are deported after diagnosis or exposure for improved infectious disease control efforts. • Identify best practices and continuing challenges in follow-up of binational patients with select notifiable diseases in the border region. This acknowledges that surveillance systems may be sufficient for some diseases, but there are limited resources and mechanisms for comprehensive follow-up (i.e. case-holding, monitoring, and contact tracing). TX-DSHS-19-1309-A-001441 17 Coordination Next Steps for Aedes-Transmitted Diseases and Rickettsioses Identify Additional Next Steps TX-DSHS-19-1309-A-001442 18 REVIEW: General Coordination Recommendations • Enhance existing mechanisms for coordinating initiatives between the U.S. federal, state, and local agencies involved in border health activities in the U.S.-Mexico border region to address the priority diseases; AND • Share state models for exchanging public health data electronically with Mexican health jurisdiction partners. TX-DSHS-19-1309-A-001443 19 REVIEW: Next Steps for Aedes-Transmitted Diseases and Rickettsioses RECOMMENDATION • Conduct gap analyses for priority diseases in the border region to inform development of comprehensive approaches (e.g. vector surveillance). PROPOSED NEXT STEP • Identify what gap analyses have been done, or are in process, for Aedes transmitted diseases (i.e through federal agencies, state health departments and CDC's Centers for Excellence) to identify remaining areas of work. TX-DSHS-19-1309-A-001444 20 Health Education, Promotion, and Capacity Building Identify Additional Next Steps TX-DSHS-19-1309-A-001445 21 Next Steps for Health Education, Promotion, and Capacity Building RECOMMENDATIONS • Improve education and outreach for populations with low English proficiency. • Ensure education materials for specific populations are tested for accuracy and understandable messaging. NEXT STEPS • Create opportunities and a platform for regular sharing of validated educational and prevention materials in border communities. • Leverage the Mexican Consulate's Ventanilla de Salud network to reach their unique population (e.g. to provide health education or test educational materials). TX-DSHS-19-1309-A-001446 22 Disease Prioritization Next Steps • Request written feedback on the prioritization of next steps. • USMU staff will then circulate a draft of all the identified next steps and a draft plan for review and comment. • Disease prioritization workshop final report is being developed. TX-DSHS-19-1309-A-001447 23 24 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, April 12, 2019 4:28 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Attachment(s): "Supplementary Information for ELC FY 2019_v3.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please find the FINAL updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 3) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, March 29, 2019 3:53:18 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Good afternoon, Please find the updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 2) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks and we look forward to seeing many of you next week! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 21, 2019 6:04:53 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Supplementary Information for 2019 Good afternoon, Please find the Supplementary Information for Applying to 2019 ELC NOFO document attached here, and also located in REDCap in the file repository. As mentioned in previous communications, this document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • • • • describe the new ELC structure and contrast it with previous project periods, offer tips for developing effective work plans, milestones, and budgets, provide additional information about the submission process and tools that may aid applicants, illustrate materials from the ELC and partner program webinars, including a compilation of frequently asked questions for applicants to reference, and instructions on how to download the recorded ELC webinars. PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Thank you, ELC Team TX-DSHS-19-1309-A-001449 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) April 2019 VERSION 3 TX-DSHS-19-1309-A-001450 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 20 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 21 ELC Data Management Plan (DMP) Checklist ......................................................................................... 21 5. Submission Process ................................................................................................................................. 23 Submission Checklist ............................................................................................................................... 23 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 23 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 28 7. Program-Specific Frequently Asked Questions and Guidance................................................................ 40 Project C: Health Information Systems Capacity ........................................................................................ Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance ................................................... Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond .................................................................................................................................. Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-001451 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Yellow highlighted sections are new additions to this document, since the first version was shared on March 21, 2019. Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-001452 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-001453 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 14-1401 CK 19-1904 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-001454 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-001455 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-001456 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-001457 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-001458 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-001459 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-001460 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-001461 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-001462 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. *AMD Capacity proposals should be requested in Section A- Cross-cutting – AREA A: SURVEILLANCE, DETECTION, AND RESPONSE- Strategy 1b (page 75) Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Two other related programs and projects in this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-001463 • G. Hospital-acquired infections and antimicrobial resistance To simplify the application process, for those two specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and through the program-specific activity (i.e., Activity F or G); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those two activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. H. Vector-borne Diseases (p. 156) Clarification to text found in the Funding Strategy section (p.157). The third bullet states: • Estimated average award amount: Approximately $266,000. The average award will depend upon the project activities (tiers) in which a jurisdiction participates. In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities. These jurisdictions must document capacity at lower tiers to be granted higher tier funding. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the text is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-001464 award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. I. Mycotics: Detecting and Preventing Fungal Infections (p. 167) Supplementary guidance was provided via webinar to applicants on March 28, 2019. Webinar slides are located in ELC’s REDCap file repository. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. • The Project J template was modified to include 3 “other” activity options per strategy. The new version of the template replaced the previous version, and can be downloaded directly from REDCap. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-001465 • • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. N. Parasitic Diseases Surveillance (p. 193) • Guidance for strategy 1c Expand Surveillance for STH surveillance and control strategies: The scope and intent of the proposed activities could include improving diagnostic capabilities and identification of parasites to detect STH infections and expanded surveillance for STH infections. Expanding surveillance could involve a prevalence survey or enhancing reporting of identified infections. Both epidemiological and laboratory activities can be included. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this • Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-001466 o information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Prepare a report identifying the populations and outlining strategies to improve coverage.  Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities.  Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks.  Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission.  Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-001467 • Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. W. Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats (p.264) • Please disregard Strategy X provided in the guidance, and respond comprehensively to Strategy 1g and Strategy 1h in the work plan. Strategy X was inadvertently omitted from the work plan template. o Strategy 1g: Strengthen connections across the health departments to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts o Strategy 1h: Advance innovative IT strategies to monitoring linked mother-child health information while minimizing burden NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-001468 NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. This column is not mandatory and in the absence of specific guidance, it can be left blank. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-001469 laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” For personnel line items: Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. For non-personnel line items: a. Contracts (non-personnel), maintenance/service agreements, etc. can have the designation of ‘C’ (continuing) if the request received financial assistance in the prior budget period. The use of ‘C’ would not be applicable for those non-personnel items that were funded as one-time only funding or through post-award actions (e.g., carry-over, redirection, etc.). b. Travel, if it is a required element of a position request that also has a ‘C’ designation, can be denoted as ‘C’ (continuing). For example, if a regional epidemiologist is a position that received financial support in the prior budget period and the request is for continued funding in the upcoming budget period; plus, the travel in the budget is required for the activities of the position to be completed then the travel can also be designated as ‘C’. If the travel is to attend various meetings, conferences, trainings it should be designated as ‘N’ (new) even if it was requested and supported in the prior budget period because this travel would be part of new activities in the new work plan, as opposed to an element under a previous-supported position. ELC Data Management Plan (DMP) Checklist While the Data Management Plan requirements in the 2019 ELC NOFO specifically pertains to collection of public health data related to ELC-funded activities, we strongly encourage that efforts be made to make the DMPs as complete as possible. 1. Description of ELC Data - Describe types of data collected (e.g., performance measure data, financial data, success stories). Things to think about: • What data will be generated through programmatic activities? • What data types will you be creating or capturing? • How will you capture or create the data? • If you will be using existing data, how will you acquire it? 2. Period of data retention - Describe plans for archiving data or explanation of why that is not necessary. Things to think about: • How long will the data collector retain the right to use the data before opening it up to Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-001470 • wider use? Explain details regarding data retention periods. 3. Data format – Describe general data formatting standards. Things to think about: • Which file formats will you use for your data, and why? • What transformations to more shareable formats will be necessary to prepare data for preservation and/or data sharing? • What contextual details (metadata) are needed to make the data you capture or collect meaningful? • How will you create or capture these details? 4. Data dissemination – Describe how data will be disseminated and how other parties gain access. Things to think about: • How and when will you make the data available after data collection? (Include the resources needed to make the data available: equipment, systems, expertise, etc.) • Who gets access to data specifically? • How will data are to be shared and managed with partners and other major stakeholders? • What other types of information should be shared regarding the data, e.g., the way it was generated, analytical and procedural, information? • What is the process for gaining access to the data? • Will any permission restrictions need to be placed on the data? • Are there ethical and privacy issues? If so, how will these be resolved? • How will you manage data with sensitive information? 5. Data storage and preservation of access – Describe long-term strategy for storing, archiving and preserving data. Things to think about: • What is the long-term strategy for maintaining, curating and archiving the data? • Which archive/repository/database have you identified as a place to deposit data? • How long will/should data be kept beyond the life of the budget/project period? • What data will be preserved for the long-term and why? • What documentation will be submitted alongside the data or created for archival in order to make the data reusable? Centers for Disease Control and Prevention 22 TX-DSHS-19-1309-A-001471 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 23 TX-DSHS-19-1309-A-001472 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method wilf be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDF from .Eile... ~ PDF from .S.canner f'~ PDF from Web Page... Save as Otner EJcporlTo Shift+Ctr l +O f'e,PDF from .Clipboard ~ J.!➔..I ~:!!I Comb ine Files into a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF £ortfolio ... ~ udget.pd f PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001473 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-001475 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.p<.1 1~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.p<.lf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDF and save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001476 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q. We are having trouble accessing the assurances/certifications forms on Grants.gov, is there another way to access these required forms? A. All of the required assurances/certifications are covered by signing the SF-424B (Federal-wide assurances) and the CDC certifications document. Also, here is the online version of the CDC certifications (https://www.cdc.gov/grants/additional-requirements/index.html). Q. Where can I locate the FY19 NOFO? A. The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A. The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A. The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q. What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-001477 Awards Made ELC NOFO Published Budget Web inar App licat ions Due Feb 28 2019 HAI/AR Perfo rmance M easures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toR EDCa.!! 2014-20 18 Closeout Report & 2018 Perfo rmance Measures Due Aug 1 Q. What is the application due date? A. The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A. Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q. When should we submit our Close-Out Reports? A. A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-001478 for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? A. To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q. What needs to be included in the overall Evaluation Plan that is referenced in the 2019 ELC NOFO? A. The requirement for an overall Evaluation Plan listed in the 2019 ELC NOFO is an artifact of new cooperative agreement elements which are hard-coded into the system. Given that the ELC portfolio consists of various programs & projects which each have evaluation plan components, the hard-coded requirement is redundant and less useful for ELC. Therefore, as part of the supplemental information, ELC is providing a checklist to help ensure the requirements are met without placing unnecessary burden on applicants. Please reference pp. 21-22 of this document for the DMP Checklist. Q. How do we address the needs assessment requirement to identify gaps and/or training needs in epidemiology and laboratory? Is there a particular assessment tool ELC wants us to use or are we to develop our own? A. Currently the ELC is working with partners (i.e., CSTE, APHL) to complete a list of competencies which will be used to develop a training repository on the CDC TRAIN platform. A standardized training assessment will be developed and provided to Recipients by ELC. The assessment will likely be completed by October 2019, and ELC will require Recipients to use this tool to complete the needs assessment activity under the Cross-cutting Epidemiology & Laboratory Capacity Program. In the work plan, applicants can refer to using the ELC training assessment tool to complete the activity. Q. The application template for the Cross-cutting Epidemiology and Laboratory Capacity Program only has three (3) ‘other’ activity options, is there a way to insert additional activities for priority requests? Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-001479 A. During the 2019 ELC Annual Meeting, there was a session on building a strong work plan which addressed the notion of ‘more is better’. Specifically, a strong work plan is one that has specific, measurable, achievable, realistic activities that can be achieved in the 12-month timeframe inherent with the budget period being funded. It is better to have a well-developed work plan that has targeted activities rather than have a work plan that includes numerous unrelated activities which may not address the priorities outlined in the NOFO guidance. Because the nature of the Cross-cutting Epidemiology and Laboratory Capacity Program is one of flexibility, there are a few (i.e., three) ‘other’ options where additional activities can be added so long as they related to the overarching strategies and ELC Overall Roadmap. In the rare instances where the three (3) ‘other’ options under the particular strategy are not sufficient, there are additional solutions. (a) The application template affords three (3) ‘other’ options per strategy, across all eight (8) strategies. This means that there is a total of twenty-four (24) ‘other’ options in the application template. If the three (3) ‘other’ options in the strategy being addressed are insufficient, then use one of the ‘other’ options in another strategy. To avoid confusion and ensure reviewers give proper credit, please note in the implementation plan which strategy/activity the entry addresses. (b) If the twenty-four (24) ‘other’ options still do not provide adequate room to address all planned activities in the budget period, there are overflow text boxes on the application template (under the ‘Approach’ tab) which can be used. If electing to use this option, please format the entries to correspond to what is listed on the ‘Work Plan’ tab (e.g., implementation plan, activities, milestones, etc.). Q. The new ELC NOFO (CK19-1904) does not seem to have continued support for activities under the current ELC Cooperative Agreement (i.e., CK14-1401), for the section on Public Health Laboratory Sustainability (Project F in CK14-1401). For those funded for lab sustainability, how can requests for continued financial support be made in the new ELC NOFO (CK19-1904)? A. The new ELC NOFO (CK19-1904) is not only a new 5-year funding announcement but also a restructuring of various infectious disease projects and activities to align better with current CDC programmatic goals and priorities. In terms of the Public Health Laboratory Sustainability section (Project F in CK14-1401), many of the activities have been incorporated into the newly defined activities in the Cross-cutting Epidemiology and Laboratory Capacity Program (section A of CK19-1904) in the 2019 ELC NOFO. While there may not be a one-to-one match, former activities under the lab sustainability project, if a priority for the jurisdiction, can be incorporated into the implementation plan when responding to the new activities within this section. Additionally, there are the three (3) ‘other’ options per strategy which allows for a customized activity to address work plan activities that do not logically fit into the pre-populated ones in the application template. Q. How can meetings (e.g., ELC Annual Meeting, CSTE, APHL) be addressed in the work plan or should they? 1111 A. Meetings, trainings, etc. are understood to be important and attendance is supported by the ELC. It is also appreciated that some jurisdictions are required to have documentation of the importance of Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-001480 meetings in order to obtain travel approvals. While meetings, trainings, etc. are not stand-alone activities they can be elements listed in the implementation plan for a more overarching activity (e.g., staff development, workforce training, etc.). The activity could have elements such as assessing training needs; attending meetings/trainings (e.g., ELC Annual Meeting, CSTE, APHL) to stay current on latest guidance, practices, etc.; taking information back and sharing with staff not able to attend; etc. As a reminder, milestones should reflect discrete points in the budget period that can be used to measure progress in completing the overarching activity (e.g., staff development, workforce training, etc.). One caveat, if in the 2019 ELC NOFO a particular program/project section specifically requires the listing of attending a meeting, etc. as an activity then to meet the requirements and ensure a strong application score, please follow the specific guidance as outlined in the NOFO language. Q. If a jurisdiction (e.g., a city) does not have the necessary infrastructure (e.g., lab testing) internally but relies on another jurisdiction (e.g., the state) how is this best reflected in the application? Also, is there a way for the benefiting jurisdiction (e.g., a city) to ask program reviewers to consider awarding funds to the partner jurisdiction (e.g., state) to help cover the extra costs for the support being provided? Can a recipient request funding in the budget and then ask the funding be awarded to another jurisdiction? A. Using a city/state relationship as an example, if the city has an established agreement/relationship whereby the state provides services (e.g., laboratory testing) which are necessary elements in the application then this should be noted in order to ensure that reviewers understand the resources are in place to meet the requirement. One potential way to demonstrate this relationship would be for the city and state to have a letter of intent/commitment, memorandum of understanding, etc. that both applicants would upload as supplemental material to their completed application. In terms of funding, the city would not put the request for financial assistance in the city’s budget template and then ask that the funds be directed to the state instead of the city. Requests for financial assistance can only be made by the jurisdiction in which the funding, if approved, will be awarded. In this case, the state would make the request for financial assistance noting the additional laboratory costs associated with providing testing services to the city. To strengthen the request, the city could provide a letter of support to the state which, in turn, would include it in the application as supporting documentation. Q. Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-001481 Q. Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q. Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o Enter these narratives on “approach” tab in each template. • Performance measures will NOT be collected with application. o To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. • The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. • Therefore, the activities names are hard coded. • Work plan details are not pre-populated, as this is the first of a five year period of performance • Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. • Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q. Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-001482 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. Is the way to use ‘C’ (continuing) as opposed to ‘N’ (new) the same in making personnel versus nonpersonnel requests in the budget template? A. Prior guidance (above) for Personnel support remains unchanged. To summarize: a. If it is the same position, same level of funding = ‘C’ b. If it is a new position in the program/project = ‘N’ c. Same position, new level of funding (e.g., increasing from 75% financial support to 100% financial support) i. Same level portion (i.e., 75%) = ‘C’ ii. Additional support requested (i.e., 25%)= Separate line entry and marked ‘N’ Non-Personnel requests have started to create a need for consistency in guidance; therefore: a. Contracts (non-personnel), maintenance/service agreements, etc. can have the designation of ‘C’ (continuing) if the request received financial assistance in the prior budget period. The use of ‘C’ would not be applicable for those non-personnel items that were funded as one-time only funding or through post-award actions (e.g., carryover, redirection, etc.). b. Travel, if it is a required element of a position request that also has a ‘C’ designation, can be denoted as ‘C’ (continuing). For example, if a regional epidemiologist is a position that received financial support in the prior budget period and the request is for continued funding in the upcoming budget period; plus, the travel in the budget is required for the activities of the position to be completed then the travel can also be designated as ‘C’. If the travel is to attend various meetings, conferences, trainings it should be designated as ‘N’ (new) even if it was requested and supported in the prior budget period because this travel would be part of new activities in the new work plan, as opposed to an element under a previous-supported position. - Q. In which program or project should I request support for cross-cutting training and peer-to-peer travel? A. It is recommended that any training/travel request in the budget relates to an activity in the work plan. Travel and training requests made in the Cross-cutting Epi & Lab Program should link to crosscutting outcomes. For trainings and travel specific to a program/project, please include these requests in the specific program/project application template. For the ELC Annual Meeting: • If the request if for the ELC Governance Team members to attend the ELC Annual Meeting, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For specific trainings or conferences, such as CSTE, Public Health Informatics, APHL, etc. Centers for Disease Control and Prevention 34 TX-DSHS-19-1309-A-001483 • • If the request is for cross-cutting epi &/or lab staff travel to travel to a specific conference, it may be requested in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For Peer-to-Peer Site Visits • If the Peer-to-Peer request is for cross-cutting epi &/or lab staff to visit another jurisdiction to either learn or share best practices, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. Q. Can requests for laboratory costs simply be entered into the budget template or does something also need to be added to the application template? A. In order to apply for funding an application must be submitted, which includes the completed application template & budget template. The application template is the one that includes the approach & work plan. In the work plan, there needs to be an implementation plan, an activity, and related milestone(s) which support the request for financial assistance. In the work plan, the activity could be at a higher level and incorporate both epidemiology & laboratory efforts necessary for achievement. Regardless, there needs to be something in the work plan that supports the financial request. In the budget template, the specifics about the laboratory requests for financial support can be detailed. In the justification section for each line item, information can be included which links the request back to the Strategy/Activity in the work plan. Q. For contractual requests, what information is needed and how do we provide it in the application? A. For details about the elements that need addressing pertaining to financial assistance that will go into contractual mechanisms, please see the OGS Budget Preparation Guidance which can be found at: https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf If the six elements are known at the time of application, they can be entered in the budget justification section on the budget template; or, they can be addressed on a separate document and uploaded as an attachment to the completed application. If not all the elements are known at time of application, then ‘TBD’ can be entered in the budget template; however, please keep in mind that the missing information will need to be provided to OGS within 30 days post award in order to receive the required priorapproval before entering into a contractual agreement. Q. Can a request for a position be placed at 100% under two programs/projects to ensure that the position is funded? For example, we need a position funded to primarily do HAI outbreak response work but not sure the HAI/AR Program will fund given the focus is on only three defined positions. As a backup, we would also like to place under the Cross-cutting Epi & Lab Program but this would mean the request exceeds 100% which we heard at the ELC Annual Meeting is not allowed. A. It is true that a position cannot be funded for more than 100% across all federal funding sources (e.g., ELC, PHEP, etc.). Additionally, requesting more than 100% funding for a position in the ELC budget template in one program/project is not permitted due to the data quality checks built into the tool. Understanding the intent of the request is the critical part in ensuring that the entries will not be seen as Centers for Disease Control and Prevention 35 TX-DSHS-19-1309-A-001484 violating the 100%-rule. If a position is requested in a program/project (e.g., HAI/AR) at 100% but there is uncertainty that the funding program will provide the requested financial assistance, then a second request can be made in the Cross-cutting Epidemiology & Laboratory Program. The way this type of request is made is by noting in the budget justifications section, at the beginning of the entry, that the position is also being requested in the other program/project. This will alert reviewers and the ELC Project Officers that the intent is to increase likelihood of funding, not that a duplicative funding attempt is being made. Q. If a position (e.g., epidemiologist, laboratorian) does work in various areas (e.g., food, influenza, etc.) should the position be split across the different projects/programs impacted, like has been done in previous budget periods, or should the request be placed in Project B: ELC Leadership, Management, & Administration because it is cross-cutting? A. If the position is providing support to complete activities in two or more programs/projects and has been funded in those sections in the previous budget period, keeping them in the same programs/projects allows for designating them as ‘C’ (continuing) positions. There is the opportunity to transition the position into the Cross-cutting Epidemiology & Laboratory Program; however, listing the position there would necessitate noting the position as ‘N’ (new) given that the position had not previously been supported in this section. It is important to keep in mind that while there is no limit on the number of position requests made in the Cross-cutting Epidemiology & Laboratory Program section, there is a finite about of funding available for this program. While application to the ELC Leadership, Management, and Administration Project is encouraged, the intent of the project under the Cross-cutting section of the 2019 ELC NOFO is to provide dedicated resources for the optimization of ELC funding through leadership, coordination, and fiscal management. While the responsibilities of the positions in this section will function across the ELC portfolio, it is for the purpose of leadership & management rather than assisting in the completion of various activities in work plans across programs/projects. Q. What are some of the new ELC Budget Template Features? A. There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the Centers for Disease Control and Prevention 36 TX-DSHS-19-1309-A-001485 total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users Centers for Disease Control and Prevention 37 TX-DSHS-19-1309-A-001486 Submitting Your Applications Questions Q. Where do I submit my completed application? A. Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Q. Are recipients still required to submit applications to GrantSolutions? A. No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q. How do I gain access to REDCap A. In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Q. What should we submit via REDCap? A. The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q. What resources will be available for recipients to complete applications? A. The ELC will release the following resources to assist recipients with completing and submitting their grant application: Centers for Disease Control and Prevention 38 TX-DSHS-19-1309-A-001487 Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". Centers for Disease Control and Prevention 39 TX-DSHS-19-1309-A-001488 • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com. 7. Program-Specific Frequently Asked Questions and Guidance Project C: Health Information Systems Capacity Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 40 TX-DSHS-19-1309-A-001489 ELC Health Information Systems Application Information The following information is provided to help jurisdictions complete the ELC HIS application. Please reach out to edx@cdc.gov for any questions regarding the ELC HIS application. The application templates this year are similar to last year. Please note: 2018/Budget Period 5 (BP5) activity-level progress reports and BP5 performance measures will not be collected with the new NOFO application, and will be collected in close-out reports in late October 2019. The application template for the FY19 NOFO includes four tabs (sections): 1) Home Page 2) Approach 3) BP1 Work Plan and 4) Guidance. An updated Budget Template will be used this year. Home Page The Home Page, as shown below, provides instructions on how to complete, print and PDF your application template, and provides space for contact information for the person completing the application template. Select a Jurisd iction) First Name : Last Name : Email: Phone : Posit ion/ T"itle : Project lead 's Contact tnrormatlon Alternate POCContact tnro (Optlonal) Instructio ns.: Please proc eed to the Approac h a nd then BPl Work Pla n ta bs to complet e all a ct ivities and fields . Printi ng or Uploading t o Grant Solutions : Use the button to t he right o expo rt the oo l o a PDF. Once in PDF orm at, you may pr int, or sa ve and upload , s ect ions o th e to ol by s pecifying th e des ired pag e numbe rs during prin ·ng. Depending on the version of Microsoft Excelyo u are using, you may ob ta in bd t u results by print ing to the "Microsoft Print to PDF" printer item (under File, Print) . Make PDF Spell Check: Use the follow ing bu tton to run s~ ll check ac ros s th e ent ire documen t. Note tha th e fo rm may freeze if spe llc heck process is inter ru pted or ca nceled befo re complet ion. Spell Check Submission : Please refer to i:uidance provided by the ElC team for subminion of application templates to Grants.gov and REDCapELCApplication and Monitoring Portal. Supporting Documentation Documents can be included to support information in the application (e.g., document with the name and address of hospitals/facilities identified to be onboarded for syndromic surveillance, organizational charts, workflow diagrams). You may upload documents to the supporting documentation section of the ELC Application and Monitoring Portal 2019–2020 REDCap project located at the bottom of the Completed Application Templates page. Update to HIS Tier 1 Requirements in NOFO NOTE: There is a typo in the Tier 1 summary listed for Project C (page 52 of the NOFO). It should reflect the required activities listed in the Project C section. Specifically: 1 TX-DSHS-19-1309-A-001490    Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. 2018 Application Work Plan vs 2019 Application Work Plan The differences between the information requested in the previous and the new ELC HIS application are listed in the following chart. Although Strategy 1, Enhance Health Information Systems Workforce, is no longer a strategy, ELC HIS is committed to providing cross-cutting flexible IT/informatics personnel to accomplish the strategies and activities. BP5 (2018-2019) I: Enhance Health Information Systems Workforce a. Designate a public health information systems specialist with flexible responsibilities… b. Develop and sustain core personnel needed to support integrated surveillance systems… c. Develop and sustain personnel resources to support and advance electronic data exchange… d. Increase public health informatics and information technology skills…through training… II. Advance Electronic Information Exchange Implementation a. Increase the percentage of lab reports received through ELR. b. Automate the use of all ELR. c. Increase ELR based on Meaningful Use (MU) standards. d. Increase public health laboratory capacity for electronic data exchange. e. Participate in the ELC Health Information Systems Implementation Support and Monitoring effort f. Implement new HL7 NNDSS Case Notification Messages. BP1 (2019-2020) No longer a separate strategy for HIS. See guidance below for including personnel and workforce in Applicant Capacity I. Strategy 1h: Advance Electronic Data Exchange… I.a.i. Maintain existing ELR transmissions (required) I.a.ii. (Required for jurisdictions below 75%) Increase ELR… I.a.iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way I.a.iv. Develop or enhance ELR data quality assurance processes No longer included as a separate activity I.c. Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. I.d. Advance electronic data exchange for Public Health Laboratories. No longer a separate activity for HIS. See guidance below in Applicant Capacity. I.b.i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (required) 2 TX-DSHS-19-1309-A-001491 g. Implement electronic case reporting (eCR). h. Create the capacity to transfer ELR messages and eCR messages between jurisdictions… III. Sustain and/or enhance integrated surveillance information systems I.e.i. Implement electronic case reporting (eCR) I.f. Advance electronic information exchange between jurisdictions II. Strategy 1i: sustain and enhance information systems… II.a. Maintain existing information systems… a. Maintain existing surveillance information including the personnel and operating system. environment/supporting software (required) b. Implement (if appropriate) a new/replacement II.b. Implement (if appropriate) new/replacement integrated surveillance information system. information systems. c. Enhance existing integrated surveillance II.c.i. Enhance existing information system(s) by information system(s) by adding or improving adding or improving functionality for Integrated functionality… surveillance information system; II.c.ii. LIMS; II.c.iii. Syndromic surveillance information system d. Move, or explore the efficiencies of moving, II.d. Implement additional innovative an existing or new integrated surveillance enhancements that improve analysis, enable labinformation system to a cloud-based/hosted epi collaboration, or increase the sustainability or environment. efficiency of systems… e. STD surveillance II.c.i.b. Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. II.c.i.c. Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. II.d. Innovative enhancements that improve analysis, enable lab-epi collaborations or increase sustainability or efficiencies of systems. II.e. Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. Approach The Approach tab (new) is designed to capture how the applicant will address the public health needs for their jurisdiction and/or the population they serve by clearly stating the problem, providing justification on how your jurisdiction will address the identified problem through activities, outlining the resources that will be used to address this problem through the suggested activities and how this entire plan will be evaluated for the current year. Under the Approach tab, you have fields for the Problem Statement, Justification, Applicant Capacity, and Evaluation Plan 2019. Additional information is provided below to assist with the Applicant Capacity and the Evaluation Plan for 2019 sections. Applicant Capacity Applicant capacity should include information to address the jurisdiction’s current capacity to successfully implement the proposed strategies and activities including staff and infrastructure in place that will be sustained or enhanced. This section should include staff for supporting flexible IT resources, to support electronic data exchange and integrated surveillance (previously included in Strategy 1) to 3 TX-DSHS-19-1309-A-001492 implement, maintain, or enhance integrated surveillance information systems, and the infrastructure and support to advance electronic data exchange (e.g., ELR, case notifications, syndromic surveillance, eCR). Supporting documentation (e.g., organizational chart, pictures or graphics of system processes) may be included to support the narrative. Be sure to also include information to support the following cooperative agreement requirements (page 83 of ELC NOFO) in this section:  Designate a person with overall responsibility for HIS activities (i.e., lead public health information systems specialist) and personnel responsible for each activity. This should include key personnel resources in IT, public health informatics, surveillance, and public health laboratories responsible for the implementation, enhancement, and maintenance of:  Integrated surveillance system  Electronic Laboratory Reporting  Syndromic Surveillance  Participate in ELC HIS implementation, support, and monitoring efforts.  Participate in Technical Assistance consultation assessment to identify priorities.  Work with CDC to measure key aspects of implementation (e.g., ELR volume at least once during the project period, HL7 case notifications sent to CDC, emergency departments (EDs) onboarded and sending data to CDC BioSense).  Participate in efforts to define consistent ways to link surveillance data to laboratory findings from public health labs and CDC labs for all conditions. Evaluation Plan for 2019 Describe the plan and the ability to collect the necessary data to report on each of the performance measures associated with the proposed activities (see table below, information in red is required) and the cooperative agreement requirements for measuring key aspects of implementation (e.g., percentage of ELR volume, HL7 case notifications sent to CDC, Emergency Departments onboarded and sending data to CDC BioSense). Activity Maintain and enhance Electronic Laboratory Reporting (ELR). Implement New NNDSS Case Notification Messages Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED)…. Establish electronic test ordering and reporting (ETOR) using HL7 messages with 1 or more hospitals or public health labs. Performance Measure Percent of lab report volume received through ELR Percent of conditions for both state reportable and nationally notifiable conditions that use the new HL7 format Percent of emergency departments (EDs) sending HL7 Promoting Interoperability (formerly MU) compliant syndromic surveillance messages to the health department and BioSense Platform1 Number of hospitals and public health labs with established electronic ordering and reporting (ETOR). 1 Required if funded for Syndromic Surveillance. If jurisdiction is only using CDC BioSense, health departments do not need to receive the messages directly. 4 TX-DSHS-19-1309-A-001493 Enhance systems to automated processing and use of ELR Percentage of STD case investigations (e.g., Chlamydia, Gonorrhea) auto-created from ELR. For the first year of the cooperative agreement, there is not a separate tab for your Progress Report. The progress report and performance measures will be captured later in the year in a closeout report. Highlights and additional information to describe proposed activities, including baseline information, can be included in each activity’s Implementation Plan under the BP 1 Work Plan. ELR volume will be collected once during the 5 year cooperative agreement for jurisdictions above 75% ELR. For jurisdictions below 75% ELR, volume will be collected annually as it has been in the past. CDC reserves the right to request ELR volume during the cooperative agreement as necessary for inquiries and funding justifications. CDC would provide guidance and ample notice in the event of a request. We recommend documentation of the volume calculation methodology at your jurisdiction to ensure that a volume request would be completed accurately and within the needed time frame. BP (Budget Period) 1 Work Plan The BP1 Work Plan section of the application template is where the applicant will outline the proposed activities, implementation plans, and milestones for Budget Period 1 (BP1). The BP1 Work Plan section is very similar to last year. Key differences include all activities are built into the template (no drop-down option to select activities), and all activity sections are expandable/collapsible for easy navigation. All required activities need to be included in the application. All other activities included in the application should be based on jurisdiction need and capacity. All implementation plans for each area should highlight successes, how barriers and challenges will be addressed, and how achieving identified milestones improve performance. Additional information to assist with completing the application for selected activities is listed below. NOTE: All activities or implementation milestones may not be included in the examples of implementation plan or milestones (i.e., development of process to enhance ELR data quality and assurance, etc.). Strategy 1h: Advance Electronic Data Exchange Electronic Laboratory Reporting a.) Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. i. (Required) Maintain existing ELR transmissions ii. (Required for jurisdictions below 75%) Increase ELR - propose and execute a plan to increase the volume and percentage of lab reports received through ELR over the next year iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way (vs. re-keying or manually uploaded). iv. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. Implementation Plan may include: i. Plans to maintain ELR, including baseline and target percentage of ELR volume a. Jurisdictions above 75%: Continue to establish ELR with labs, as appropriate 5 TX-DSHS-19-1309-A-001494 ii. iii. iv. Jurisdictions below 75%: Propose and execute a plan for the next year to increase the volume of ELR to reach 75%, move to next quartile (i.e., 50%), or have a minimum increase of 10%. The plan should include: a. Highlights and successes with onboarding over the past year b. High level summary of labs to be onboarded including estimated increase in ELR volume c. How barriers and challenges will be addressed Enhanced processes for ELR to be entered into surveillance system in an automated way. a. This may include efforts for accepting CDC ELR. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. a) Maintain and enhcnce Electronic Laboratory Reporting (ELR}to enable public health agencies to rece ive reports from labo rator ies in a more efficient electronic format. Hide A:t ivity Expand Act ivity BP Imp lem ent at ion Plan 11000 char) The goa l for BP1 is to increase the a nnu a l ELR percentage from 6~% to 75 %. Act ivit ies inc lude va lida t ing the str ucture a nd conter t of messages . a nd pr ovid ing t ime ly a nd acc ura te feed bac k for message refinement. We success fu lly onboa d ed La bcorp with min ima l iss ues a nd our la rgest hos p ita l system cons ist ing of SO fac ilit ies . We a re ta rget ing bet.veen 4 a nd 5 systems to move from Accepta r ce Tes t ing to Prod uct ion for eac h qua rt er. ELR vo lume percentage will be s ign ifica nt ly impac ted by Ques t a nd tva yo go ing live. Ques t a nd Ma yo contr ibute a ppr oxima te ly 10% of report s se nt to the sta te hea lth depa rtm ent Mos t of the rema in ing hos p ita l systems ha ve outsta nd ing cha llenges . Cha llenges inc lude incorr ect message structure. vendo r incons istenc ies . miss ing res ults. a nd LIS upgrades or switches . Co n t inu ed ELC H IS f:'-PPOrt for t h e !:t a ff w h o !:u pp o rt ELR o n b oa r d ·n s a n d m a in t en a n ce if: c r it ica l t o br in g onboa rd ing goa ls to fru it ion. The fo llowing sta ff ma nage a nd coord ina te ELR onboa rd ing tas ks: John Smith • ELR coo rd ina tor for our jur isd ict ion Jaso n Ha ll • Message Va lida tor Miche le Hoo ver • Surve illa nce System ma nage r Milestones:     List of specific facilities that you plan to onboard. Examples of how to complete that would be: o Facilities per quarter on each row o Facilities by lab type (e.g., hospitals/hospital systems on 1 row, large reference lab on the next row, etc.) o Hospital systems per row You do not have to list each facility individually per row, there are options of how to relay this information as listed above. Enhancing ELR data quality and assurance processes, as applicable. Jurisdictions above 75% should continue to onboard new labs, as appropriate, to improve volume of ELRs received. 6 TX-DSHS-19-1309-A-001495 BP Mile:stones1255char) Our ju ri sd i cti on w ill mov e t he a ll ow i ng h os pit a l syst e ms ro m t est to pro d ucti on : Bapt i st Hea lt h Chil d re n's Hea lt hca re HCA Hamil to n Hosp,it a l Syst em These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,erce nt age by S p ercent age po i nt s. Our ju ri sd i cti on w ill mov e t he a ll ow i ng re ere n ce l ahs i nto pro du cti o n: Quest Di ag nost i cs Mayo Cli n i c Dept . o Lab Med Pat h ol ogy These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,er-ce nta ge hy 10 percent age po i nt s. Our ju ri sd i cti on w ill cont i nu e to mo nitor ELR da t a q ua li ty vi a -custom a b l ea u das hbo ards a nd mo nt h ly a udit i ng re port s. W e w ill add ress da t a q ua li ty iss ues see n i n ,curre nt o nbo arded f eeds . W e w ill cont i nu e to e nsure t h at ELRs are de li ve red a utom at i-ca ll y to ou r i nt egrat ed surve ill ance syst e m. PersonResponsible ELR Coo rd i nator Message Va li da tor Surve ill a nce Syst em Ma nage r Achieveby Date July2020 ELR Coor d i nator Message Va li da tor Surve ill ance Syst em Ma nage r Febr ua ry 2020 Surve ill a nce Syst em ma nage r July 2020 I Surve ill a nce Syst em ma nage r July 2020 r.;- NNDSS Case Notifications b.) Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (a) Extract, translate and transmit the data for conditions contained in 5 additional finalized HL7 Nationally Notifiable Message Mapping Guides using the new HL7 case notification structure and retire the corresponding legacy formatted transmissions. (b) Use the CDC NNDSS onboarding process to receive approval for the new HL7-based case notifications before production transmissions are initiated or legacy transmissions are retired. Implementation Plan may include:   List of MMGs previously onboarded and in progress. Plans to implement and onboard at least 5 additional new HL7 Message Mapping Guides including: o Highlights and successes with onboarding o High level summary of MMGs to be onboarded in Yr01 o Description of barriers and challenges and how they will be addressed A list of finalized MMG and Artifacts and event codes (included under MMG Related Documentation) are available at NNDSS HL7 Case Notification Resource Center. Additional resources and information to request technical assistance are available at the NMI Technical Assistance and Training Resource Center. 7 TX-DSHS-19-1309-A-001496 b) Suppo rt CDC'sabilit y to monit or, cont rol, and preven t diseases and ot he r healt h t hreat s by standa rdizing the repo rt ing of surveill'ance dat a (requi red fo r all repo rt ing ju risdictions). Hi de Act iv ity Expand Act iv ity BP Implementa t ion Plan (1000 char) W e p l a n t o i mp l ement case n ot i i cat i o ns o r 5 i nal i zed HL7 Nat i o na ll y Not i i ab l e MM Gs: M ump s, Pert uss i s, Va r i cell a, Hepat it i s, S. D an d Co ngen it a l Sy p h ili s. Gen v 2 and Ar b ov i r a l 1.3 w ere on boa rded an d dat a i s bei ng t ra nsmitt ed success u ll y to CDC. Key pro cesses l ea d i ng u p to on bo ard i ng i ncl u de i na li zat i o n of t he MM G (so me a re i n p il ot st age). ga p an a ly si s a nd page devel opm ent , da t a port i ng , a n d da t amart dev el opm ent. he l att er i s p a i red wit h d i sease-s pecif i c mo d u l e i mp lement at i o n to ensu re da t a av a il abili ty . Each MM G i s est i mat ed to t a ke 3 mo nt h s rom ga p a na ly si s t o HL7 on boa rd i ng. As new MM Gs a re-read y fo r p il ot t est i ng, t he Su rv eill an ce Sy st em M an ager w ill o rga ni ze t he pr oj ect t ea m a nd ma nage t he ov era ll i mpl ement at i o n sc hed u l e. S.ig ni i ca nt new w or k d u r i ng t h i s per i od w ill be needed to mo d ify o u r su rv eill an ce sy st em t o co mp l et e-MM G i mp l ement at i on . MM G i mp l ement at i o n w ill be-p r i ma r il y managed by t he su rv eill an ce sy st em manager . Milestones:   Guides in progress. Examples of how to complete that would be: o Each line can be its own MMG along with steps for implementation o Grouping prioritized MMGs per row o Grouping MMGs by quarter These are not the only options, only examples of how it can be done based on your jurisdiction’s preference. BP Milesto11es(255 cl1art Ach.ieve by Date Perso11Respomi.ble I mp l ement M ump s, Pert uss i s and Var i cell a MM Gs Surv eill ance Sy st em manager Oct ober 20 19 I mp l ement Hepat it i s MM G Surv eill ance Sy st em manager Janu ary 2020 I mpl ement S D and Congenit al Sy phili s MM Gs Surv eill ance Sy st em manager Apr il 2020 Ensure our surv eill ance sy st em has t he req ui r ed updat es Surv eill ance Sy st em m anager July 20 20 to i mp lement add it i ona l MM Gs. Att end ongo i ng eSHARE webi nar s and st ay up t o dat e w it h Surv eill ance Sy st em manager July 20 20 MM G nat i onal pro gr ess v i a NM I Not es Syndromic Surveillance Note: All ELC recipients are eligible to apply for syndromic surveillance activities. c.) Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. i. Increase coverage and number of facilities submitting syndromic surveillance data to the BioSense Platform according to jurisdictional needs (a) (Required for any jurisdiction applying for Syndromic Surveillance funding) Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED) and urgent care facilities with messages that include the NSSP priority 1 and 2 data elements. ii. (Required for any jurisdiction applying for Syndromic Surveillance funding) Participate in the NSSP Community of Practice and other efforts to strengthen syndromic surveillance practice and use. This may include participation in meetings, workshops, and trainings; development of collaborative projects; increase use cases and practical applications by public health 8 TX-DSHS-19-1309-A-001497 programs; share lessons learned and best practices, and providing feedback on the BioSense Platform. (a) Develop or enhance data quality control and assurance processes (b) Enhance timeliness of messages sent to jurisdiction systems and to NSSP BioSense Platform. iii. Enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements. iv. Develop or enhance syndrome monitoring and response protocols. v. Develop at least two collaborative projects (one with a CDC program) where syndromic surveillance can be used to address health department surveillance data needs. Projects done in collaboration with CDC should include sharing the syndromic data with the CDC program through the BioSense Platform. Implementation Plan should include: i. ii. iii. iv. v. If currently sending data to the NSSP Platform: Propose and execute a plan to maintain or onboard new emergency department (ED) or urgent care facilities and send data to the NSSP BioSense Platform, with a focus on HIDTA counties. Include: a. Successes with onboarding facilities in the past year. b. High level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal to submit additional information as needed regarding facilities. c. How barriers and challenges to onboarding will be addressed. If currently not sending data to the NSSP BioSense Platform: Develop and execute a plan to onboard new or existing facilities data to the BioSense Platform, with a focus on HIDTA counties. Include: a. Current facilities sending data to the jurisdiction system. b. As appropriate, high level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal as needed to submit additional information regarding facilities. c. How barriers and challenges for onboarding will be addressed. Plans to enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements, including data elements and the facilities/systems who will be contacted to address issues. Plans to enhance timeliness of messages sent to jurisdiction systems and NSSP BioSense data, including identification of facilities/system identified who will be contacted to address issues. Identify specific syndrome monitoring and response protocols that will be developed or enhanced. Development of at least two collaborative projects (one with a CDC program). Collaborative projects include:  Working with any public health partners including local health departments, other state health departments, and program areas (e.g., injuries, hepatitis, HIV, other infectious diseases, opioids).  Potential projects could include using syndromic surveillance data to assist with: o Public health investigation o Providing information to provide communications for decision makers, health providers, media, etc. o Development of additional specific surveillance activities based on syndromic data 9 TX-DSHS-19-1309-A-001498 o Identification of need for public health intervention See https://www.cdc.gov/nssp/success-stories.html for examples of collaborative projects. Hide Act ivity Expand Act ivity BP Implementation Plan (1000 char) Our j urisd ict ion has be-en us ing syndrom ic s urveill a nce (SyS) s ince 2009 a nd a re a mem ber of t he NS.SP Commun ity of Prac t ice. We curr ent ly se nd t o BioSense a nd have 25 eme rge ncy de pa rt ments a nd 10 urge nt ca re centers s ubmitt ing syndrom ic s urveill a nce da t a t o our HIE (se,e s upp leme nt a l info rma t ion or t he list of on boa rded fac ilit ies ). We will priorit ize increas ing t he nu mber of bot h eme rge ncy de pa rt me nt s a nd urge nt ca re centers t hat s ubmit syndrom ic s urveilla nce da t a t o t hough t he st at e HIE a nd will oc us efforts on high intens ity drug tr a fficking a rea (HIDTA) co unt ies . As mo re ac ilit ies a re onboa rded , we a nt icipat e increas ing our coverage . As a co lla borat ive project. we pla n t o increase s urveill a nce of ILi by working wit h t he de pa rt ment o ed uca t ion t o obta in data t o tr ac k sc hoo l a bse nte,eism . Milestones:      Identify which facilities to be onboarded including name and address of facility and how targeted facilities will increase coverage once onboard Specific data elements and facilities/systems identified to address issues with data quality Specific syndrome monitoring and response protocols that will be developed or enhanced Ensure/improve timeliness of reporting to BioSense platform Key milestones for collaborative projects BP Milestones (255 char) Perwn Responsible On boa rd 5 eme,rge ncy depa rt me nt s a nd 5 urge nt ca re Sy nd rom ic s urveill a nce Achieve by Date ce,nt ers (se,e de t a il ed li st o t a rge,t ed ac ilit ie,s in coo rd in at o r July 2020 s u pp leme nt a l info rma t io n) W ork wit h Best Hea t h Ca re syst em t o add ress da t a Sy nd rom ic s urveill a nce q ua lity iss ues ide nt i ied us ing a b lea u das h boa rd (see coo rd in at o r July 2020 s u pp leme nt a l infor ma t io n for li st of da t a e leme nt s ) Ens u re all da t a a rr ives at j u risd ict io na nd NS.SP Biose nse Synd rom ic s urveill a nce p la orm wit h in 8 ho urs . o rece ipt a t st at e hea lt h coo rd in at o r M arch 2020 depa rt me nt Cont inu e t o pa rt icip-at e in SS-re lat ed tr a in ings , Sy nd rom ic s urveill a nce w o rks ho ps a nd nat io na l web in a rs coo rd in at o r Ens u re rece ipt of sc hoo l abse nt ee ism da t a wit h 3 la rges t Sy nd rom ic s urveill a nce sc hoo l d ist ricts in o u r j urisd ict io n July 2020 December 20 19 coo rd in at o r Public Health Laboratories d.) Advance electronic data exchange for Public Health Laboratories. i. Create and send ELR based on Promoting Interoperability [formerly Meaningful Use (MU)] standards for all reportable conditions to or within the public health department. ii. Map local test, result, and specimen source codes to LOINC and SNOMED standards. iii. Establish electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. 10 TX-DSHS-19-1309-A-001499 Implementation and Milestones:    This section is for enhancing electronic data exchange for Public Health Laboratories including: o Plans for working to send PHL ELR messages for all reportable conditions. o Mapping local codes to LOINC and SNOMED standards o Establishing electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. This section is for HL7 messaging for ETOR activities. o If ETOR is proposed using a web portal, that activity should be included in Strategy 1i, activity C. This activity can include regional labs and state public health labs, but does not include CDC Labs. LIMS activities and milestones should not be included in this activity. LIMS enhancements should be included under Strategy 1i, Sustain and enhance information systems. d) Advance electronic data exchange for Public Health Laboratories . Hide Activity Expand Activity BP Implementation Plan (1000 char) Develop and im ple m ent an ETORinterfa ce wit h a loca l hosp ita l syste m, which se nt nea rly 3,000 STD repo rts to t he state public hea lt h lab in 2018. This will improve data qua lity , efficiency, and a llow t he state lab to de live r ELRsto our integ rated surv eillance syste m . We will also deve lop a pub lic hea lt h lab networ k wit hin ou r juri sdict ion's 12 reg ional pub lic hea lt h labs to improve electro nic data excha nge. Update t he LIS wit h new test codes and map t he m to LOINC codes fo r HL7 2.5 .1 trans miss ion pur poses . New test codes shall be ma ed wit hin 14 da softest code u date . BP Milestones (255 char) Person Responsible Develop and imp leme nt ETORinterface with loca l hospita l PHL Ma nage r s ste m wit h hi h vo lume of STD re orts Map new test codes to LOINCstandards PHL Ma nage r Achieve by Date July 2020 July 2020 (Select Date] [Select Date] (Select Date] Electronic Case Reporting e.) Advance electronic information exchange between electronic health records and public health. i. Implement electronic case reporting (eCR) (a) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for conditions published in the Reportable Condition Trigger Tables and use Reportable Conditions Knowledge Management System (RCKMS) for public health reporting decision support. (b) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for Chlamydia and Gonorrhea. Technical guidance on electronic case reporting for Gonorrhea and Chlamydia is available in a document named “Advancing ECR of STIs: Technical Guidance for Public Health Departments.” This document allows jurisdictions to choose different technical architecture of implementation while providing consistent guidance on the science of STI reporting. ii. Participate in national efforts by engaging in the: 1) discussion and development of eCR standards by participating in the HL7 Public Health Working Group; and 2) development and 11 TX-DSHS-19-1309-A-001500 updates to default reporting specifications and trigger codes by participating in the CSTE RCKMS vetting process iii. Participate in the RCKMS to author jurisdictional reporting criteria and maintain reporting specifications Implementation Plan and Milestones:  Describe a plan that includes details on partners and vendors and the data format that will be   used to send eCR (includes i.a. and i.b.). Plans for participation in national efforts High level overview of which conditions will be authored in RCKMS. e) Advance electronic information exchange between electronic health records and public health Hide Activity Expand Activity BP Im lementation Plan 1000 char Our ju risdict ion will part icipate in national eCR efforts. For 2018-19, our ju risdict ion part icip ated in RCKMS author ing for at least one set of RCKMSdisease-specific report ing specificat ions. This occurred with the establishment of Jurisdiction Adm i ni strator(s) , RCKMS accounts for relevant authors , and RCKMS tra ini ngs. We have selected 2 pi lot facili t ies and the ir respect ive EHRvendors (Epic and Sunquest ) who are exp lor ing the ir abili t ies to use tr igger codes . These pil ot sites are high volume faciliti es that have successfull y onboarded for ELRin the past. Our j urisdict ion inte nds to util ize the AIMS Hub to rece ive elCRs, whi ch with we have already estab li shed a connection. Our surveillance system will be enhanced to consume elCR , which is planned for the 3rd quarter of the BPl . We will cont inu e to stay up to date on national eCR progress and participate in the monthly eCR workgroup led by another ELCapp lic ant. BP Milestones 255 char Ensure necessary survei ll ance system enh ancements are comp leted to consume elCR formats Work wi th 2 pil ot facili t ies to send test elCRs to our surve ill ance system . Move 1 pilot facili ty into production for elCRsto be sent for STDcond it ions. Person Res nsible Surveillance System Manager Achieve b Date December 2019 Surveillance System Manager April 2020 Continue to part icip ate i n eCR workgroup meet in gs and w eb in ars. Stay up to date on nat iona l eCR efforts and Digital Bridge pilot project. Surveillance System Manager July 2020 Author at least 1 rule in RCKMS Surveill ance System Manager July 2020 Ensure stab ili ty of app licat ion where facili t ies can register Surveillance System Manager their int ent to send elCRs to the health dept . July 2020 Electronic Information Exchange between Jurisdictions. f.) Advance electronic information exchange between jurisdictions. i. Create the capacity to transfer ELR messages and eCR messages between jurisdictions. These transfers refer to the electronic sending of ELR and case data between two jurisdictions for a lab report or a case that was reported to one jurisdiction but belongs to another jurisdiction. Implementation and Milestones should include:   Partnering states, bidirectional/unidirectional, via AIMS or direct connection o Although the example given does not specify which partner will collaborate on interstate data exchange, be specific about who you’re proposing to work with. This activity is strictly referring to interstate (state to state) exchange and not intrastate (e.g., city to state). If you need assistance with intrastate exchange, you can submit an ELR Technical Assistance request. 12 TX-DSHS-19-1309-A-001501 f) Advance electronlc informa ,tion exchange between juris-dlctlons. Hi de Act ivi ty Expand Act ivity BP Implementation Plan 11000 char) ·w e w ill cont i nu e to , w ork w ith ne ighb or i ng sta t es t o exp l ore exchange o both ELRs and eCRs. W e have an esta bli shed mechani sm w ith t he AIMS hub , so i partn ers are w illi ng, w e are ab l e speci i c to ELRs. We have esta bli shed a bi di rect i ona l ELR ee d w ith 1 neighb ori ng ju ri sd i cti on vi a AIMS. Est abli shi ng th ese i nte rf aces w ill repl ace paper report s bei ng hand-e nt ered i nto our surveill ance syst em, and w ill i ncrease our ELR percent age. BP Milestones 1255 char) W ork w ith 2 neighb ori ng ju ri sd i cti on s t o se nd and receive ELRs vi a AIMS Monit or th e onb oa rd ed ELR eed al read y esta bli shed w ith a neighb ori ng ju ri sd i cti on Person Responsible Achieve by Date ELR Coordi nator Febr uary 2O:ID ELR Coor di nator Ju ly 2020 Strategy 1i: Sustain and Enhance info systems Maintain Information Systems a.) Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Implementation Plan and Milestones should include:  Maintenance needs for surveillance system, LIMS, syndromic surveillance system, and any supporting software. a) Maintain existing information systems , including the pers-onneland operating environment/supporting s-oftware necessary for them to function. Hi de Activi ty Expand Activity BP Implementation Plan (1000 char) W e w ill cont i nu e our mont hly meet i ngs w ith our surveil ance syst em cont racto r t o tr ack de li verabl es, and to revi ew and pr i or it i ze w ork. We w ill cont i nu e month ly i n-house devel opm ent meet i ngs, te chn i cal t ea m meet i ngs, use r group meet i ngs, and tr ai ni ngs . Mai nt enance o our syst em i ncl udes se rver and sof tw are upgrades . We w ill need to mai nt ai n un di ng or our surveill ance syst em cont racto r as w ell as our softw are li cense or th e too l s th at make usi ng t hese syste ms se cure and sust ai nabl e. Due t o exi st i ng i ssues w ith t he t rai ni ng portal, th e surveill ance syst em t ea m pl ans to rebu il d th e use r app li cat i o,n and dat ab,ase . An up dated tr ai ni ng envi ronment w ill p-rovi de a bett er un de rst andi ng o t he syst em and dat a quali ty expectat i on s. ·w e have st arted a pr ocess to docum ent_, eval uat e, and i mp rove th e oll ow i ng pr ocesses : use r tr ai ni ng, enr oll ment , access mo di i cat i on, dea ctivat i on, and BP Milestones (255 char) Mai nt ai n surveill ance syst em vendo r cont racts Mai nt ai n t rai ni ng port al ·or syst em use rs b,y up dat es use r ap,pli cat i on and data base Mai nt ai n i nteg rat i on engi ne and tr ansport i nt erf aces (SF P and PHINl'v1S eeds ) Mai nt ai n LIMS Mai nt ai n syndro mi c surveill ance syst em Person Responsible Achieve by Date Surveill ance Syste m Manage r Surveill ance Syste m Manage r July 2020 Ma rch 2020 Surveill ance Syst em Manage r July 202!0 Surveill ance Syste m Manage r and PHL manager Surveill ance Syste m manage r and Syndromic Surveill ance coor di nator July 202!0 July 202!0 13 TX-DSHS-19-1309-A-001502 b.) Implement (if appropriate) new/replacement information systems. Implementation Plan and Milestones should include:    Justification for transitioning to a new system Detailed work plan of requirements for replacement system How the plan for replacement will impact the particular program or jurisdiction 1:1)Implement (if appropriate) new/replacement information sy~ems . Hi de Activi ty Expand Act ivi ty BP Implementation Plan (1000 char) Our ju ri sd ict i on w ill exp l o-re th e po ss i b•ili ty o, repl ad ng our current Lead surveill ance syst em w ith a modul e w ith i n our i nt egrat ed surveill ance syst em. Our current syst em i s i ncapabl e o, p,rocess i ng HL7 messages and i s over 2Dyea rs ol d. Like many oth er ju ri sd i cti ons, Lead i s a high vol ume condit i o-n and tr ansit i oni ng to , th e i nt eg rat ed syst em w ill pos it ively i mpact da t a proc ess i ng, t i meli ness and BP Milestones (255 char) S.ch ed ul e at l eas t 4 de mos or th e Lead pro gram t o Achieveby Date PersonResponsible Lead Prog ram and S.urveill ance November 2019 get a th oro-ugh un de rst andi ng o, oth er surveill ance S.yst em Manage r syst em opt i ons and capabili t i es Com pl et e RFP pr ocess Lead Prog ram and S.yste m Manage r Deve l op, and t est Lead m odul e Lead Prog ram and S.yst em Manage r Go li ve w it h repl a-cem ent Lead mod ul e Lead Prog ram and S.yst em Manage r Po,st -pro ducti on bu g ix es and syste m eval uat i on Lead Prog ram and S.yst em Manage r S.urveill ance December 2019 S.urveill ance April 20 2:0 S.urveill ance June 20 2:0 S.urveill ance July 2:020 Enhancing Information Systems c.) Enhance existing information system(s) by adding or improving functionality. Prioritized enhancements are listed below, but other enhancements may be requested. i. Integrated surveillance information system: (a) Enhance systems to enable the automated processing and use of eCR (and if desired, Reportability Response) documents. (b) Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. (c) Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. If using a standalone CS database, migrate CS surveillance into an existing integrated information system. States using NBS version 5.3 or newer should use CS module available within the system. (d) Enhance systems to enable the automated processing and use of ELR, including complete susceptibility findings. ii. LIMS (a) Enhance system to enable the automated processing and use of HL7 electronic test orders. (b) Consult with CDC to evaluate options for implementing and integrating a web portal to support electronic test ordering and reporting (ETOR). iii. Syndromic surveillance information system 14 TX-DSHS-19-1309-A-001503 (a) Explore, evaluate, and incorporate new data sources at your jurisdiction that can enhance syndromic surveillance. Implementation Plan and Milestones should include: For the integrated information system  Provide a high level overview of plans to enable automated processing and use of eCR documents.  Describe a plan for transitioning STD, including legacy data, into an existing or replacement system and how the plan will impact the STD program.  Describe how the jurisdiction will transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. Hard copies of congenital syphilis case report forms will no longer be accepted by CDC’s STD program.  Describe a plan for being able to automatically process and use full ELR, including complete susceptibility findings. For LIMS  Include LIMS maintenance and upgrade activities or LIMS replacement plans.  Provide a high level overview of plans to enable the automated processing and use of HL7 electronic test orders.  Prior to the development of a new web portal to support electronic test ordering and reporting (ETOR), plan to include a consultation with CDC to evaluate options. For Syndromic Surveillance  Develop a plan to identify additional data sources to be added to the jurisdiction data system and how they will be used. c) Enhance existing information system(s) by adding or improving functionality. Hide Act ivi ty Exp and Act iv ity BP Im lementation Plan 1000 char Our j urisdiction is curr ent ly on t he lat est v ersion release of ou r int egrat ed surve ill ance syst em . Enhancemen t act ivit ies w ill be focused on t est ing and imp leme nt at ion of surve ill ance sy st em upg rades; and upda t es and dev elopme nt of Tableau dashbo ards. The surve ill ance syst em manageme nt t eam is curr ent ly w orking on dat a ro ut ing en hancemen t s w ill aut oma t e curr ent manua l assignmen t s, facili t at ing dail y inclusion of ne w codes and fac ili t at ing qua lity assurance on all exist ing code comb inat ions . Toget her t hese efforts w ill imp rove f unct iona li ty and dat a qua li ty fo r ou r use rs, and improve pub lic healt h response and analysis.The nex t ve rsion release wi ll ensu re t hat elCRsand ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em . The curr ent STD surve ill ance syst em is no longe r supp orted by CDCso plans w ill be made t o m igrat e STD surve ill ance int o ou r int egrat ed surve ill ance syst em . The PHL LIMS syst em w ill be upg raded t o t he lat est ve rsion w it h t he assist ance of t he PHL vendo r. BP Milestones 2!.5 char Upgrade t o t he lat est ve rsion release fo r int egrat ed surve ill ance syst em ; Cont inue t o ensu re all ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em Person Res nsible Surve ill ance Syst em Manage r M igrat e STD surve ill ance from legacy syst em t o t he int egrat ed surve ill ance syst em Upgrade PHL LIMS t o lat est ve rsion Enhance synd rom ic surve ill ance syst em t o inco rpo rat e ne w dat a sou rces Transit ion any rema ining hard cop ies of congen it al syph il is case report fo rms t o an electron ic f eed STD Prog ram and Surve ill ance Syst em Manage r PHL Manage r Syndrom ic Surve ill ance Coordinat or STD Program and Surve ill ance Syst em Manage r Achieve b Date January 2020 July 2020 July 2020 July 2020 December 2019 15 TX-DSHS-19-1309-A-001504 Innovative Enhancements to Improve Collaborations with Lab and Epi data. d.) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Illustrate projects: i. Enable lab-epi collaboration by identifying and implementing a universal case identifier (or similar linking variable) to include with laboratory and case data transmission (e.g., patient identifier that links data from health systems; identifier to link PulseNet data to case reports). ii. Develop systems or tools for public release of public health data. iii. Explore the efficiencies of moving an existing or new information system to a cloudbased/hosted environment. iv. Identify software or platforms that enable the integration and visualization of surveillance and laboratory data. v. Identify solutions to integrate AMD data with surveillance data for analysis or visualization. Implementation Plan and Milestones should include:  Any other projects or enhancements that promote collaboration or efficiency. For example, universal patient IDs, moving a surveillance information system to a cloud-based/hosted environment, data sharing/release, epi-lab data integration, or data visualization. d) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Hide Act iv ity Expand Act iv ity BP Im lementation Plan 1000 char Our j urisdiction needs modern and af fo rdable t echno logy solut ions t o de li ve r produ cts and serv ices t o ou r prog rams. We have been w orking w it h Amazon on t he Amazon Cloud Com put ing (AWS) dat a cent er m igrat ion . We w ill com plet e a proo f of conce pt , m igrat ing in t est mode a num ber of app li cat ions . Our surve ill ance syst em , int egrat ion eng ine and ot he r supp ort ing infras t ructu re t echno logies w ill be moved t o AWS. This w ork w ill requ ire us t o exam ine and add ress any surve ill ance syst em security concerns , and updat e curr ent processes and archit ectu re t hat won 't be supp orted in AWS. BP Milestones 255 char Deve lopmen t of M igrat ion Plan t o Amazon Web Service (AWS) Cloud and com plet e m igrat ion Im pleme nt updat es t o ELR Tableau dash boards on a quarte rly basis Achieve b Date Person Res nsible Surve ill ance Syst em Manage r July 2020 Surve ill ance Syst em Manage r and prog ram leads July 2020 [Select Date ) Advanced Molecular Detection (AMD) Technical Infrastructure e.) Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. i. Implement management and analytic software ii. Increase network bandwidth and computing power and/or use cloud infrastructure to support AMD initiatives This section is focused on providing support for the technical infrastructure needed to support AMD. It does not include diagnostic equipment, sequencers, testing supplies, or personnel using the data. All laboratories that submit reportable lab findings to public health via ELR should submit reportable antimicrobial resistance (AR) laboratory findings via ELR, with messages conforming to nationally 16 TX-DSHS-19-1309-A-001505 accepted standards, validated for accuracy and completeness of content and structure when sent or received. Laboratories that are not currently reporting via ELR are encouraged to do so, especially as electronic reporting of AR is a compelling reason to develop this capacity. Additional information is available through the CSTE’s Best Practices for Surveillance of Antimicrobial Resistance via Electronic Laboratory Reporting and the Antimicrobial Resistance Surveillance Task Force Year 2 Report and Recommendations. Implementation Plan and Milestones may include:     Procuring Cloud Infrastructure (e.g., cloud storage, computing processing) Increased bandwidth for network infrastructure Specialized software to assist in using AMD data with epi data Increase in-house computing processing and storage e) Increase HIS capacity to support Advanced Molecu lar Detection (AMD) activities. Hide Act ivi ty Expand Act ivi ty BP Im lementation Plan 1000 char In ou r wo rkplan t o t ransit ion t o t he AWS (see prev iou s activ ity ), w e w ill inclu de clou d procu rem ent fo r st orage of AMD dat a. BP Milestones 255 char Wo rk w it h procu rem ent t o acquire add it iona l st orage fo r AMD dat a Person Res nsible Surve ill ance Syst em Man ager Achieve b Date .luly 2020 [Select [Select [Select [Select Date ) Date ) Date ) Date ) Guidance The Guidance tab of the application template provides a link which will open the respective FY19 NOFO Guidance section, for applicant reference. The link should open a PDF in a new window on your desktop, that might appear behind the Excel template file. Additional Budget Information The FY19 Budget Template is similar to last year with some key enhancements and new columns including:   Instructions Tab: Provides instructions for all fields within the ELC Budget Template New SF-424 Feature: Section B of this form automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This tab will autopopulate as applicants complete their detailed budgets, and can be printed and submitted directly to Grants.gov to satisfy the SF-424 requirement. 17 TX-DSHS-19-1309-A-001506 Budget Requests for Personnel Budget requests to support cross-cutting health information personnel can be requested in multiple area of the ELC application. The major areas where flexible IT and health/laboratory informatics personnel may be included are in one or a combination of the following: • A: Cross-Cutting Epidemiology and Laboratory Capacity • Personnel supporting cross-cutting epidemiology and laboratory informatics activities • B: ELC Leadership, Management, and Administration • Leadership and Management positions assist in the leadership, management, coordination and administration of the ELC Cooperative Agreements, including integration of epidemiology, laboratory, and health informatics activities. • C: Health Information Systems Capacity • Personnel who only work on ELC HIS activities In the budget justification, applicants should indicate the areas of the application where the same personnel are being requested in multiple areas as a safeguard. This will avoid duplication of funding. Budget Requests for Training, Meeting Participation, and Peer-to-Peer Travel If travel to conferences/meetings and participation in trainings is requested for ELC Governance Team members, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If travel to conferences/meetings and participation in trainings is requested for HIS staff, not the HIS person of contact on the Governance Team, then the request would should be included in the Health Information Systems Capacity (Project C in the ELC NOFO) budget. Similar to the conference travel and training requests, if Peer-to-Peer travel is a request for epi or lab staff to visit another jurisdiction to either learn or share best practices, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If Peer-to-Peer travel is a request for HIS staff to visit another jurisdiction, then the request would need to be entered on the Health Information Systems Capacity budget. 18 TX-DSHS-19-1309-A-001507 Notes and Q + A from 3/20 ELC HIS Application Guidance Webinar: ETOR:       Using a web portal with an LIS system is another way to implement ETOR without using HL7 messaging Letters of support from hospitals for ETOR work is not necessary, but can be included in the application in the supplemental Q: Does ETOR through state HIE count as one connection with a hospital? A: Yes Examples of ETOR: If you are receiving HL7 format and it’s going into LIMS system, it counts as ETOR. If data is being keyed in and transformed into HL7 and then going into LIMS system, it also counts as ETOR. Try to limit ETOR connections to hospitals and “other” type labs. Public health clinics do count as ETOR, but we are trying to limit the field for ETOR connections. Q: If ETOR is already up and running and we want to sustain that connection, should we list this work as a project in the application? A: Yes, include this work in the application or include it in the measures. Syndromic Surveillance:      The Syndromic Surveillance activities are NOT required. However, if you do apply for Syndromic Surveillance activities, there are some activities that are required. All previous NSSP funding will be moved into ELC. We are hoping for level funding and should have additional 1-year dollars to help with syndromic surveillance activities. All ELC grantees can apply for syndromic funding Q: Can you elaborate on the collaborative projects activity in the syndromic surveillance section? o ESOOS is a requirement for funding on the syndromic side (NCIP Co-Ag side), so it does NOT count as a collaborative project on the ELC side. o There are additional examples of collaborative projects above. The syndromic surveillance measure mentions emergency departments (EDs), but urgent care facilities can also be counted eCR:   RCKMS is needed for eCR work: o Activity e, ia is a broad eCR project and requires triggering through RCKMS o Activity e, ib is STD-specific and builds off a pilot already in place. Triggers are implemented at the EHR, therefore RCKMS is not needed. To clarify, there will be no additional work for RCKMS in the new 5 year Co-Ag. Any RCKMS activities that are mentioned in the guidance are the ones that currently exist. RCKMS authoring will eventually expand from the initial 6 conditions. NMI: 19 TX-DSHS-19-1309-A-001508   CDC is currently working with the FDD guide and other larger guides to determine the best strategy to make it more equitable because some guides have several conditions included and some have only one. The FDD guide will count as 2 MMGs if you implement half of the conditions at a time. If you take on all conditions (entire guide at one time) then it would count as 3 MMGs In terms of jurisdictions implementing 5 MMGs, as long as folks are working towards implementation of as many guides as possible, the NMI team is maintaining expectations on how many guides can realistically implemented for each jurisdiction. General Application:    Each activity has 5 milestones hard coded in, they are not expandable. 5 is the limit number of milestones, you don’t have to use all 5 for each activity. If there is no character limit for a section, please try to be as concise as possible AMD:  This AMD activity is about technical support, cloud procurement, increased bandwidth for network infrastructure, specialized software for analysis, etc... It is NOT about sequencers, diagnostic equipment, testing supplies, or staff (i.e. bioinformaticians used to analyze the data). Miscellaneous:     We are using 2018 ELR volume estimates to determine the >75% ELR cutoff for each jurisdiction. Those who are below 75% ELR will continue to provide ELR volume estimates every year in the grant cycle. Q: For advanced electronic data exchange between jurisdictions, is there a preference for push or pull? A: If interested, there are existing mechanisms supported through APHL to assist with transmission but CDC does not have a preference for push or pull options. Q: What does automation of STD ELRs mean? A: STD initiation of investigations from STD ELRs that come in. The system automatically creates investigation bases on ELR details rather than someone manually having to create the investigation. There is an activity referencing PulseNet (under Strategy 1i, activity d: implement additional innovative enhancements that improve analysis…) in the NOFO. Although PulseNet is in the process of being replaced, it is used in the guidance as an example here to help people think through projects that identify a universal case identifier to include with laboratory and case data transmission. 20 TX-DSHS-19-1309-A-001509 2019 ELC Section F: Frequently Asked Questions General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE FoodNet Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSS Enhanced OHHABS and GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvp2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov; 404.718.4155) Amy Kirby (agk1@cdc.gov; 404.718.3161) Mia Mattioli (kuk9@cdc.gov; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhq5@cdc.gov; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814) Jared Reynolds (uvz6@cdc.gov; 404.639.3519) Erin Stokes (ykt3@cdc.gov; 404.718.1175) Aron Hall (esg3@cdc.gov; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Aron Hall (esg3@cdc.gov; 404.639.1869) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Jonathan Yoder (jey9@cdc.gov; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov; 404.639.0704), Efrain Ribot (eyr4@cdc.gov; 404.639.3521) Template-related questions 1. What happened to the ‘other’ option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an ‘other’ option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001510 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 3. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 4. What if we have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001511 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity (p 100-101) 5. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. HL7 Transmission of case surveillance data 6. Variations of this activity are found in Strategy 1a, Strategy 1c, and Strategy 1h. Can you clarify how we can respond to these? Should they be treated independent of each other, or should be addressed as a unit? Activity I (pages 99-100) addresses integrating data elements into existing surveillance systems and working with informatics staff to enable transmission of data elements. Activity IV (pages 102-103) addresses collecting and transmitting national case surveillance data, but does not specify sending via HL7. Activity IX (page 107) very specifically and in detail describes sending condition-specific data/national case surveillance data via HL7. Strategy 1a is focused on the workforce capacity needed to develop internal capacity for, and complete or continue implementation of HL7 messages for the data elements specified in Generic Version 2 (GenV2) and the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Responses should include identification of any additional staff or training needed to complete the sub-activities listed. Additional staff may include epidemiologists needed to provide temporary capacity during the labor-intensive onboarding process activities. Strategy 1c is focused on the processes of data collection, reporting, and data cleaning, independent of the data transmission method. Responses for part B should include descriptions of the questionnaires, or when no questionnaire is available, the data elements collected for each of the conditions indicated. Additional information for these conditions can be found in Project F Appendix 1. Strategy 1h is focused on advancing and modernizing information exchange. Responses should indicate if the jurisdiction is planning to implement all or a portion of the FDD MMG. If a jurisdiction is not able to implement the entire guide, they are able to subset the guide into 2 four condition sections and implement one section in the budget period. The response should specify which four condition tabs will be implemented. For the remaining four condition tabs the jurisdiction should indicate if electronic tabular format or traditional mechanisms will be used. (Can we somehow reference the previously provided FAQs here as well?) The response should also include activities related to incorporating all condition-specific data elements in the FDD MMG into data management systems. PulseNet and NARMS Funding 7. Should requests for WGS funding be separated by type or pathogen between PulseNet and NARMS? Requests for WGS personnel, supplies, and equipment for enteric/foodborne pathogens should be combined for PulseNet and NARMS in the Food and Water laboratory capacity budget (F2). It is no longer necessary to specify requests by PulseNet and NARMS, as was done in the previous ELC cycle. Please be sure to continue to requests funds specifically for shipping NARMS routine surveillance and outbreak isolates to CDC for antimicrobial susceptibility testing. 8. How much per isolate should we factor in for sequencing supplies? You should use $125/isolate as an average cost for sequencing supplies. 3 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001512 9. Will PulseNet award funds for serotyping? No, neither PulseNet nor NARMS will provide funds for traditional or molecular serotyping. 10. Will PulseNet fund any PFGE? PulseNet will no longer fund PFGE activities. Waterborne (General) 11. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 12. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 13. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. 14. For Activity III (b.iii, page 102), what are some examples of other water related issues? Hurricanes? Flooding? Water-related emergencies like floods or droughts are good examples; health risks that are not necessarily waterborne disease outbreaks. CryptoNet 15. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) 4 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001513 • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) Cyclospora genotyping: One of the tier 2 activities included in the ELC grant application is Cyclospora genotyping. Can you tell me if the expectation of this activity is for state labs to conduct genotyping of cyclospora at state labs? Or is it for states to send to CDC for genotyping as we did last year? Both options are available. States can either apply for funds to continue to send samples to CDC for typing, or to perform the typing locally and submit the MiSeq sequencing files for analysis at CDC. Great Lakes Restoration Initiative (GLRI) 16. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. **Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 17. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future 5 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001514 ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 18. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, for fungal diseases this would be blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-diseasereporting-table.html. Specifically for parasitic diseases, this would be giardiasis and free living ameba infections. 19. For activity IV (e), what is NORS looking for in terms of data completeness? For example, a jurisdiction is entering all details for all foodborne, waterborne, animal contact, and environmental outbreaks but only those person-to-person outbreaks for which there is decent data. Would they rather have all person-to-person outbreaks even if the data quality is lower for the majority of those? Only five variables are required to create an outbreak report in NORS: the state-assigned outbreak ID (or state ID), date first ill, estimated number of primary ill, state of exposure, and the primary mode of transmission. We encourage all states to report all foodborne, waterborne, and other enteric illness outbreaks even if that is all the information available to them. We strongly encourage additional information to be reported if available but we fully recognize that state and local health departments may not have access to detailed information for all outbreaks. During data cleaning for person-to-person, animal, environmental and unknown modes of transmission, NORS staff checks for values in other questions, such as age/sex and setting, but these can all be set to “unknown” if that information is not available. Entering “unknown” will satisfy the data checks, as it lets NORS staff know that the information is unavailable rather than assuming it was omitted. If data entered is illogical or unclear (such as entering an etiology as “confirmed” but not having any labconfirmed cases), NORS staff are more likely to follow up with you directly to ensure the data is corrected. We understand that moving to report person-to-person and other non-food/non-water outbreaks is challenging for most states, and we don’t expect 100% of variables to be completed for all reports. Our focus is on seeing more states beginning to report these outbreaks and working towards improving reporting rates and report completeness. We also plan to release an integrated data cleaning feature within the NORS interface sometime next month. More details are coming soon, but we do expect that this will allow states to more easily keep up with data checks as reports are entered and finalized, making the year-end data cleaning process much less burdensome. 6 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001515 20. For activity IV (e), what is the timeliness factor for NORS reports? For example, a jurisdiction strives to get NORS reports started within 60 days of initial onset for foodborne and most waterborne disease outbreaks but wanted to know if there is a target/goal that CDC wants to achieve for reporting outbreaks associated with person-to-person, animal, and unknown modes of transmission as well. CDC has not included a timeliness target/goal for NORS reports in the 2019 ELC NOFO, placing a greater emphasis instead on improving reporting rates and report completeness. In general, states/territories are asked to determine when and how (e.g., manually entry, NORS Direct) to initiate, as well as update and finalize NORS reports. Ultimately, we would like to have all reports entered before data cleaning begins. These dates are staggered by the NORS primary mode of transmission. Additionally, states/territories may want to consider the ELC timeline so that reports are included in the metrics that CDC NORS staff will provide back in 2020. 21. For activity IV (e), what does environmental contamination mean? Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). 22. For activity IV (e.iii), what does preventative measures refer to? This refers to the prevention measure question in the animal contact section (pg. 4 of the NORS 52.13 form) which asks states to report any prevention measures or recommendations (e.g., handwashing) that were used to help stop the outbreak and prevent additional infections. 23. Should Legionella outbreaks be reported to NORS as waterborne outbreaks? Do you have any guidance about Legionella? All Legionella outbreaks should be reported to NORS if they involve 2 or more cases. The Legionella Team is available to provide guidance and technical assistance if state and local health departments have any questions about how to proceed with the investigation. They can be reached by emailing travellegionella@cdc.gov. 24. For activity IV (h): For Tier 1, is exploring the feasibility of reporting HAB associated event and illness data to OHHABs limited to data entry or could this also be related to supporting surveillance activities? The sub-strategy (IV. Strategy 1c, (h), “Explore feasibility of reporting HAB associated event and illness data (human and animal) to OHHABS”) uses language specific to reporting, however, the data entry involved in reporting is just one component of surveillance work, and we recognize that other actions might be needed to be able to detect, investigate, and subsequently report to OHHABS. We would be interested in states exploring feasibility at all points that they felt were necessary to be able to report effectively into OHHABS. - 7 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001516 Activity IX: Advance electronic information exchange implementation (p 107) 25. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 26. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. 27. For activity IX(b. iv) page 107, for cryptosporidiosis, does this mean we should transmit data for all cases submitted for subtyping, then outbreak-associated cases, then sporadic cases? Or does it mean all cases submitted for subtyping AND outbreak-associated cases, then sporadic cases? The second example is the intended activity; if HL7 transmission is not feasible then please assess feasibility to send electronic data following this prioritization: 1) each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet AND for each outbreak-associated case 2) sporadic cases for which a Cryptosporidium specimen has not been submitted to CryptoNet. Activity X: Implement health promotion strategies 28. For activity X (a and b) page 107-108, these aren't really in the day-to-day responsibilities for food and waterborne epidemiologists. Is the expectation that epidemiology staff should be doing this, or should we be reporting on meeting with our communications teams to achieve these goals? The intention is to be working with health communications group to make sure that food and water prevention messages are available to their constituents. Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. 29. For activity X (d) page 108, we're aware of the MAHC and reference it on occasion, we rely heavily on EH partners to implement the details. Should we report here on partnerships with EH or are we expected to spend more time on this? Reporting on partnerships with EH on the MAHC is acceptable. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) 8 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001517 Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. Environmental Microbiology 1. For activity XIX (a.i), p111 and XX (a.i), p112, would it be acceptable to respond with environmental testing for Legionella here? What are some of the other environmental waterborne diseases to test for under each of these activities? Legionella sampling alone is not sufficient to meet this strategy. Legionella testing activities are included in other sections of the NOFO. The Section F, Tier 2: Environmental Microbiology activities cover other waterborne infections. Our most common pathogens for environmental testing are Cryptosporidium, E. coli, and Norovirus, though there are others that could fall under this strategy. FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC 9 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001518 NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #16 for more information about how to apply for GLRI funding). Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 10 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001519 4. What are the minimum activities for a CoE? Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? 11 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001520 Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. 12 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001521 o o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). 6. Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). 7. Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. 8. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. 13 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001522 9. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 14 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001523 HAI/AR Program 2019 ELC Application Q&A April 10, 2019 Updates will be posted throughout the application period New questions (since April 5th version) marked NEW Last updated: April 10, 2019 Page 1 of 18 TX-DSHS-19-1309-A-001524 Table of Contents HAI/AR General Questions ........................................................................................................................................3 Component G1 General Questions............................................................................................................................7 G1 Strategy I ........................................................................................................................................................ 10 G1 Strategy II ....................................................................................................................................................... 10 G1 Strategy III...................................................................................................................................................... 11 G1 Strategy IV ..................................................................................................................................................... 11 G1 Strategy V ...................................................................................................................................................... 11 G1 Strategy VI ..................................................................................................................................................... 12 G1 Strategy VII .................................................................................................................................................... 13 G1 Strategy VIII ................................................................................................................................................... 14 G1 Strategy IX...................................................................................................................................................... 14 G1 Strategy X....................................................................................................................................................... 14 G1 Strategy XI...................................................................................................................................................... 14 Component G2 General Questions......................................................................................................................... 16 Last updated: April 10, 2019 Page 2 of 18 TX-DSHS-19-1309-A-001525 HAI/AR General Questions NEW: Q: If a staff member performs both laboratory and epidemiologic work, is it ok to apply to both G1 and G2 for different portions of their salary? A: Yes, health departments may derive portion of staff salary from both G1 and G2 as long as the funding requests have sufficient detail regarding which G1 and G2 strategies/activities staff would support. Strong applications will connect staff funding requests with the core G1 functional roles and activities as well as those of G2. Q: How do we express multi-year goals in the application? In the background section, implementation plan, and/or milestones? A: The Application should focus on the current budget year. However, multi-year goals can provide helpful context. Applicants can describe multi-year goals in the problem statement (Approach tab) and activity-specific multi-year goals in the implementation plan (Work Plan tab). Milestones should have a completion date consistent with the coming budget period. Q: When referencing NOFO strategies and activities in our application, what labeling convention should we use? A: Each strategy is labeled by a capitalized roman numeral (I, II, III, etc.). Each activity is labeled by a lowercase letter (a, b, c, etc.). And each sub-activity is labeled by a lowercase roman numeral (i, ii, iii, etc.). For clarity, it’s best to describe an activity by both its strategy number and its assigned letter. E.g., “Strategy II, Activity a” and “Activity II.a” are both helpful ways to indicate the same activity. E.g., “Strategy II, Activity a, sub-activity iii” and “sub-activity II.a.iii” refer to the same sub-activity. Note that the descriptions for each HAI/AR strategy also include references back to the ELC logic model (page 7 of the NOFO). For example, the description for G1 Strategy II begins, “Strategy 1b: Support rapid response.” The highlighted portion in this example refers to the ELC logic model, and should not be used in workplan applications to refer to portions of the NOFO. - Q: What is the purpose of the “Work Plan Overflow Section” on the Approach tab in the application templates for Program G? How is this different from the BP Implementation Plan text boxes on the BP1 Work Plan tab? Why is there an overflow for only certain activities? A: At stages in the development of the Application Template, the Implementation Plan character limits were intended to be strictly enforced, and the HAI/AR program requested additional overflow space for complex activities (i.e., those with many sub-activities). However, the final decision was that the Implementation Plan character limits would not be strictly enforced, making the overflow sections less important. There is a limitation to the number of characters Microsoft Excel will display at one time, but all text entered into the Implementation Plans will still be accessible by the HAI/AR program during review. Q: Can you provide a link for the SharePoint site where supplemental guides and other documents are stored? Last updated: April 10, 2019 Page 3 of 18 TX-DSHS-19-1309-A-001526 A: HAI/AR supplemental guides and other documents in support of the 2019 application are available on our ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, or via email by request (haiar@cdc.gov). Applications will be stronger for considering and/or referencing these supplemental guides. Q: Since progress reports will not be collected in the 2019 ELC application, how can we incorporate our program’s progress in our goals/activities to strengthen our application? What about sharing important charts and figures? A: The ELC office will collect a close-out report in October 2019 that will cover progress for the current budget period 5 (2018-2019). In terms of using prior successes for the 2019 application, applicants are encouraged to be strategic how and when to include that information. For Tiers 2 and 3, it is important for the applicant to demonstrate capacity to perform the respective activities. In addition to the text fields in the application templates, applicants can upload supporting documents (appendices, charts, etc.) via REDCap. Important supporting documents should be cited in the text of the application template. Q: If we don’t apply for Tier 2 or Tier 3 activities in budget period 1, can we apply in a later year? Or will Tier 2 and Tier 3 funding in subsequent years only be for previously funded recipients? A: Typically in a continuation year, if a recipient has already demonstrated capacity to perform optional activities, then that recipient will have an advantage when applying for those activities. That does not preclude NEW applicants from being awarded for those activities. Note that for G1 epidemiology activities, Tier 2 is very competitive for all items and is expected to be so for the duration of the cycle. Note that for G2 laboratory activities, all applicants are encouraged to apply for Tier 2, though funding specifically for WGS within Tier 2 is very competitive. Q: Will there be one reviewer for G1 and G2, or will there be separate reviewers? A: The G1 and G2 applications will be reviewed separately, but reviewers will meet and share information to coordinate across components. Q: What is the relationship between the HAI/AR program and similar cross-cutting activities in ELC? A: Cross-cutting activities are managed by the ELC main office. HAI/AR program applicants should work with their principal investigator (PI) and ELC project officer when coordinating HAI/AR activities with cross-cutting activities. Applicants might consider applying, in part, for cross-cutting funds to support staff engaged in surveillance or outbreak response activities for more than one program or project, equipment that will be used for more than one program or project, or IT reporting infrastructure. Q: For those activities that do not have performance measures provided by CDC in the supplemental guidance, do we as the applicant need to create our own performance measures? If so, where will this information be included? Last updated: April 10, 2019 Page 4 of 18 TX-DSHS-19-1309-A-001527 A: The HAI/AR program will collect those performance measures described in the NOFO guidance during the 2019/2020 budget period. While there is no need to create additional performance measures, the milestones offer an opportunity for applicants to describe accomplishment and results associated with each activity. For Tier 2 activities, strong applications will include reduction goals and methods for baseline, process, progress, and outcome measurements, where appropriate. Q: What is the HAI/AR program guidance for milestones? A: The HAI/AR program does not have specific guidance for milestones. Applicants might consider reviewing the Cross-Cutting Epidemiology and Laboratory Capacity Program for guidance on developing milestones. Additionally, applicants can review the “G1 (Epi) Performance Measure Details Supplemental Guidance” and the “G2 (Lab) Performance Measure Details Supplemental Guidance” found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request (haiar@cdc.gov). It is beneficial for applicants to review the performance measures documents and align their milestones accordingly, where applicable. It is also recommended that applicants include a defined timeline or “achieved by date” and not always default to the funding period. In cases where one milestone may relate to multiple activities, applicants should enter that milestone for each corresponding activity. Q: Is there a minimum number of milestones for the application? A: No, there is no minimum number of milestones, as there are some instances where it’s appropriate not to enter any (e.g., when an activity is not applicable to or within the authority of the jurisdiction). Milestones are a key part of the application review, indicating the applicant’s plans to manage resources throughout the budget period. Additionally, milestones will serve as a baseline for technical assistance and technical monitoring across the budget period. Strong applications will take this into account. Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: Yes, in general, the AR/AS Expert in G1 is conceived as one position, with the individual focused on epidemiology, infection prevention, and data for action in antimicrobial resistance and stewardship (G1 Strategy VIII). By comparison, the AR Lab Expert is someone identified as having the appropriate laboratory expertise to guide G2 activities and implementation (G2 Strategy II). Note that for smaller programs, these roles might not be full time. Conversely it is possible that more than one individual might fulfill each function in larger programs. Q: On the budget template, how will the HAI/AR program use the NEW column H (Program/Project Component)? A: Column H is an open text field that ELC added to the budget template this year. It allows CDC programs and projects to specify line-level information that can aid the review process. For Component G1, applicants must enter the number “1”, the number “2”, or the word “BOTH” for each budget line item. This will indicate to reviewers that the line item will support Tier 1 activities, Tier 2 activities, or both. Blank entries will be considered both. For Component G2, applicants must enter the number “1”, the number “2”, or the number “3” to indicate the corresponding tier for each line item. Please do not use “BOTH” for Component G2. Also for G2, if Last updated: April 10, 2019 Page 5 of 18 TX-DSHS-19-1309-A-001528 applying for funding for more than one Tier, we suggest having a line item for each Tier. This way, if you do not receive funding for a higher Tier, your budget needs for the lower Tier are stated clearly. If you do consolidate line items for multiple tiers, but are not funded for all tiers, the line item budget will be reduced accordingly. Q: What is the HAI/AR program looking for in the NEW “Public Health Allocation” columns (I and J) on the budget template? A: These columns are managed by the ELC main office, and are intended to give ELC an understanding of how funding awarded at state level is being applied to local and regional (within the jurisdiction) levels. Applicants should review guidance from the ELC office for more details. Q: Should we include travel to the HAI/AR Annual Meeting in our budget request for the 2019 ELC application? A: Yes! The next HAI/AR Annual Meeting is scheduled for November 12–13, 2019. Applications should include travel funding requests for core HAI/AR program staff, such as the HAI Coordinator, the AR/AS Expert, and the AR Laboratory Expert. Note that travel funding to cover attendance at AR Lab Network Regional Meetings is covered by APHL and should not be included. Q: How is the HAI/AR program utilizing Direct Assistance (DA) positions for the coming budget period? A: The HAI/AR program does not plan to fund any NEW DA positions this year. Q. Is it possible to cross-walk other CDC funding or national partner activities, as it relates to this application? We want to align efforts with our HPP program and stakeholders like AHA, QIN/QIO. If CDC/DHQP is partnering in those efforts – I'd like to have an idea of what unique role we should be partaking in and what supporting role we can take with our partners. A. We do not have a cross-walk of other CDC funding or national partner activities at this time but will consider this for a future project. Please consider reaching out to your partners at the jurisdiction level, especially for PHEP/HPP. Q: We understand there is an average amount of award. Is there a maximum amount or ceiling that states cannot get above? A. The HAI/AR Program does not have a maximum amount or ceiling. Q: Just confirming that the background and justification can be applied across the board for Healthcare Associated Infections (G). The template looks to only allow one entry. A: G1 and G2 have separate application templates. Each application template has an approach tab, where applicants can provide the problem statement, justification, applicant capacity, and evaluation plan. Please complete both application templates. Last updated: April 10, 2019 Page 6 of 18 TX-DSHS-19-1309-A-001529 Component G1 General Questions NEW: Q: For Component G1, is it appropriate to apply to more than one Tier 2 activity? A: G1 applicants can apply for multiple Tier 2 activities. When doing so, they should include detailed descriptions of the separate Tier 2 activities in their budget requests. NEW: Q: If applicants propose new Tier 2 projects, are they competing with applicants who have already established projects? A: Yes, all applicants for a given Tier 2 application are competing for the same funding, whether they are proposing new projects or the continuation of established projects. NEW: Q: For staff members who might work on both Tier 1 and Tier 2 activities, can we split their funding requests into two budget line items? A: Yes, applicants can separate the funding request for one position into two budget lines as appropriate. NEW: Q: When the Ebola Supplement ended, some positions that were funded under Ebola/ICAR were transitioned to core ELC funding. Should these positions be marked as “continuing” on the budget request template, even if they’ve only been funded under core ELC for a few months? A: Applicants should review the guidance provided by the ELC main office when determining the priority (continuing, new, etc.) of these types of positions as would be done for all other Personnel budget line items. We strongly encourage applicants to use the “budget justification” field to describe how positions fulfill key HAI/AR roles. NEW: Q: If all our staff positions are listed as Tier 1 in the G1 budget request, does that affect our application for Tier 2 activities? A: The plan for implementation of Tier 2 activities will vary by jurisdiction. We expect the budget request to correspond to the jurisdiction’s proposed Tier 2 work plan and to detail how prospective funds will be used to execute the activity, including any staffing needs. NEW: Q: Is there an opportunity to receive funding to support IT infrastructure related to support for AUR module adoption? If so, where does it fit in the NOFO? A: HAI/AR program applicants interested in improving IT infrastructure to enhance electronic data exchange projects (e.g., to support AUR module use) could consider working with their principal investigator (PI) to outline their needs and proposed activities within Health Information Systems Capacity project (Project C). These activities can be cross-referenced within the appropriate section of the G1 work plan (e.g., G1 Strategy V). Last updated: April 10, 2019 Page 7 of 18 TX-DSHS-19-1309-A-001530 Q: Sub-Activity I.a.i addresses establishing tiers of organisms based on local epidemiology and detailing how we detect MDROs and criteria we use to respond. The plan for Activity IV.a seems intended to cover exchange of information between ARLN, PHLs and Epi, and to describe the flow of specimens and result communication. So can the plan for Activity IV.a be part of the comprehensive plan from Sub-Activity I.a.i? A: The written Containment Plan and the Coordinated Epi-Lab Work Plan are related documents that should complement one another. The documents can be organized in whatever way that best serves the health department's needs as long as the elements provided by CDC are addressed (see "G1 Containment Supplemental Guidance" and "G1-G2 Lab-Epi Coordination Supplemental Guidance"). The scope of the Lab-Epi Work Plan should be broader than just Containment-related activities. Q: On page 132, the NOFO states “Priority for funding optional activities in this year will be given to Recipients who showed progress during the prior ELC funding cycle as presented in the application (background and current capacity).” However, on the “Approach” tab of the application template, in the “Workplan” spreadsheet, there is an “Application Capacity” section but no section titled “Background.” Does “Background” in the NOFO refer to the “Problem Statement” and “Justification” sections in the “Approach” tab? A: Please use the Problem Statement and Justification sections in the approach tab to describe progress during the prior ELC Funding Cycle. You can further expand upon the progress and capacity in relevant sections of the workplan. Applicants are encouraged to be strategic how and when to include prior successes information. For G1 Tier 2, it is very important for the applicant to demonstrate capacity to perform the respective activities. Q: G1 Strategies I and II both refer to “interconnected” facilities. Does this mean facilities that share patients? A: Yes, this refers to facilities that share patients, including for example, transfer from an acute care hospital to a post-acute care facility. Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: Strategy I is focused on containment, so the epi-lab coordination for that strategy should relate solely to containment activities (see “G1 Containment Supplemental Guidance” found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request at haiar@cdc.gov). Strategy II is focused on response activities, and likewise the epi-lab coordination for that strategy should relate to response activities that are not already described in Strategy I. Finally, Strategy IV describes epi-lab coordination not already described in Strategies I or II and calls for the development of a shared epi-lab coordination plan (see “G1-G2 Lab-Epi Coordination Supplemental Guidance” also found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request at haiar@cdc.gov). Q: The Safe Injection Practices Coalition (SIPC) and the One and Only Campaign no longer appear in this year’s guidance. Will the SIPC continue to be supported? A: While injection safety activities are not singled out in the 2019 NOFO guidance for the HAI/AR program, they can be included as part of other listed activities. E.g.: Strategy II rapid response activities; Strategy IX education Last updated: April 10, 2019 Page 8 of 18 TX-DSHS-19-1309-A-001531 and training activities; and for Tier 2 optional work, the “other” prevention projects under Strategy VI, Activity C. Note that Tier 2 activities are highly competitive, and the priority for Strategy VI, Activity C, will be to fund a few large projects. Generally, those jurisdictions wishing to include injection safety activities should try to include them in Tier 1. CDC intends to continue providing technical and programmatic support for the Safe Injection Practices Coalition to raise awareness about safe injection practices in healthcare facilities (e.g., via regular calls and other communications and activities). Q: When contracting to perform HAI/AR activities, does that include contracting with local health departments? A: The proposed contractor is at the recipient’s discretion. If it’s important to contract with local health departments to complete the work for a given activity, please describe that decision-making in the application. Q: For onsite infection control assessments, will the HAI/AR program provide assessment tools similar to those provided under the Ebola Supplement? A: The response-driven assessments under Strategy III should be conducted as follow-up to outbreaks and/or the identification of a targeted threat. In these cases the recipient can use an existing assessment tool or a customized assessment tool, as the response dictates. The prevention-focused assessments under Strategy VI, targeting long-length-of-stay settings, highacuity settings, dialysis settings, outpatient settings, etc., have more similarity to those conducted under the Ebola Assessment. Here again recipients can use the existing tools and/or modify tools as needed, for which CDC DHQP is available for consultation. Q: The HAI/AR webinar conducted on March 15th included an estimated award of $33 million to $35 million for Component G1. What is the estimated average award for G1? A: The HAI/AR program expects to provide 57 awards for G1 Tier 1, which is the priority for that component. Individual award amounts for G1 will vary based on several factors, including the strength of the application, population size, and the available funding for proposed activities (Tier 1 and Tier 2). Q: Targeted Assessment for Prevention (TAP) has been a required activity in the past for the HAI/AR program, and now it’s listed as optional. How should TAP capacities that have been developed to date be continued? A: TAP is specifically identified in two Tier 2 optional activities (VI.b and VI.c) in the NOFO guidance for the HAI/AR program. But there are other areas in Tier 1 where TAP can be included with broader work: the Tier 1 portions of Strategy V and the prevention activities in Strategy VI. The expectation is that recipients will integrate the TAP capacities developed in prior years into ongoing core HAI/AR work. Q: Are G1 Tier 2 activities expected to continue for the entire 5 years of the upcoming ELC cycle? A: No, G1 Tier 2 optional activities are not necessarily 5-year activities. As described in the G1 NOFO guidance, optional activities in Tier 2 might be included in only the first two or three years of the ELC cycle, so work plans Last updated: April 10, 2019 Page 9 of 18 TX-DSHS-19-1309-A-001532 should reflect the potential for time-limited funding. As such, Tier 2 applications that include concrete timelines are stronger than those that don’t. Q: During the webinar, you estimated $2 million for 3–4 Device- and Procedure-Associated Prevention Projects. Will smaller Tier 2 projects be considered? A: A limited number of large Tier 2 projects with clear, measurable goals will be prioritized. However, applications for strong small projects will be considered if funding is available. G1 Strategy I Q: The description for Strategy I, Activity a states that “organisms included in each containment tier or targeted for regional intervention may vary by region depending on the local epidemiology.” Does “regional” in this case mean our HHS region, or does it mean our jurisdiction? A: Applicants have the latitude to define region in a way that is most appropriate for their health department's context. They are not bound by any previously defined regions (e.g., HHS or AR Lab Network regions). For some health departments, "region" might be part of a state, a full state, or multiple states. The goal is to think about the strategies and interventions for the most relevant geographic area. Q: Strategy I, Activity A has instructions to develop and regularly update written plans that ensure timely detection and response to targeted resistant threats. Is CDC going to provide a template for this plan? A: No, the HAI/AR program will not provide a template. Recipients should develop plans as appropriate to their capacities and usage, taking into account the criteria listed in the guide “G1 Containment Supplemental Guidance” (available on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and via email by request at haiar@cdc.gov). Q: What organisms fall under this strategy? A: We encourage applicants to review the revised CDC containment strategy guideline to help guide plans for containment responses (which would be included in Strategy I) versus other responses (which would be included in Strategy II). We recognize that organisms included in each containment tier may vary by region depending on the local epidemiology. [See related answer under G1 Strategy II] Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: [See answer under Component G1 General Questions] G1 Strategy II Q: What organisms fall under this strategy? Can we include Invasive Group A Streptococcal infections (iGAS) investigations based on previous ICAR and outbreak findings? Last updated: April 10, 2019 Page 10 of 18 TX-DSHS-19-1309-A-001533 A: Strategy II includes all HAI/AR response activities that are not covered by Strategy I (please see related question under G1 Strategy I for more detail). The types of organisms and response activities covered by Strategy II are heterogeneous; the common denominator is that they are affecting healthcare patients. For anticipated response activities involving organisms that are already covered by another ELC-funded program/project, consider describing how the HAI/AR request differs from or compliments other ELC-funded program/project requests. For cross-cutting response activities, applicants can also consider outlining their needs and proposed activities in the CrossCutting Epidemiology and Laboratory Capacity Program section. Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: [See answer under Component G1 General Questions] G1 Strategy III Q: When providing milestones for the response-driven onsite assessments, should we provide a number of assessments that we intend to complete? Or can we instead reference the number completed last year in the implementation plan? A: The number of response-driven onsite infection control assessments you perform under Strategy III will depend on the number of facilities where targeted organisms or resistance mechanisms have been identified and the number of facilities where outbreaks have occurred. If your health department is able to enumerate an expected number of on-site assessments for the budget year (e.g., based on prior years), this would be helpful to include in the implementation plan. Q: For onsite infection control assessments, will CDC provide assessment tools similar to those provided under the Ebola Supplement? A: [See answer under Component G1 General Questions] G1 Strategy IV Q. The supplemental guidance does a good job of detailing the components of a strong work plan. It is not clear what is expected for this application. Is it enough for us to say that we have these elements already documented, will work over the grant year to develop the additional elements and comprehensive work plan, and have the plan finished by July 2020? Or do you want details on each element now? A: Applicants should include sufficient detail to help reviewers understand how the work plan will be developed, what elements it will include, and when the plan will be completed. G1 Strategy V Last updated: April 10, 2019 Page 11 of 18 TX-DSHS-19-1309-A-001534 Q: In G1 Strategy V, Activity e the text in sub-activities v and vi is almost identical. Are these two versions of the same sub-activity? If not, can you please clarify how they are different? A: A recipient of Activity V.e is required to complete only one HAI validation report and assessment of the NHSN validation guidance. Sub-activities v and vi describe what should follow. Under sub-activity v, validators are expected to provide feedback to facilities, educational training if needed, and to correct the data in NHSN. Subactivity vi suggests providing recommendations to modifications in guidance and providing quantitative estimates of errors classified by error type to NHSN. Q: Can you further explain what you are looking for in Strategy V Activity b (identify and implement mechanisms to detect MDROs within the jurisdiction)? A: Applicants should describe how they use or plan to use various sources of data (e.g., NHSN, EIP, AR Lab Network, state/local data) for detecting emerging MDROs and to define the local and regional epidemiology. G1 Strategy VI Q: Strategy VI, Activity b, sub-activity i (Tier 2) states that for TAP, “For most jurisdictions the minimum expectation is 10 facilities.” Does this refer to the total number of facilities targeted over the funding cycle, or does it refer to the target over a funding year? A: Applicants should target at least 10 facilities in the first funding year, then expand to include other facilities in subsequent funding years as appropriate. Although we do not anticipate completed outcome measures until at least 18 months after initiation, interim measures will be expected after the first year of funding, even if there are not yet measurable improvements. As a Tier 2 optional activity, we expect funding for 2-3 years, but not necessarily for the entire 5-year funding period, so applicants should make proposals in consideration of this timeline. Q: In Strategy VI, Activity a, there is language explaining how this activity should be distinct from Area A, Strategy III. Within that language is a reference to Area B, Strategy I. There is no Strategy I under Area B. Is this a typo? A: Yes, this is a typo in the NOFO. “Area B, Strategy I” should read “Area B, Strategy VI.” Note that this was corrected in the application template for Activity VI.a. Q: For onsite infection control assessments, will CDC provide assessment tools similar to those provided under the Ebola Supplement? A: [See answer under Component G1 General Questions] Q: Under Strategy VI, Activity a, what is a reasonable number of onsite assessments? Is there a guide or standard for the targeted number of facilities? Last updated: April 10, 2019 Page 12 of 18 TX-DSHS-19-1309-A-001535 A: The appropriate target for number of assessments varies widely by setting and jurisdiction, and this variation makes a standard approach impractical. Our expectation is that each recipient will tailor and scale their approach to align with their local epidemiology and respective needs. Q: Under Strategy VI, Activity c, does Sub-Activity ii allow for prevention projects that cover work other than device- or procedure-associated infections? A: Device- or procedure-associated infection prevention projects will be prioritized for Strategy VI, Activity c, Sub-Activity ii. Other prevention project proposals can be included in this activity and will be considered if funding is available. G1 Strategy VII Q: Can you clarify what’s expected for the sub-activity VII.a.v, “Monitor state-level outpatient antibiotic use and use of selected antibiotic classes (e.g., fluoroquinolones) in order to inform dissemination strategies and collaborative activities. Data can be obtained from CDC's Antibiotic Resistance Patient Safety Atlas at https://gis.cdc.gov/grasp/PSA/indexAU.html?” A: Strong applications will describe how the health department plans to use data from the jurisdiction when developing dissemination strategies. Using the Patient Safety Atlas data to identify targets for stewardship strategies may help states with antibiotic prescribing above the national average. Other options for using data to target dissemination strategies include using Medicaid data, collaborating with the QIN-QIO to use Medicare data, leveraging the QIN-QIO’s use of Medicare data, or collaborating with local health systems and/or insurers to find and target dissemination to high prescribers. Q: With respect to Strategy VII, is the required section (Activity a) limited only to the activities listed, or can we include other additional activities? Or should we place any other additional activities under the optional section (Activity b)? A: To the extent possible, please align activities with the NOFO. If you want to include additional activities under Strategy VII, we recommend including them where they seem to align best. If they are discrete data-driven, intervention projects, then Tier 2 Activity b would be best. If the activities are more focused on building antibiotic stewardship capacity and working with facilities, then Tier 1 Activity a would be more appropriate. If you decide to include additional activities, please include a description of how the impact of each activity would be assessed, since it may not be reflected in the current performance measures. Q: Can you clarify the intent of Strategy VII, Activity b (Tier 2)? It seems to indicate applications for largescale, well-defined, time-limited special projects funded above and beyond routine stewardship activities. Do you have specific projects in mind for VII.b? What could this funding be put toward? E.g., could this funding go toward supporting partner involvement, supporting facilities, supporting outside resources to disseminate clinical decision support tools, collecting data, in addition to supporting state health department staff time? A: For Activity b (Tier 2), we are looking for projects that are intervention-based with a quantitative component, specifically data-driven interventions that are supported by evidence or have been shown to be successful. It is up to the jurisdiction to determine whether that involves academic or other partners, but the specifics of the Last updated: April 10, 2019 Page 13 of 18 TX-DSHS-19-1309-A-001536 intervention and how impact will be assessed must be clearly described. Tier 1 activities are more conducive to supporting staff time. Q: Under G1, Strategy VII, Activity b, “Implement targeted project to improve antibiotic use,” do applicants have to choose only one of the listed sub-activities? Is there a possibility of getting more than one funded? A: Applicants can include one, two, or three of the sub-activities in the application for G1 Activity VII.b. If the applicant includes more than one sub-activity, these may need to be prioritized by the HAI/AR program in the review process. Note that this a Tier 2 activity and thus very competitive. G1 Strategy VIII Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: [See answer under HAI/AR General Questions] G1 Strategy IX Q: Strategy IX, Activity d says to "Improve onsite assessment capacity by developing expertise in facility assessment.” Examples include “training staff in conducting assessments.” Does this refer to training facility staff or staff within the health department’s HAI program? A: Activity d refers to staff within the health department’s HAI program, with the goal of ensuring the program has sufficient expertise to conduct assessments. G1 Strategy X Q: For Strategy X, Activity b, should we apply if we’re not an EIP site? A: Activity X.b is intended for EIP sites. However, this is a required Tier 1 activity, so please don’t leave it blank on the application template. If the applicant is not an EIP site, the text for X.b can simply indicate that. G1 Strategy XI Q: As a local jurisdiction, are we expected to create an HAI plan? Or is that just for states? A: In this cycle, all ELC-funded HAI/AR programs are expected to create and update an HAI plan regularly. Local health departments should work with the state health department to ensure that plans are coordinated based on collaborative discussions and planning. Q: Will CDC provide a template for the jurisdictional HAI plans? Last updated: April 10, 2019 Page 14 of 18 TX-DSHS-19-1309-A-001537 A: CDC does not currently have a revised template for jurisdictional HAI plans. We anticipate that jurisdictions will have latitude to update their current plan’s existing structure/outline (if it still serves their needs) or to consider a NEW/revised/expanded format. The goal is to reflect current activities, data-driven needs and goals (e.g., future directions and priorities), with input from your HAI/AR advisory committee and health department leadership. Examples of plans can be found at: https://www.cdc.gov/hai/state-based/index.html. Last updated: April 10, 2019 Page 15 of 18 TX-DSHS-19-1309-A-001538 Component G2 General Questions NEW: Q: What items should we include in applications for the Tier 2 WGS funding in G2? A: Given the anticipated amount of funding available and the highly competitive nature of this portion of the G2 award, we suggest you think of Tier 2 WGS funding as an opportunity to support sequencing reagents, supplies, and/or small equipment, ideally in laboratories with some existing infrastructure. DHQP can provide resources and bioinformatics support for analysis of WGS data. If you are seeing opportunities within your laboratory to support bioinformatics training and staff, think of Project I Section I (Cross-cutting EID Capacity, Systems, and Leadership) for AMD workforce development. NEW: Q: Is the G2 Tier 2 WGS funding to support just sequencing for our state or will we also be responsible for sequencing for other states in our region? A: Tier 2 WGS funding is to support activities in your state alone. Regional labs will provide WGS support for the jurisdictions in their region. NEW: Q: Is there flexibility in how states funded for G2 Tier 2 WGS testing choose how to prioritize their sequencing? A: Yes, states can choose how best to set their sequencing priorities, within the list of CDC priorities, as they will be dependent on local epidemiology and needs. NEW: Q: Do Tiers 1 and 2 of G2 include funding opportunities to support PFGE or environmental sampling? A: We are not providing funding to specifically support PFGE or environmental sampling. CDC may be able to provide assistance for these activities. Please contact HAIAR@cdc.gov for more information. NEW: Q: Does G2 Tier 2 WGS funding support long-read sequencing? A: The funding levels and priorities of Tier 2 WGS opportunities are focused on short-read sequencing. Further genomic characterization may be beneficial but long-read sequencing would be at the discretion of and with funding support by the sequencing lab. DHQP is available for consult in deciding which isolates should be considered for long-read. NEW: Q: Is there some flexibility in G2 Tier 2 WGS funding for a state to pool their resources and knowledge with another state to do WGS? A: We will be funding individual jurisdictions for WGS pathogens within their jurisdictions only. It would be difficult in terms of funding to disseminate funds to multiple jurisdictions to accomplish one goal. NEW: Q: Can we use the DNA flex kit for WGS? Last updated: April 10, 2019 Page 16 of 18 TX-DSHS-19-1309-A-001539 A: We are currently evaluating the use of this kit with our protocols but do not anticipate any issues with labs wanting to use this kit. NEW: Q: Can non-regional labs apply for funding to support CPO colonization screening? A: At this time we are not currently funding non-regional labs for CPO screening since the regional labs are already funded for this activity. Although there are some non-regional labs that are performing colonization screening, they are not being funded through ELC. If you feel this is an activity you would like to perform in your lab, we encourage you to include this in your grant application with a detailed justification. NEW: Q: G2 WGS priorities list “all CRAB”. Are we expected to perform PCR for the primary targets first or skip straight to WGS? A: Perform PCR first to facilitate rapid detection of primary carbapenemase gene targets. NEW: Q: Pan-resistant isolates are not included in your WGS priorities for G2. Should they be? A: G2 WGS priorities will not include suspected pan-resistant isolates. Suspected pan-resistant isolates will be sent to CDC for comprehensive AST and long-read WGS. NEW: Q: Can you please specify/point out where I can find the DHQP recommendations for testing a proportion of CRPA isolates, as referenced in the following activities: Strategy I Activity a, Strategy I Activity b, Strategy III Activity a? A: You’ll find some guidance in the CRE/CRPA State Testing Guidance document on ShareFile. In that document, titled “Guidance for Testing CRE & CRPA in State and Local Public Health Labs” we recommend each public health lab “tests at least 10 CRPA isolates each month. Labs may choose a sampling scheme (e.g., the first 10 isolates received, the last 10 isolates received) and focuses testing in regions or facilities with high prevalence.” Q: In the G2 guidance, under Strategy I, Activity b (Tier 1), you are asking for mechanism testing by PCR on E. coli, Enterobacter, Klebsiella, and Citrobacter, as well as a portion of CRPA isolates. However in Tier 2 Citrobacter is mentioned as an expanded organism along with Serratia, Providencia, and Proteus. Is the mention of Citrobacter in Tier 1 in error? A: Yes, Citrobacter was included in Tier 1 in error. The correct language for Strategy I, Activity b should say “(at least E. coli, Enterobacter, and Klebsiella) and a proportion of CRPA.” Q: Given the expectation of $44k per award for G2 Tier 1, is the expectation to request lab staff in G1? A: No, the applicant should apply for what is needed for lab activities under G2, applying for expanded testing in Tier 2 as appropriate. Depending on capacity and burden in the jurisdiction, if an applicant doesn’t need one full time person, the HAI/AR staff encourages the applicant to request a part-time position. Last updated: April 10, 2019 Page 17 of 18 TX-DSHS-19-1309-A-001540 Q: Is there any place to include environmental surveillance for antibiotic resistance? A: This year’s G2 application does not include environmental surveillance. Q: Regarding whole genome sequencing (WGS) for isolates, given the capacity limitations in state labs, will it be acceptable to collaborate with another program that can accomplish the work and upload the sequences? A: If an applicant’s best means for conducting whole genome sequencing is with a partner, it is appropriate to propose that. Please be as detailed as possible; whatever party does perform the sequencing should do so according to established guidelines. Note that this specific Tier 2 activity is very competitive. Q: Since there is a preferred platform for sequencing (MiSeq), can this be funded as part of G2? A: Yes, applicants can request funding under “Equipment.” Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: [See answer under HAI/AR General Questions] Q: Should budget requests include travel funding for AR Lab Network Regional Meetings? A: Funding to cover attendance at AR Lab Network Regional Meetings is covered by APHL and should not be included in the ELC budget request. [See related answer under HAI/AR General Questions] Q: Is the Strategy in Tier III, Number VI, Activity e, “Expand and sustain AR lab testing and reporting for surveillance,” a required strategy or is it optional? A: If applying to be a regional lab, then all Tier III strategies (except XI and XII) are required. If not applying to be a regional lab, then you should not be applying for work under Tier III. Q: If applying for regional lab funding, should we also apply for all activities under Tier II, understanding that WGS and Candida identification is included under both Tiers? A: If you want to be funded for WGS and Candida identification and are also applying to be a regional lab under Tier III, it may make sense to apply for funding for these activities under both Tiers, in case you are not selected to be a regional lab. Please note that you will not receive funding for activities under BOTH Tiers. Last updated: April 10, 2019 Page 18 of 18 TX-DSHS-19-1309-A-001541 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-001542 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-001543 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-001544 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-001545 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-001546 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-001547 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-001548 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-001549 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-001550 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-001551 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-001552 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-001553 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-001554 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001555 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001556 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001557 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-001558 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-001559 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-001560 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-001561 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-001562 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-001563 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-001564 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-001565 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-001566 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-001567 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-001568 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-001569 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-001570 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-001571 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-001572 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-001573 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-001574 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-001575 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001576 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001577 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001578 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-001579 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-001580 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-001581 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-001582 Supplemental Guidance: Targeting facilities and clinical laboratories for AR Lab Network testing of CRE and CRPA The Epidemiology and Laboratory Capacity (ELC) for Infectious Diseases Guidance for the 2019–2023 cycle includes two programs that encourage coordinating connections with clinical laboratories serving the state or jurisdiction to solicit isolates of carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas aeruginosa (CRPA) from healthcare facilities (including acute and poste-acute care facilities) to test for novel and emerging antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Early detection of targeted resistant organisms in a jurisdiction is critical for controlling their spread. Health Departments should strive to develop laboratory networks that are representative and that support regional control strategies. This document has 2 aims (1) to assist G1 and G2 recipients without an established network to identify high-risk settings and develop connections between healthcare facilities and clinical laboratories as the basis for a regional network; (2) to assist G1 and G2 recipients, who have already developed a regional network, to troubleshoot and expand connections to other high-risk healthcare facilities and clinical laboratories. CDC is available to provide additional consultation to assist health departments and public health laboratories. For more information, please contact HAIAR@cdc.gov. Goals of Network The goals of the network should include: 1. Identifying isolates with novel resistance phenotypes quickly (i.e., as close as possible to importation into a region). 2. Capturing isolates from a representative set of facilities. 3. Supporting the jurisdiction’s current strategy to slow the spread of targeted resistance. This might include: o Identifying initial instances of importation of targeted organisms in areas where these organisms are uncommon, OR o Informing control interventions in areas where these organisms are more common. Considerations • Health departments should aim for 100% enrollment of clinical laboratories serving facilities in the jurisdiction if capacity is available to test all CRE and CRPA. • If capacity is not available to test all CRE and CRPA, health departments should strategically target laboratories according to local epidemiology, priorities for detection and prevention, and the characteristics of the healthcare facilities and populations served. • Prioritize recruitment of laboratories that serve short stay acute care hospitals and high-acuity post-acute care facilities in healthcare regions not currently represented or underrepresented in the current clinical laboratory catchment TX-DSHS-19-1309-A-001583 Designing a Network – General principles and Strategies 1. Identify healthcare regions: Divide the jurisdiction into healthcare regions that best represent where patients receive care in order to provide a broad overview of the jurisdiction. Different approaches can be used to define these healthcare regions. One approach is to identify the major population centers with each region. Alternatively, jurisdictions can assign healthcare regions according to known healthcare referral/transfer networks; data on healthcare referral regions is available through the Dartmouth Atlas for Healthcare. 2. Identify healthcare facilities and affiliated clinical laboratories in each healthcare region: Within each healthcare region, prioritize acute care, long term acute care and skilled nursing facilities that frequently refer patients to these facilities; map each facility to the affiliated clinical laboratory. Determine which clinical laboratories within a healthcare region are not submitting isolates to the AR Laboratory Network. 3. Expand clinical laboratory catchment strategically*: • • Consider targeting healthcare facilities that will collaborate effectively with public health authorities to implement local infection control recommendations. For example, if a patient is identified as having a rare CRE, the facility will implement appropriate transmission-based precautions and perform surveillance screening if necessary. Recruit laboratories based on local epidemiology (e.g., stage of emerging mechanism emergence). Examples of recruitment approaches for different stages of emergence follow. Many jurisdictions have targeted MDROs in different stages of emergence, and may use a combination of the strategies below to prioritize laboratory recruitment. o To promptly detect resistance mechanisms that are novel to the region, target laboratories that serve high risk populations. This primarily includes laboratories that serve high-acuity post-acute care facilities LTACH and skilled nursing facilities with ventilator units) but could also include clinical laboratories that serve academic and tertiary care short-stay acute care hospitals. Consider prioritizing short-stay acute care hospitals where international patients or patients from outside the region receive care. o To prevent spread of targeted resistance mechanisms from areas of higher prevalence to areas of lower prevalence, prioritize enrolling laboratories serving ‘bridge facilities’. Bridge facilities are tightly connected to other healthcare facilities in the region and might serve as a conduit for spread to other healthcare facilities or regions. An example of a bridge facility might be an LTACH in a suburb of a major city; the LTACH may accept patients from hospitals within the city but the prevalence of multidrug-resistance may be lower than other healthcare facilities within the city. Patients in the LTACH may be referred to other nursing homes or short stay acute care hospitals in other parts of the region. o If some targeted organisms are considered endemic (multiple facilities are repeatedly identifying cases without clear epidemiologic links) in part of the region, recruit laboratories to facilitate detection and response to emerging threats in the TX-DSHS-19-1309-A-001584 endemic region and prevent spread to other regions. For example, a jurisdiction with endemic KPC-CRE in a metropolitan area may recruit laboratories in that city serving high risk facilities to detect emerging resistance mechanisms (e.g., NDM-CRE), while also recruiting laboratories serving bridge facilities to prevent spread outside the metro area. CDC Support Available CDC is available for additional consultation to help public health departments and laboratories develop their network and/or generate lists of target facilities. For more information or assistance, please contact us at HAIAR@cdc.gov. TX-DSHS-19-1309-A-001585 Interim Guidance for Whole Genome Sequencing of HAI/AR Pathogens Supplemental guidance includes: 1. Priorities: Selection of isolates for sequencing 2. Platforms: Illumina MiSeq (paired-end) for all sequencing; other Illumina platforms that can produce paired-end reads are acceptable 3. Protocols: Please refer to protocols used for PulseNet. Job aids and best practices for additional technical assistance (i.e., Gram positives, Pseudomonas, etc.) will be available 4. Sequence Data Quality Metrics and Processing: QuAISAR-H pipeline provide an easy, all-in-one tool for initial processing and analyses of raw sequence data 5. Data Sharing Methods: Multiple avenues to accommodate different systems and capacities 6. Posting to NCBI: DHQP-hosted umbrella “CDC HAI-Seq”; include SRA number in LIMS as link to WGS data 7. Metadata Guidelines: Non-identifiable isolate information will accompany sequence data TX-DSHS-19-1309-A-001586 Priorities for Sequencing at State/Local/Regional Labs   Untenable to sequence every HAI or MDRO pathogen Priorities for sequencing are as follows: 1. Sequencing that supports outbreak investigations (CRE, CRPA CRAB) 2. All CRAB isolates 3. CRE and CRPA that may carry novel carbapenemase genes • Carbapenemase-producing (e.g., mCIM- or CarbaNP-positive) but PCR negative for KPC, NDM, OXA-48-like, VIM, and IMP • Note: Exclude isolates with resistance profiles that explain carbapenemase production – Enterobacter that are cefotaxime, ceftriaxone, and ceftazidime resistant but cefepime susceptible (indicates high levels of AmpC beta-lactamase) – Serratia that are resistant to carbapenems and susceptible to 3rd generation cephalosporins (indicates presence of SME gene) 4. Non-KPC isolates • Resistance to any beta-lactam above meropenem (e.g., aztreonam-avibactam; ceftazadime-avibactam; meropenem-vabrobactam) unless AST and RT-PCR suggest KPC TX-DSHS-19-1309-A-001587 Platforms  State and local public health labs should use the Illumina MiSeq (pairedend) for all sequencing.  Other Illumina platforms that can produce paired-end reads are acceptable. TX-DSHS-19-1309-A-001588 Protocols   Please refer to protocols used for PulseNet (with adjustments recommended – see below) (https://www.cdc.gov/pulsenet/pdf/PNL32-MiSeq-Nextera-XT.pdf) – DHQP will investigate the impact of any changes to current PulsetNet protocols on the sequencing of HAI pathogens Recommended adjustments to current PulseNet protocols – HAI pathogen WGS runs may be of higher diversity than those typically seen for PulseNet activities • Consider a slightly higher phiX spike-in for runs of higher diversity (~2-5% is generally appropriate) – To plan sequencing runs with maximum efficiency and data quality, please use our pooling job-aid calculator tool (forthcoming) – If sites need further technical assistance, (for example, for gram positives) – DHQP is working to provide job aids/best practices • Pseudomonas aeruginosa are difficult to sequence and should be sequestered to their own Pseudomonas-only runs as much as possible. Alternatively, a small number (<5) of Pseudomonas can be included in non-Pseudomonad sequencing runs. • DHQP working on a QMS version of a calculator tool for planning sequencing runs of diverse organisms and other job aids TX-DSHS-19-1309-A-001589 Sequence Quality Metrics and Processing: QuAISAR-H Pipeline  Pipeline for Quality control, Assembly, species Identification, Sequence typing, Annotation, and Resistance mechanisms for Healthcare-associated pathogens  Automates routine evaluation and provides an easy, all-in-one tool for initial processing and analyses of raw sequence data  Available for sites that want to run it locally – Command line available on GitHub soon (link forthcoming) • Complex, not originally intended for broad distribution • Requires many pointers and dependencies be set up locally • DHQP cannot support all states as they set this up – GUI-like application on CDC AMD Portal currently in beta-testing • Available to external partners via SAMS Level 1 credentialing TX-DSHS-19-1309-A-001590 QuAISAR-H Pipeline       QuAISAR-H iX, Quality control steps trim reads, remove PhiX, check for contaminants using two bioinformatics tools, Kraken and Gotcha Genomes are assembled by SPAdes Classified using publically available MLST schemes Annotated using Prokka Species verified with Average Nucleotide Identity Antimicrobial resistance genes are identifiedd using c-SSTAR to apply non-redundant ResFinder and ARG-ANNOT databases ( C Trimmomatic Assesment Kraken ( SRST2 ) Gottcha ) SPAdes plasmidSPAdes ( Kraken ) Trim contigs Trim contigs ( C-SSTAR ) )-----1 ( plasmid Finder, ___ 16s1D) ___. ~ QUality control Assembly Identification plasmid Finder ( BUSCO) Resistance mechanisms Healthcare TX-DSHS-19-1309-A-001591 Sequence Quality Metrics    Quality Metrics – Aim for 60X coverage • No lower than 40X (quality concerns) • No higher than 100X (cost, more than quality concerns) – Species ID should match expected ID from traditional laboratory methods, using QuAISAR-H pipeline – 200 contigs or less, using QuAISAR-H pipeline – Assembled genome ratio should be between 0.6-1.4, using QuAISAR-H pipeline To ensure quality metrics are met, sites should send their first sequencing run to DHQP for confirmation before proceeding with further sequencing Note: Data must pass quality checks prior to uploading to NCBI TX-DSHS-19-1309-A-001592 Data Sharing  All WGS data will be shared by states with DHQP for centralized analyses  Options for sharing data directly with DHQP – BaseSpace – Secure CDC Sharefile (similar to Box) – MMB secure FTP – Additional options under consideration  Working toward developing capacity for direct NCBI upload is important TX-DSHS-19-1309-A-001593 Posting to NCBI    DHQP will host an NCBI umbrella, “CDC HAI-Seq” – For bioprojects and sequence data generated by CDC and other public health laboratories related to healthcare-associated infections – Can include any data format, including raw reads and/or assemblies – Broad BioProjects for NTM, Staph, Cdiff, Gram negatives, etc. For outbreaks: – Delays between the completion of sequencing and submission to CDC/DHQP should be minimized. – Internal analyses by state health departments should not be prioritized if it will compromise the speed with which data are shared with DHQP so that data can be evaluated from across the outbreak. – DHQP will post a representative sample(s) to NCBI as a reference and to support data sharing and improved public health response. Ideally, states communicates NCBI ID (SRA number) to DHQP via LIMS, HL7 messaging, or other mechanism; not spreadsheet/emails TX-DSHS-19-1309-A-001594 Plan for Metadata on NCBI  Setting conservative limits to the metadata included across all HAI/AR activities – Time: Specimen collection year – Type: Specimen type (human, animal, environmental, other) – Location: Specimen collection location (United States) – Source: Specimen source (blood, urine, device, surface, etc.) – Organism: Genus, species – ID: Isolate identifier (unique ID assigned to isolate by organization who sequenced it; cannot be linked readily to original ID without master) • Isolate ID must be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically • Follow CDC guidance for assigning WGS IDs TX-DSHS-19-1309-A-001595 Plan for Metadata on NCBI  Suggested WGS ID (under development) – YYYYLC-00000, where • YYYY=year sequenced • LC = Location code for where sequencing was performed (code assigned by and key retained at DHQP) • 00000=Consecutive numbers assigned by the sequencing lab  Again: Isolate ID should be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically TX-DSHS-19-1309-A-001596 Questions? Metagenomics and Molecular Biology, Division of Healthcare Quality Promotion HAIseq@cdc.gov For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-001597 2019 Epidemiology and Laboratory Capacity (ELC) Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Frequently Asked Questions Personnel 1. Can jurisdictions ask for more than one FTE or FTE equivalent in Tier 1 if that is what is needed to accomplish Tier 1 activities in our jurisdiction? Yes, you CAN request more than 1.0 FTE to support Tier 1 activities; however, the accompanying narrative must justify that this personnel time is required. To the extent that the same personnel support Tier 2 and/or Tier 3 activities, please indicate this in your narrative and budget request. 2. How do I ask for funding for staff that works on both Tier 1 and Tier 2 activities? If we split their time between tier 1 and tier 2, what happens if I do not get the funding for tier 2? Staff funding is tied to the activities the staff person supports. Under the proposed scenario, if Tier 2 activities are funded, funding for staff supporting those activities could be supported. In contrast, if Tier 2 activities are not funded, funding for staff supporting those activities may not be supported. Please see the answer in #1 of this section as well. 3. I rely on contractors to complete activities. Are they considered the same as FTEs, as noted in your webinar and Q&A document, if they are performing the same activities? Contractors would be considered the same as FTE staff. 4. Several positions have been historically funded by ELC to complete ELC activities. Can I still ask for funding for this position in the new competitive cycle? What about historical positions that are currently vacant? Yes, applying for funding to support these positions is appropriate under the new competitive cycle. Budget 1. Is there additional funding attached to tier 2 beyond the $150,000-260,000 range mentioned? The NOFO language is: “In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities.” Please clarify this NOFO language. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the NOFO language is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on TX-DSHS-19-1309-A-001598 historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. 2. In regards to preparing two different budgets, one for Tier 1 and one for Tiers 2 and 3, how should we submit this when our capacity is already much higher than just Tier 1? We acknowledge that many jurisdictions may already have vector-borne disease capacity that goes beyond Tier 1. Regardless, please prepare the two budget tabs to differentiate between “core” and “enhanced” VBD capacity and associated funding needs. The Tier 1 tab in the budget should include your needs to be successful in all required Tier 1 activities as applicable to your jurisdiction. Budget needs for additional (optional) enhanced activities beyond Tier 1 should be included in the second budget tab, covering Tiers 2 and 3. 3. Could we submit an application for Tier 2 or Tier 3 activities in future budget period years? Will we be able to apply for it later if we do not ask for it now? Yes, you will have the opportunity in future years to request funding for Tier 2 and 3 activities even if you do not apply for them this year. 4. The Webinar mentioned preparing a budget for one year. In our narrative, are we writing for 1-year, or laying out plans for the 5-year period? Your work plans should reflect your plans for the year one budget period only. 5. My jurisdiction has staff positions funded from the Zika supplemental. We would like to keep these positions for this next competitive ELC cycle since they are essential to our vectorborne disease program. How do we do this? Applying for funding to support these positions is appropriate under the new competitive cycle. As the positions described in this scenario were funded using supplemental funding in previous years, we cannot guarantee these positions will be supported under this new competitive cycle for ELC. Work Plan 1. Are the tier 2 and 3 activities likely to be maintained past one year, i.e. should we submit budgets for these activities for one year or multi-year? Yes – these are likely to be maintained past year 1. Please only propose one year of funding for the first budget period. Epidemiology 1. Can you explain activity “identify and report non-nationally notifiable VBD cases to CDC”? If non-nationally notifiable diseases are captured in the state, how are these reported to ArboNET? Is it the same mechanism? Non-notifiable arboviruses are reported to ArboNET using the same mechanism for notifiable diseases. Please see the Table 1 at the end of the FAQ for a list of notifiable and non-notifiable TX-DSHS-19-1309-A-001599 arboviral disease conditions. For non-arboviral conditions, please contact the respective point of contract listed in the Program H guidance. Laboratory 1. How much detail would you like on the supply line? For example, if we are asking for PPE or PCR Reagents – how specific should we be? Please associate supplies with a specific test or activity where possible, e.g. “PCR reagents for arboviral testing” or “PPE for tick surveillance activities.” 2. My jurisdiction is interested in becoming a regional reference lab for testing. Are we allowed to do outreach to other states to see if they have a need? Are we allowed to share our letters of support to DVBD during this application period? In this scenario, it is up to the jurisdiction to determine if and how they would do outreach to other states to gain support. Unfortunately, we have no mechanism to accept letters of support for this application. Jurisdictions could note established collaborations or memorandums of understanding with other jurisdictions in the narratives sections. 3. How should collaborations with universities be handled to make sure that they are not crossing the line of “research.” If ELC is strictly non-research, what activities with universities are expected and encouraged? As you likely know, CDC cannot fund research activities under the ELC cooperative agreement. However, CDCs Vector-Borne Program does support a domestic research program through other funding opportunities, including under the Emerging Infections Program and the VectorBorne Disease Centers of Excellence cooperative agreements. In certain situations, jurisdiction staff can participate in CDC or other funded research activities if their time is not fully funded by ELC. For example, if laboratory staff are funded 50% by ELC and 50% by other sources, they may be able to support collaborative research under the 50% time covered by other support. Additionally, ELC-funded staff could collaborate with partners to help determine and prioritize research needs, participate in trainings, or host fellowship or graduate students. 4. Can we request support for maintenance agreements for laboratory equipment? Yes, requesting support maintenance agreements for laboratory equipment is appropriate if the equipment supports testing for vector-borne diseases. Cost-sharing measures should be used if the maintenance agreement supports testing for other programs as well. Ecology 1. Can you please clarify the difference between ArboNET and MosquitoNET reporting CDC collects mosquito data in two systems, ArboNET and MosquitoNET. These systems collect different information (reporting to MosquitoNET does not replace reporting to ArboNET). • ArboNET: Reports of mosquito pools testing positive for arboviruses by county and date of collection (also called numerator data). Can also report county level data for numbers of mosquitoes collected and tested weekly by species (also called denominator data). TX-DSHS-19-1309-A-001600 • MosquitoNET: Detailed mosquito abundance data by specific geographic coordinates. MosquitoNET now covers all mosquito species. We are primarily interested in jurisdictions submitting surveillance data for all medically important mosquitoes. Reporting of nuisance mosquitoes is optional. The system is also used to report insecticide resistance testing results. 2. If we request funding for some ecological surveillance activities, can we then subcontract local vector control districts or a university group to do them? Yes, subcontracting to local vector-control districts or universities is acceptable. 3. Can you clarify the difference between “passive” (Tier 1) and “active” (Tier 2) surveillance for vectors? We make the following definitions regarding passive Tier 1 surveillance and active Tier 2 vector surveillance. • Passive: entomological surveillance activities already occurring in your jurisdiction, but not performed or coordinated by you. Examples could include, universities, or other state agencies, e.g. agriculture or veterinary agencies • Active: entomological surveillance activities performed or coordinated by you. This could include collaborations with universities or local health departments/vector control agencies, or subcontracted to an outside group. 4. Will CDC support funding for tick surveillance of Dermacentor or other non-Ixodes tick species? Tick surveillance requests that relate to Ixodes species and align with the new surveillance guidance will be prioritized over other non-Ixodes tick surveillance funding requests. 5. If a jurisdiction passively receives vectors from partners, but actively conducts pathogen testing at their public health laboratory, where would this jurisdiction submit their activity request – in Tier 1 or Tier 2? Under this scenario, this activity would be consider Tier 2 if receiving mosquitoes for testing at the jurisdiction laboratory and Tier 3 if performing pathogen testing in ticks. 6. My jurisdiction currently sends collected ticks to CDC for pathogen testing. Which activity would this best align? We consider sending ticks to CDC for pathogen testing a Tier 2 activity. It best aligns with NOFO Strategy 1c, c) Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET). TX-DSHS-19-1309-A-001601 Table 1: Arboviral Condition Codes Condition Code Condition Name Nationally Notifiable 10058 Cache Valley virus disease, neuroinvasive No 10066 Cache Valley virus disease, non-neuroinvasive No 11718 California encephalitis virus disease Yes 10054 California serogroup virus diseases, neuroinvasive Yes 10061 California serogroup virus diseases, non-neuroinvasive Yes 10073 Chikungunya virus diseases Yes 10093 Colorado tick fever virus disease No 10680 Dengue Yes 11705 Dengue, severe Yes 11704 Dengue-like illness Yes 10053 Eastern equine encephalitis virus disease, neuroinvasive Yes 10062 Eastern equine encephalitis virus disease, non-neuroinvasive Yes 50237 Flavivirus disease, not otherwise specified No 10078 Jamestown Canyon virus disease, neuroinvasive Yes 10079 Jamestown Canyon virus disease, non-neuroinvasive Yes 10059 Japanese encephalitis virus disease, neuroinvasive No 10068 Japanese encephalitis virus disease, non-neuroinvasive No 11712 Keystone virus disease Yes 10081 La Crosse virus disease, neuroinvasive Yes 10082 La Crosse virus disease, non-neuroinvasive Yes 10072 Other arboviral disease, not otherwise specified (Alkhurma virus, Barmah Forest virus, Bourbon virus, Heartland virus, Highlands J virus, Kyasanur Forest virus, Mayaro virus, Murray Valley encephalitis virus, O'nyong-nyong virus, Oropouche virus, Rift Valley Fever virus, Rocio virus, Ross River virus, Sindbis virus, Tahyna virus, Toscana virus, Usutu virus, Other Arbovirus) No 10057 Powassan virus disease, neuroinvasive Yes 10063 Powassan virus disease, non-neuroinvasive Yes 11734 Snowshoe hare virus disease Yes 10051 St. Louis encephalitis virus disease, neuroinvasive Yes 10064 St. Louis encephalitis virus disease, non-neuroinvasive Yes 10074 Tick-borne encephalitis viruses No 11724 Trivittatus virus disease Yes 10055 Venezuelan equine encephalitis virus neuroinvasive disease No 10067 Venezuelan equine encephalitis virus non-neuroinvasive disease No 10056 West Nile virus disease, neuroinvasive Yes 10049 West Nile virus disease, non-neuroinvasive Yes 10052 Western equine encephalitis virus disease, neuroinvasive Yes 10065 Western equine encephalitis virus disease, non-neuroinvasive Yes 10660 Yellow fever Yes 50224 Zika virus disease, congenital Yes 50223 Zika virus disease, non-congenital Yes TX-DSHS-19-1309-A-001602 50222 Zika virus infection, congenital Yes 50221 Zika virus infection, non-congenital Yes TX-DSHS-19-1309-A-001603 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-001604 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. 16. XI. Strategy X: Work with cross-cutting health information systems team within your health department to develop core surveillance capacity within health departments to monitor and protect pregnant women, infants, and children” does not have an activity listed, and it is not listed on the BP1 Work Plan tab. How should applicants respond? Please disregard Strategy X provided in the guidance, and respond comprehensively to Strategy 1g and Strategy 1h in the work plan. Strategy X was inadvertently omitted from the work plan template. Strategy 1g: Strengthen connections across the health departments to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts Strategy 1h: Advance innovative IT strategies to monitoring linked mother-child health information while minimizing burden TX-DSHS-19-1309-A-001605 From: ZIKApregnancy (CDC) Sent: Monday, April 15, 2019 12:21 PM EDT To: ZIKApregnancy (CDC) Subject: FW: ELC Supplementary Information for 2019 Attachment(s): "Supplementary Information for ELC FY 2019_v3.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, jurisdictional partners. We wanted to ensure that everyone received the below email and attachment from the ELC Team on Friday. We also wanted to call special attention to the updated information regarding Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats. Best, Emerging Threats Team Prevention Research and Translation Branch Division of Congenital and Developmental Disorders National Center on Birth Defects and Developmental Disabilities From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, April 12, 2019 4:28 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Good afternoon, Please find the FINAL updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 3) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, March 29, 2019 3:53:18 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Good afternoon, Please find the updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 2) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks and we look forward to seeing many of you next week! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 21, 2019 6:04:53 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Supplementary Information for 2019 Good afternoon, Please find the Supplementary Information for Applying to 2019 ELC NOFO document attached here, and also located in REDCap in the file repository. As mentioned in previous communications, this document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This TX-DSHS-19-1309-A-001606 document will: • • • • describe the new ELC structure and contrast it with previous project periods, offer tips for developing effective work plans, milestones, and budgets, provide additional information about the submission process and tools that may aid applicants, illustrate materials from the ELC and partner program webinars, including a compilation of frequently asked questions for applicants to reference, and instructions on how to download the recorded ELC webinars. PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Thank you, ELC Team TX-DSHS-19-1309-A-001607 SUPPLEMENTARY INFORMATION FOR APPLYING TO 2019 ELC NOTICE OF FUNDING OPPORTUNITY (NOFO) April 2019 VERSION 3 TX-DSHS-19-1309-A-001608 Contents 1. Introduction ............................................................................................................................................. 3 2. Moving into a new competitive project period ....................................................................................... 4 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 ................................................................................... 5 Activity Progress Reports and Performance Measures ............................................................................ 8 3. Developing ELC Application Activities and Milestones ............................................................................. 9 4. Supplementary Application and Budget Template Guidance ................................................................. 12 Clarifications in NOFO Text ..................................................................................................................... 12 NEW SF-424A Form Budget Feature in Budget Template ...................................................................... 19 NEW ‘Program/Project Components’ Column H in Budget Template.................................................... 20 NEW State/Local Public Health Allocation Columns I + J in Budget Template ....................................... 20 Budget personnel designations as “Continuing” or “New” .................................................................... 21 ELC Data Management Plan (DMP) Checklist ......................................................................................... 21 5. Submission Process ................................................................................................................................. 23 Submission Checklist ............................................................................................................................... 23 Instructions to convert ELC excel applications into single PDF for Grants.gov ...................................... 23 6. ELC Frequently Asked Questions (FAQs) ................................................................................................. 28 7. Program-Specific Frequently Asked Questions and Guidance................................................................ 40 Project C: Health Information Systems Capacity ........................................................................................ Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases ...................... Program G: Healthcare-associated Infections and Antibiotic Resistance ................................................... Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond .................................................................................................................................. Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats ............................................................................................................ Centers for Disease Control and Prevention 2 TX-DSHS-19-1309-A-001609 1. Introduction Purpose of Guidance This document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • describe the new ELC structure and contrast it with previous project periods, • offer tips for developing effective work plans, milestones, and budgets, • provide additional information about the submission process and tools that may aid applicants, • illustrate materials from the ELC kick-off and budget webinars, including a compilation of frequently asked questions for applicants to reference. This document does not provide instructions for using the REDCap portal. This information can be found in the REDCap Users Guide, which can be found in the REDCap Application and Monitoring Portal 2019-2020 in the ‘File Repository.’ Yellow highlighted sections are new additions to this document, since the first version was shared on March 21, 2019. Centers for Disease Control and Prevention 3 TX-DSHS-19-1309-A-001610 2. Moving into a new competitive project period On February 28th, 2019, the Centers for Disease Control and Prevention (CDC) released a Notice of Funding Opportunity (NOFO) for the ELC Cooperative Agreement (CK19-1904). The NOFO announced is a new, competitive 5-year cooperative agreement open to the 64 jurisdictions currently funded through the ELC (CK14-1401). The new cooperative agreement incorporates feedback from recipients and partners aimed at: • Improving coordination across the portfolio of activities represented in the cooperative agreement. • Establishing a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Applicants may note that compatible cross-cutting activities from prior NOFO project areas have been merged into four robust public health programs (see page 5 for details). • Offering opportunities to implement four cross-cutting prevention and intervention projects within the public health programs, with an increased focus on integration, leadership and flexibility: o ELC Leadership, Management and Administration Project – New in 2019 o Health Information Systems Capacity Project o Impact and Evaluation Project o Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions • Implementing a tiered funding structure that allows for a scalable approach to supporting varying levels of activity and regional approaches. In August 2019, CDC expects to award approximately $200M to 64 jurisdictions to detect, prevent and respond to the growing threats posed by infectious diseases through three core areas:  Surveillance, Response, & Control  Prevention & Intervention  Communications, Coordination & Partnerships Please note: As FY19 (CK19-1904) is a competitive application year, recipients should not have an expectation of funding to be level to that which was awarded in FY18 under CK14-1401. While programmatic funding is anticipated to be relatively level, it should be taken into consideration that many recipients in FY18 (CK14-1401) received offset, along with new funding which will not be the case for Budget Period 1 in the new NOFO (CK19-1904). Centers for Disease Control and Prevention 4 TX-DSHS-19-1309-A-001611 Comparing ELC NOFOs: CK14-1401 vs. CK19-1904 Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs (green boxed below): o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] This new structure also offers opportunities to implement four cross-cutting prevention and intervention projects (blue boxed below) within the new public health programs (green boxes below), with an increased focus on integration, leadership, and flexibility: o o o o ELC Leadership, Management, and Administration Project – New in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions 2018 ELC NOFO 2019 ELC NOFO CK 14-1401 CK 19-1904 SECTION I: CROSS-CUTTING EPIDEMIOLOGY AND LABORATORY CAPACITY PROGRAM A B D F Epidemiology Capacity Laboratory Capacity Advanced Molecular Detection Public Health Laboratory Sustainability A Cross-Cutting Epidemiology and Laboratory Capacity Program SECTION I: CROSS-CUTTING PROJECTS B C G Health Information Systems Capacity Enhanced Evaluation Capacity C D H1 H2 Cross-Cutting Outbreak Capacity Cross-Cutting Outbreak Capacity E ELC Leadership, Management, and Administration Project– NEW in 2019 Health Information Systems Capacity Project Impact and Evaluation Project Cross-Cutting Emerging Issues Project: Enhanced Surveillance, Outbreak Investigation Response and Reporting, Surge Efforts and Interventions Centers for Disease Control and Prevention 5 TX-DSHS-19-1309-A-001612 To further facilitate programmatic growth in emerging areas and improve efficiencies, while also easing the administrative burden for ELC’s recipients, 16 compatible, discrete infectious disease projects from the prior NOFO are consolidated into large infectious disease programs (Section II: green boxes below). SECTION II: INFECTIOUS DISEASE PROGRAMS I1 I2 I3 I4 I5 I6 Z OutbreakNET/National Case Surveillance/NORS National Antimicrobial Resistance Monitoring System Integrated Food Safety Centers of Excellence (CoE) PulseNet USA NoroSTAT CaliciNET Capacity Building for Waterborne Disease Detection, Investigation, Reporting, and Prevention K1A Detection, Containment, and Prevention K1B External Data Validation K1C Hemodialysis BSI K1D Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Capacity Building for Surveillance, Detection, Response, Reporting, and Prevention F Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) G Injection Safety K2 Coordinated Prevention and Stewardship K3 Antimicrobial Resistance Regional Lab Network M1 West Nile Virus and Other Arboviral Diseases N1 Tickborne – Lyme Disease N2 Tickborne – Non-Lyme Disease H G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship G2. Antibiotic Resistance Laboratory Network (AR Laboratory Network) Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Fifteen remaining project areas are now organized into one disease-specific project section (Section III, blue boxes below). Most of the activities in this section remain the same as in the preceding NOFO, although they have new project titles. SECTION III: DISEASE-SPECIFIC PROJECTS X Mycotics – Improving Capacity to Detect and Respond to Public Health Issues Related to Fungal Infections I T Binational Border Infectious Disease Surveillance (BIDS) Program J U Global Migration, Border Interventions, & Migrant Health K S Enhanced Prion Surveillance L Mycotics: Detecting and Preventing Fungal Infections Binational Border Infectious Disease Surveillance (BIDS) Program Global Migration, Border Interventions, and Migrant Health Prion Surveillance Centers for Disease Control and Prevention 6 TX-DSHS-19-1309-A-001613 Rabies – Improving Case Management for Potential Rabies Exposure AND Rabies – Lab Capacity for National Rabies Surveillance M Rabies Surveillance O Parasitic Diseases N Parasitic Diseases Surveillance R1 Enhanced Vaccine Prevention Disease (VPD) Surveillance O Enhanced Vaccine-Preventable Disease Y Legionnaires’ Disease Prevention P Legionnaires’ Disease Prevention P1 P2 Influenza Surveillance and Diagnostic Testing AND Influenza Outbreak Response Non-Influenza Respiratory Diseases – Diagnostics, Reporting, and Surveillance AND Non-Influenza Respiratory Diseases – Outbreak Response Q Influenza Surveillance and Diagnostic Testing R Non-Influenza Respiratory Diseases: Diagnostics, Reporting, and Surveillance S Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity W1 W2 Q1 Q2 J1 J2 J3 R2 M2 Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity Enhanced Gonococcal Isolate Surveillance Project Intervening to Prevent Syphilis and HIV through Social, Sexual, Phylogenetic Networks Surveillance for anal human papillomavirus among men T Gonococcal Isolate Surveillance Project (GISP) U Syphilis and HIV Prevention through Social, Sexual, and Phylogenetic Networks V Human Papillomavirus Surveillance Among Men U.S. Zika Pregnancy Registry W Infants with Congenital Exposure: Surveillance and Monitoring of Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 7 TX-DSHS-19-1309-A-001614 Activity Progress Reports and Performance Measures PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Typically, ELC Continuation applications require recipients to include activity-level progress reports and the associated performance measures for each project within the application. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities being launched in Budget Period 1 of CK19-1904. Moving forward in the new period of performance for CK19-1904, performance measures will be collected prior to the continuation applications, and reporting of performance measures will no longer be included in continuation application submission. As such, activity-level progress reports and performance measures will not be collected on the 2019 activities until March 31, 2020*. To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of FY 2018/budget period 5 activity-level progress reports and performance measures until the closeout report, which will be due October 29, 2019. A closeout report is lengthier than a typical progress report captured in a continuation year, and will include the achievements and progress made over the entire past project period. ELC will provide templates, guidance and submission information for the closeout reports toward the end of the 2014-2018 period of performance. *This applies to all performance measures except for Program G: Healthcare-associated infections and antibiotic resistance, which will have performance measures collected January 31, 2020 and September 30, 2020. Centers for Disease Control and Prevention 8 TX-DSHS-19-1309-A-001615 3. Developing ELC Application Activities and Milestones Recommendations for Developing ELC Work Plan Activities and Milestones Cross-Cutting Epidemiology and Laboratory Capacity Program Purpose: The new 5-year ELC Cooperative Agreement cycle provides an opportunity to step back and review prior Notice of Funding Opportunities (NOFOs), and identify and address areas within the cooperative agreement where the organizational structure, content, and guidance might be improved. As part of the NOFO restructuring process, ELC will provide additional guidance on constructing work plans that more effectively highlight public health departments’ goals and how activities and milestones can more clearly demonstrate progress toward reaching those goals, particularly with respect to cross cutting sections. The ”Quick Reference for ELC Work Plans: Developing Better Milestones” document was developed and distributed to recipients in 2017. After release of the document, a group of general recommendations to consider when constructing activities and milestones for cross-cutting epidemiology and laboratory work plans was developed based on discussions and reviews of recipient work plans. KEY TERMS & DEFINITIONS: Strategy: Strategies are pre-defined by the program and tie back to the overarching ELC Overall Roadmap (provided in the ELC NOFO). Strategies are groupings of related activities and usually expressed as general or brief statements. Activity: Activities are major components of the program and support the overall strategy and related outcomes. They should be concrete and their implementation tracked through clear milestones. Milestones: Milestones should describe major, discrete accomplishments and tangible results associated with the activity and implementation plan. Milestones should represent measurable interim products that demonstrate the recipient is on schedule to accomplish the activity. Integrate SMART (Specific, Measurable, Attainable, Relevant and Time- Based) criteria and outcome language where possible. Overall Recommendations: 1. Utilizing the Overall Roadmap, consider how the strategies, activities, and milestones selected will help achieve your program goals/outcomes. a. The Implementation Plan should address how the expected outcomes will be achieved by the activities proposed with measurable progress reflected in the milestones b. Descriptions of the activities and milestones should focus more on recipients work plan goals/outcomes to be accomplished and less on the staff (person-centric) who will be assigned to conducting the activities. Names (when known), responsibilities, and duties of personnel funded through the ELC Cooperative Agreement are described in the Budget Template as opposed to the Application Template, where the work plan is located. 2. Improving the integration/alignment of activities and milestones between epidemiology and laboratory. a. In the 2019 ELC NOFO, the cross-cutting epidemiology and laboratory projects from prior years were integrated into one Program. This was done, in part, to encourage greater dialogue between epi and lab when developing recipient cross-cutting activities and work plans. Centers for Disease Control and Prevention 9 TX-DSHS-19-1309-A-001616 b. While it is understood that state, local, and territorial epi and lab staff routinely work very closely together, that strong working relationship has not consistently been reflected in ELC applications where they appear “siloed”. c. Choosing activities and developing implementation plans that include referencing each other’s work where applicable, strengthens the application and highlights the collaborative efforts and shared goals between epi and lab. Example: If WGS is newly being performed on all Salmonella isolates/specimens received at the PHL, what ‘new’ or enhanced surveillance activities are being pursued by the epidemiologists to more fully exploit this new technology potentially resulting in more timely and improved outbreak detection and source identification (e.g. enhanced standardized questionnaires used; engage student interview teams to attempt to contact all cases whose isolates are undergoing WGS; use GIS to look at clusters of matching WGS patterns, etc.)? 3. Number of activities and milestones. More (activities, milestones) does not necessarily translate into “better”. a. In some applications, work plans have included a large number of activities with numerous milestones listed under a specific strategy, resulting in redundant implementation plans and milestones b. Articulating and outlining first recipients’ goals and needs regarding priority areas to be addressed in the cross-cutting section will result in a more cohesive application. c. Number of activities &/or milestones should be determined by the work being proposed, not by the number submitted in last year’s application. The review, and related scoring, is contingent upon the strength of the work plan. d. Once drafted, review the entire section to identify activities and milestones that could be consolidated either under one activity listed or by rephrasing/rewording the detailed activity name. 4. Milestones. a. What they are: i. Specific, discrete activity accomplishments or outputs. ii. Described in the Activity Implementation Plan. iii. Written in active voice (examples): Complete (e.g., a CIDT survey of laboratories; an evaluation of the impact of utilizing a student interview team on CRF completeness and timeliness); Develop (e.g. a protocol on legionella outbreak investigation and management); Build (e.g. a new data entry system); Establish (e.g. an AR Taskforce; a Student Interview Team); Implement (e.g. revised salmonella case report form; new quarterly reports for LHDs); Specify a desired outcome (e.g. 80% of case report forms will be complete for critical data fields); Train (e.g. xx# lab staff cross-trained in performing WGS; xx# epi staff trained in basic/advanced SAS/ArcGIS); Hire (new staff). b. What they are not: i. Vague (examples): Enhance (e.g. reporting system; case report forms; laboratory testing practices); Improve (e.g. quality and timeliness of reports); Summarize (e.g. notes from meetings); As needed (e.g. Participate in Centers for Disease Control and Prevention 10 TX-DSHS-19-1309-A-001617 investigations, as needed); Reiteration of the Activity Name (e.g. both are “Improve quality and completeness of data”) ii. Ongoing, routine activities (examples): Continue (e.g. holding monthly meetings; monthly/quarterly reports); Maintain (e.g., staff person); Attend (e.g. meetings, conferences) 5. Timeframes for completion of milestones. As stated previously, milestones are intended to be discrete points in time when an important stage in an activity is reached. a. While it may be difficult to exactly determine when an activity may be initiated and/or completed, it is expected that you provide a logical timeline for when key components of the activity (and listed as milestones) will be completed. b. When one milestone is dependent upon the completion or near completion of another milestone within the budget period, the second milestone’s completion date should follow the first milestone’s completion date. c. Rethink milestones that can “only” have a completion date consistent with the end of the budget year (i.e., July 2020). Again, milestones are discrete points in the work plan indicating whether work remains on-track. Milestones would not be ongoing or continuous actions routinely taken. Centers for Disease Control and Prevention 11 TX-DSHS-19-1309-A-001618 4. Supplementary Application and Budget Template Guidance Below you will find information about several new features in the ELC application and budget templates, as well as specific clarifying guidance from discrete programs and projects based on questions the ELC has received to date (March 21, 2019). Important note about using all excel based templates to avoid issues with the cells becoming noneditable: if applicants are pasting text from another document (such as the Companion Tool), they should first click the cell they want to edit, and then paste the text into the formula bar (highlighted below). ~ i - • File Insert ""' Paste Cut ~Copy ELC_ProJect_C_Workplan - Excel Page Layout • 111 Cal1bn • I " Format Painter C~pboard r;, Formulas u Data Rev,ew 7 E- font V,ew ACROBAT ., .. ~ Q Tell me what you want to do _ rap, .,_ Merge&Ce •% ' ♦ Cond111onal Forr Forma tmg Tai Number Alignment l1z C4 B A D C Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Workplan 2 3 4 Home Page Approach BP1 Work Plan E Guidance ELCProject Clarifications in NOFO Text Specific CDC project leads provided clarification to some of the published NOFO guidance in their specific activity sections: Data Management Plans (DMP) (p. 30) Please see updated link https://www.usgs.gov/products/data-and-tools/data-management/datamanagement-plans A. Cross-cutting Epidemiology and Laboratory Capacity (p. 72) PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with Centers for Disease Control and Prevention 12 TX-DSHS-19-1309-A-001619 version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. AMD Funding in the cross-cutting section will support: (1) AMD-related workforce development through training at the local, state, and national level, (2) bioinformatics support, and (3) support for state and local health department initiatives to extend the use of AMD technologies. Applicants may apply to one, two, or all three components. In this document, we’re using the same definition of “Tiers” as in the ELC NOFO (see page 11 of the NOFO: Tier 1, core activities; Tier 2, enhanced activities; Tier 3: regional activities). (1) Workforce Development Component: Applicants may apply as either a Tier 2 AMD Training participant or a Tier 3 AMD Training lead. • Tier 2- AMD Training Participant- Most regions are planning one to two trainings per year; please contact your regional lead for details. Funding requests may include: o Travel related costs to attend regional AMD training and training registration. o Supplies and equipment needed to aid in the set-up of AMD technology into current laboratory workflows of labs with little to no existing infrastructure. o Other costs related to AMD training and workforce development with accompanying justification may also be considered. • Tier 3- AMD Training lead- CDC is funding one training lead for each of seven regions (those regions correspond to the PulseNet regions). Funding requests may include: o Costs associated with providing regional AMD training or workforce development.  These costs may include developing, implementing, and facilitating inperson or web-based training. o In-state travel expenses for training instructors and participants. o Travel related to AMD Training lead coordination meetings and conferences, as appropriate (2) Bioinformatics Resource Support Component: Applicants may apply as Tier 3 Regional Bioinformatics Resource lead (BRR). Funding requests may include: • One full-time bioinformatics staff member, who serves as the bioinformatics subject matter expert for the entire region. o Staff may be contracted through an academic partner or other organization; funding may be requested for the time, the costs of acquiring and implementing contract services for the personnel member. • Travel costs associated with the BRR providing consultation throughout the defined region, including on-site visits with regional public health laboratories and health departments. • Travel costs for BRR to attend or provide instruction at up to two (2) AMD Academy training for Microbiologists courses. *BRRs may serve as instructors for one or both courses; courses may be up to 4 days long. • Travel costs for BRR to attend one (1) Advanced AMD Academy course for Bioinformatics Scientists as a participant. *This course is tentatively planned to be 3 days and will include spaces for all BRRs. • Travel costs for BRR to attend a national or regional conference. • Costs associated with providing web-based consultations including platforms like Zoom. Centers for Disease Control and Prevention 13 TX-DSHS-19-1309-A-001620 • Cloud computing or computational resources to support regional bioinformatics needs, including, as necessary, third-party consultation and contract support. This may include computers need to support regional bioinformatics support. • Costs associated with providing cloud-based training environments for bioinformatics consultations and/or training. (3) AMD Capacity Component The AMD program works with programs across the public-health infectious disease spectrum, including bacterial foodborne disease, HIV, viral hepatitis, Legionnaires diseases, antimicrobial resistant organisms and others. The program doesn’t have the resources to cover operational costs for AMD-related activities in all of these, and generally relies on the CDC programs involved to cover those costs and to manage those programs. At the same time, the AMD program wants states to have some flexibility in deciding which pathogens to sequence—to be able to make decisions based on local priorities and not exclusively on CDC priorities. For this reason, the AMD program established the “AMD Capacity Component”. In addition, the AMD program hopes that this will give states and localities flexibility to innovate, for example, by combining multiple pathogen groups on sequencing runs (in this case, funding would be needed to do the validation work). In most cases, the AMD program does not have resources to support core personnel under this component (the “AMD Capacity Component”), although it does consider proposals to cover personnel or contractor costs on a short-term basis for specific projects. *AMD Capacity proposals should be requested in Section A- Cross-cutting – AREA A: SURVEILLANCE, DETECTION, AND RESPONSE- Strategy 1b (page 75) Applicants may request funding for: • Cost associated with introducing or extending the application of AMD technologies or improving AMD capacity within the applicant’s jurisdiction or affiliated laboratories. • Proposals may include equipment, supplies, cloud computing services, or personnel costs to cover AMD activities that are a priority to the jurisdiction. Funding will not be approved for: • Equipment service and maintenance contracts. • Routine office costs including office supplies, network access charges, utilities, etc. • Ongoing infrastructure costs such as internet service fees • Ongoing Cloud based services (i.e. BaseSpace). *AMD may consider funding one-time or short-term expenditures if needed to accomplish a transition, or specific projectrelated cloud computing expenses. • AMD-Day travel is not covered under this section of the ELC; OAMD has elected to fund AMD Day travel request through a different funding mechanism. • Software licenses may be funded where a compelling case can be made. The use of open-source software is encouraged where feasible. The AMD program may determine on a case-by-case basis fund software licenses for commercial genomic analysis software, where a compelling case was made, especially where the packages are needed to making transitioning easier. Note with regard to other programs and projects in the ELC NOFO Two other related programs and projects in this year’s ELC NOFO also cover AMD-related activities: • F. Foodborne, waterborne, and enteric diseases Centers for Disease Control and Prevention 14 TX-DSHS-19-1309-A-001621 • G. Hospital-acquired infections and antimicrobial resistance To simplify the application process, for those two specific areas, please apply for funding only in those activities. Do not apply for funding both through Activity A (where AMD is located) and through the program-specific activity (i.e., Activity F or G); apply only through the programspecific activity. The AMD program will be coordinating with the programs managing those two activities. B. ELC Leadership, Management, and Administration Project (p. 81) To demonstrate true need, we would recommend requesting positions that are providing administration, oversight, policy, communications, and coordination across the entire ELC portfolio. These types of positions may include, but are not limited to: principal investigators, epidemiologylaboratory-health information system coordinators/liaisons, program managers. If a relevant position has been supported in a specific project (outside of the Cross-cutting epi and lab) in FY2018, we recommend placing request in both the specific project where it was previously funding, and in the leadership project. Please be sure to add a note in the budget worksheet justification to indicate position was included in two places in the application. C. Health Information Systems Capacity Summary with Tiered Activities (p. 52) There is a typo in the Tier 1 summary listed for Project C. It should reflect the “required” activities listed in the Project C section. Specifically: • Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. • Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). • Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Additional information is being prepared to assist with drafting Project C and will be available after the webinar on March 20, 2019. To request a copy of the information or webinar materials, send an email to EDX@cdc.gov. H. Vector-borne Diseases (p. 156) Clarification to text found in the Funding Strategy section (p.157). The third bullet states: • Estimated average award amount: Approximately $266,000. The average award will depend upon the project activities (tiers) in which a jurisdiction participates. In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities. These jurisdictions must document capacity at lower tiers to be granted higher tier funding. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the text is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total Centers for Disease Control and Prevention 15 TX-DSHS-19-1309-A-001622 award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. I. Mycotics: Detecting and Preventing Fungal Infections (p. 167) Supplementary guidance was provided via webinar to applicants on March 28, 2019. Webinar slides are located in ELC’s REDCap file repository. J. Binational Border Infectious Disease Surveillance (BIDS) Program (p. 172) • Clarification of NOFO text: Applicants should determine which activities are the best fit for their particular circumstance considering the information provided in ‘Funding Strategy’. For Strategy 1i: Sustain and/or enhance information systems through integration of binational variables, activities (a), (b), and (c) are required, and applicants are also required to implement at least one of the two optional activities, (d) or (e). Applicants are also required to conduct at least one activity in Strategy 1b: Enhancing investigation and outbreak response. Applicants must describe how they plan to collaborate with and/or fund local health departments to conduct proposed activities. If the applicant cannot conduct the required Strategy 1i activities, or a Strategy 1b activity, the applicant must provide a detailed justification and explanation of the barriers. Activities in Strategy 1c: Improve surveillance and reporting will be considered for funding only if the applicant is addressing Strategy 1i as required and at least one activity in Strategy 1b. • The Project J template was modified to include 3 “other” activity options per strategy. The new version of the template replaced the previous version, and can be downloaded directly from REDCap. K. Global Migration, Border Interventions and Migrant Health (p. 180) • Clarification of NOFO text: The activities in this project were incorrectly designated at “required.” Please note that all activities in this section of the guidance are optional for applicants, and applicants may choose to apply for one or more activities in this section. L. Prion Surveillance (p.184) • Prion Surveillance activities are recommended to focus on CWD (Chronic Wasting Disease) rather than CJD (Creutzfeldt-Jakob Disease). This programmatic change in focus was not clearly noted in the guidance. M. Rabies (p. 190) Centers for Disease Control and Prevention 16 TX-DSHS-19-1309-A-001623 • • Clarification for NOFO text: The rabies application can include both epidemiology and laboratory related requests. What this means is that the activities previously supported in Rabies –Improving Case Management and Laboratory Reporting (W1) & RabiesImproving Capacity for National Rabies Surveillance (W2) under the current (soon to be expiring) ELC Cooperative Agreement (CK14-1401) is now under Rabies Surveillance (M) in the new ELC NOFO (CK19-1904). If you look at the Strategies under Rabies Surveillance (M) in the new ELC NOFO you will see that there are places where laboratory activities (e.g., testing, training, supplies, etc.) can fit in both the activities and also in the budget template. The Rabies Surveillance (M) guidance is actually intended to focus on both laboratory activities and the resulting informatics & data sharing, just in a format that reflects the intended collaborative working nature that we want to promote to build capacity. N. Parasitic Diseases Surveillance (p. 193) • Guidance for strategy 1c Expand Surveillance for STH surveillance and control strategies: The scope and intent of the proposed activities could include improving diagnostic capabilities and identification of parasites to detect STH infections and expanded surveillance for STH infections. Expanding surveillance could involve a prevalence survey or enhancing reporting of identified infections. Both epidemiological and laboratory activities can be included. O. Vaccine Preventable Diseases (p. 196) • For personnel requests where individual efforts individual’s effort is split across multiple programs and projects, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Please provide justification about the additional functions (e.g., AFM support, health IT coordination) expected as a result of any additional “percentage” effort being requested. Including the Tier 2 AFM activities would be a prudent way to emphasize this • Tier 2 measles activity: The measles program is planning to request more defined deliverables going forward, and will discuss these with jurisdictions that apply for this activity in the upcoming project year. o Deliverables: Keeping in mind the varying work done by jurisdictions and the flexibility of activity implementation, these deliverables may include providing Centers for Disease Control and Prevention 17 TX-DSHS-19-1309-A-001624 o information on specific community data, and/or a line list of persons exposed to measles in certain settings to measure effectiveness of PEP. Activity examples:  Analyze the vaccination status of persons in jurisdiction registry to identify and characterize populations that are under-immunized and most vulnerable to measles outbreaks.  Use zip code level data to identify communities potentially at risk for measles outbreaks.  Use IIS data to assess pockets of need that leave a group at higher risk of an outbreak (geographic, demographic, gathering point).  Analyze statewide school vaccination coverage data and the annual survey of immunization rates in childcare settings data to identify populations with low MMR coverage who could be at risk for outbreaks. Prepare a report identifying the populations and outlining strategies to improve coverage.  Measure up-to-date MMR vaccine coverage rates using immunization registry and identify factors associated with lack of MMR vaccine receipt. Partner with colleges/universities, federally qualified health centers, and providers who serve large immigrant communities to evaluate the vaccination rates among these groups. Develop and disseminate education modules for providers and communities.  Evaluate the usefulness of school exemption rates as a marker of populations at risk for measles outbreaks.  Measure the impact of isolation, quarantine, and exclusion strategies in limiting measles transmission.  Improve the public health response to measles cases by hosting inperson trainings for local health departments with new staff members unfamiliar with VPD investigation techniques and local health departments with problematic investigation techniques. The trainings cover using the state immunization registry to identify unvaccinated contacts, working with Immunization to plan for interventions, and describing the community risk by assessing the geography and vaccine hesitancy of the community. P. Legionnaire's Disease Prevention (p.210) • The CDC Legionella Laboratory can provide methods and consultation to state public health laboratories for the adoption of molecular methods for Legionella detection, including PCR and sequencing. Jeff Mercante (wyh5@cdc.gov) is the main laboratory point of contact for these purposes, but several other individuals can also serve as contacts, including: Jonas Winchell (zdx2@cdc.gov), or Claressa Lucas (chl9@cdc.gov). • CDC’s intent is to support public health laboratories in their ability to provide both Legionella whole genome sequencing capacity and data analysis. The CDC Legionella Centers for Disease Control and Prevention 18 TX-DSHS-19-1309-A-001625 • Program prioritizes the sequencing and analysis of isolates at public health laboratories and projects designed to increase laboratory capacity to conduct WGS testing would fall under the scope of this proposed activity. In terms of data analysis for Legionella, we understand that this can be a hurdle but that it goes hand-in-hand with WGS capacity building. Multiple bioinformatic methods exist for characterization of Legionella WGS, and as part of our prioritization of Legionella data analysis and to help laboratories flesh out their analytic pipelines, the CDC Legionella Lab freely offers several data analysis tools to public health laboratories and partners, including a whole genome MLST database for high resolution L. pneumophila typing and cluster detection. Outside of the ELC cooperative agreement, the CDC Legionella Lab is a reference laboratory, and public health laboratories are encouraged to submit Legionella isolates of clinical origin for identification and typing (submission of environmental isolates is only done under special circumstances, such as an outbreak, that requires prior consultation). Our current laboratory extended pipeline for isolate characterization includes WGS as a terminal output, which is meant to support public health labs as they stand up their own sequencing capabilities. S. Threat of Antibiotic-Resistant Gonorrhea: Rapid Detection and Response Capacity (p. 230) • Please refer to the Funding Strategy section (page 232 & 233) of the ELC NOFO, paying special attention to the fact that the estimated number of recipients will not exceed eight (8). Competitive applications will be those that can demonstrate a strong track-record and existing capacity to address the activities listed in the NOFO. To help determine whether a strong track-record exists, applicants can refer to the previous NOFO (i.e., BP5 of CK14-1401) for reference of activities that should have previously been undertaken. W. Infants with Congenital Exposure: Surveillance and Monitoring to Emerging Infectious Diseases and Other Health Threats (p.264) • Please disregard Strategy X provided in the guidance, and respond comprehensively to Strategy 1g and Strategy 1h in the work plan. Strategy X was inadvertently omitted from the work plan template. o Strategy 1g: Strengthen connections across the health departments to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts o Strategy 1h: Advance innovative IT strategies to monitoring linked mother-child health information while minimizing burden NEW SF-424A Form Budget Feature in Budget Template The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This page of the budget workbook can be submitted directly to http://www.grants.gov to satisfy the SF 424A requirement. Centers for Disease Control and Prevention 19 TX-DSHS-19-1309-A-001626 NEW ‘Program/Project Components’ Column H in Budget Template Specific CDC program and project leads provided the following instructions on how applicants should notate the “Program/Project Components” column H in the budget template, which is particularly important for the larger complex programs. Where epidemiology and laboratory budgets are not completely separate, we encourage applicants to note costs that are specific to “epi” or “lab” in Column H. This column is not mandatory and in the absence of specific guidance, it can be left blank. Please note specific guidance from programs below: A. Cross-Cutting Epidemiology and Laboratory Capacity • Use Program/Project Component column to notate where cross-cutting resources are requested to directly support other programs or projects. F. Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases: Surveillance, Detection, Response, Reporting, and Prevention • The program/project components column is optional for this section. If the applicant feels that it is helpful to include information here, they may, but this program is not asking for specific designations in the budget by project or Tier. G. Healthcare-associated Infections and Antibiotic Resistance Program • G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship: For the G1 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1” or “2” in the corresponding cell. If a line item is intended to cover funding for both Tier 1 and Tier 2 activities, please enter “Both.” • G2. Antibiotic Resistance Laboratory Network (AR Lab Network): For the G2 budget request, please use the Program/Project Components column to flag each line item by tiers. Do so by entering “1,” “2,” or “3” in the corresponding cell. H. Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond • H.1 Vector-borne Diseases: Core (Tier 1): Use program/project components column in the budget to notate each line item as Epidemiologic, Laboratory or Ecologic • H.2. Vector-borne Diseases: Enhanced (Tiers 2&3): Use program/project components column in the budget to notate each line item as Tier 2 or Tier 3, and AREA: Epidemiologic, Laboratory or Ecologic NEW State/Local Public Health Allocation Columns I + J in Budget Template This is a new requirement in the budget template for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by line item if the cost will be expended at “state,” “local/regional,” or “both.” If applicant selects “both,” they should also include an estimate of the percent which will be allocated to local/regional health departments. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or Centers for Disease Control and Prevention 20 TX-DSHS-19-1309-A-001627 laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Budget personnel designations as “Continuing” or “New” For personnel line items: Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. For non-personnel line items: a. Contracts (non-personnel), maintenance/service agreements, etc. can have the designation of ‘C’ (continuing) if the request received financial assistance in the prior budget period. The use of ‘C’ would not be applicable for those non-personnel items that were funded as one-time only funding or through post-award actions (e.g., carry-over, redirection, etc.). b. Travel, if it is a required element of a position request that also has a ‘C’ designation, can be denoted as ‘C’ (continuing). For example, if a regional epidemiologist is a position that received financial support in the prior budget period and the request is for continued funding in the upcoming budget period; plus, the travel in the budget is required for the activities of the position to be completed then the travel can also be designated as ‘C’. If the travel is to attend various meetings, conferences, trainings it should be designated as ‘N’ (new) even if it was requested and supported in the prior budget period because this travel would be part of new activities in the new work plan, as opposed to an element under a previous-supported position. ELC Data Management Plan (DMP) Checklist While the Data Management Plan requirements in the 2019 ELC NOFO specifically pertains to collection of public health data related to ELC-funded activities, we strongly encourage that efforts be made to make the DMPs as complete as possible. 1. Description of ELC Data - Describe types of data collected (e.g., performance measure data, financial data, success stories). Things to think about: • What data will be generated through programmatic activities? • What data types will you be creating or capturing? • How will you capture or create the data? • If you will be using existing data, how will you acquire it? 2. Period of data retention - Describe plans for archiving data or explanation of why that is not necessary. Things to think about: • How long will the data collector retain the right to use the data before opening it up to Centers for Disease Control and Prevention 21 TX-DSHS-19-1309-A-001628 • wider use? Explain details regarding data retention periods. 3. Data format – Describe general data formatting standards. Things to think about: • Which file formats will you use for your data, and why? • What transformations to more shareable formats will be necessary to prepare data for preservation and/or data sharing? • What contextual details (metadata) are needed to make the data you capture or collect meaningful? • How will you create or capture these details? 4. Data dissemination – Describe how data will be disseminated and how other parties gain access. Things to think about: • How and when will you make the data available after data collection? (Include the resources needed to make the data available: equipment, systems, expertise, etc.) • Who gets access to data specifically? • How will data are to be shared and managed with partners and other major stakeholders? • What other types of information should be shared regarding the data, e.g., the way it was generated, analytical and procedural, information? • What is the process for gaining access to the data? • Will any permission restrictions need to be placed on the data? • Are there ethical and privacy issues? If so, how will these be resolved? • How will you manage data with sensitive information? 5. Data storage and preservation of access – Describe long-term strategy for storing, archiving and preserving data. Things to think about: • What is the long-term strategy for maintaining, curating and archiving the data? • Which archive/repository/database have you identified as a place to deposit data? • How long will/should data be kept beyond the life of the budget/project period? • What data will be preserved for the long-term and why? • What documentation will be submitted alongside the data or created for archival in order to make the data reusable? Centers for Disease Control and Prevention 22 TX-DSHS-19-1309-A-001629 5. Submission Process Complete applications are due at 11:59pm ET on May 10th, 2019 to Grants.gov, with courtesy copies of the Excel application templates and budget template submitted to the REDCap ELC Application and Monitoring Portal 2019-2020. Submission Checklist 1. Completed Application must be submitted to www.grants.gov. 2. Courtesy Copies of all completed templates should be submitted to REDCap. Instructions to convert ELC excel applications into single PDF for Grants.gov The instructions below are provided as a guide to combine your many Excel files into a single PDF file for submission in Grants.gov. This is a two-step process. First, each Excel file will need to be converted to a PDF. Next, all the newly converted PDFs need to be compiled into one PDF. Step 1 outlines how to convert each Excel file into a PDF. Step 2 outlines how to take all your newly converted PDFs and compile them into one PDF for submission. Two different options are provided for compilation: A) Using the Adobe Acrobat program or B) Using a free, public website. Note: If you do not have Adobe Professional installed on your computer, you may not have the ability to convert the Excel files to PDF format. In this case, please send an email to elc@cdc.gov to inform the CDC ELC team that you need assistance with this process. When all of your Excel templates are complete and ready for submission, please upload all of the completed templates into REDCap and notify us when this is complete. The CDC ELC team will convert all of the templates to PDF format and compile them into one PDF file, and then provide the combined PDF file onto REDCap for you to access it and complete the official submission into Grants.gov (this step must be performed by the recipient and not CDC). We recommend notifying the CDC ELC team at least 3 days prior to the submission deadline if you need assistance with this process. If you do have Adobe Professional installed on your computer, please follow the instructions below to complete the steps for conversion, compilation, and submission to Grants.gov. Step 1: Converting the Excel Files to PDFs 1. Open the Excel file you wish to convert 2. Click on ‘File’ >> ‘Print’ to bring up the print options 3. Under the printer option, select ‘Microsoft Print to PDF’ and under settings, be sure to choose ‘Print Entire Workbook.’ These selections are shown in the picture below. Centers for Disease Control and Prevention 23 TX-DSHS-19-1309-A-001630 Print Cop1at! 1 Print Printer ~ Msc:rosoftPnnt lo PDF -;!)C'il Ready Ptint thP.imtire worlcboolt - it>.~ ;_.,,_.-; Collat,d 123 1 23 1.23 4. Once these settings are confirmed, click print. Name the file and choose the destination for the file (It will be helpful to create a new folder and save it there). It will be saved in the destination as a PDF. Repeat these steps for each Excel file you need to convert. Be sure to save all the files in the same folder. Step 2: Combining multiple PDFs into one consolidated PDF Option A: PDFCompilation with Adobe Acrobat Note: If you have Adobe Acrobat Pro DC installed on your PC, this method wilf be straightforward and should be used. If you do not have Adobe Acrobat, please skip to Option B below. 1. Open 'Adobe Acrobat Pro DC' from your Windows start menu. 2. Click 'File'» 'Create'» 'Combine files into a single PDF...' as shown in the picture below: U Adobe · [ d it Acroba t Pro DC View Vlfindow I lelp Ctrl+O re Ctrl+i'l PDF from .Eile... ~ PDF from .S.canner f'~ PDF from Web Page... Save as Otner EJcporlTo Shift+Ctr l +O f'e,PDF from .Clipboard ~ J.!➔..I ~:!!I Comb ine Files into a Single PDt,, e , .....L.J • l I r,"1,,ti ,.,,.!:"f'Bf- f; ~ ~ Create FQnn ... ~ PDF £ortfolio ... ~ udget.pd f PmPnl fi-n -;,nn ndf Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001631 3. Once the 'Combine Files' window pops up, you have two options to upload your newly converted PDFfiles, shown below: ~ Comb,,., X D Files Add Fik>s..• • --- Add your new PDF files from your folder using this drop -down OR Drag and drop your PDFfiles anywhere into this space :: ·- Options Help Add files using the dropdown or drag and drop them here. You can then arrange them In the order you want. c,na,1 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Combine Files' button. (:o D .. •• ·- Md Filco... • l±JELC 11.pdf l±JELC Kl C.pdf Oµ liuns I rle !Ll l±JELC KlD.pdf lff! IR e,=-==-...l:"g [- ·• ~ -- • - •L'i .,. ~::-;; a @$&~ --=·a= ~~ ::.::-.=.=.."":!;-".:.;:;. ':'= ~=-=,;,:,:::, = .::.·-- - · · -= - -···i=a ·---- ·- C:!11 -a-:c. ::;;;:.._._... 11:11 ....;-=:::=:;: ;::. .. '77'.:"'t •· ·""'5:=;_ •.- ~ ~ -=-.=.:..-:= : . Centers for Disease Control and Prevention 26 TX-DSHS-19-1309-A-001633 4. Once uploaded, your PDFswill appear in the window as tiles. You can click and drag them to move them into the order you want to combine them in. When you are ready to combine them into a single PDF, click the 'Merge PDF' button. ~ Pagemode ELC KIC.p<.1 1~ i 5. ( File mode ) Once your files are in order, click Merge PDF I - -- C 11.p<.lf ~ AddmoroPDf• © Click and drag on the tiles to reorder your PDFs MERGEPOFl ➔ Once your PDFshave successfully merged into one file, you will have the option to download the PDF. Download the PDF and save into a folder of your choice. ~ f 'ti in G+ Vay! We merged all yo ur doc ument s to one single fi le! That 's grea t ! START OVIER Dow nload File Now e3j rnerged.pdf Edit 6. C □ Compress Submit this combined PDFas a single attachment in Grants.gov. Centers for Disease Control and Prevention I TX-DSHS-19-1309-A-001634 6. ELC Frequently Asked Questions (FAQs) In an effort to ease the application submission process, the ELC has created a list of frequently asked questions regarding the following areas within the application process: • • • • • • Notice of Funding Opportunity (NOFO) General Questions ELC Application Templates ELC Budget Template Submitting Your Applications REDCap Performance Measures Notice of Funding Opportunity (NOFO) General Questions Q. We are having trouble accessing the assurances/certifications forms on Grants.gov, is there another way to access these required forms? A. All of the required assurances/certifications are covered by signing the SF-424B (Federal-wide assurances) and the CDC certifications document. Also, here is the online version of the CDC certifications (https://www.cdc.gov/grants/additional-requirements/index.html). Q. Where can I locate the FY19 NOFO? A. The ELC FY19 NOFO was published on www.grants.gov and can find here: https://www.grants.gov/web/grants/view-opportunity.html?oppId=310241 Q. When was the NOFO published? A. The ELC FY19 NOFO was published on Thursday, February 28, 2019. Q. What are the dates for the ELC FY19 NOFO? A. The first budget period for this NOFO begins August 1, 2019 and continues through July 31, 2020. The application work plans should be written for the first budget period only. The period of performance for this NOFO is August 1, 2019- July 31, 2023. Q. What are some important dates we should keep in mind for this NOFO Application Period? A. While completing your application there are several dates to keep in mind in order to ensure your applications is complete, please see timeline below: Centers for Disease Control and Prevention 28 TX-DSHS-19-1309-A-001635 Awards Made ELC NOFO Published Budget Web inar App licat ions Due Feb 28 2019 HAI/AR Perfo rmance M easures fo r 8/1 to 12/31 All 2019 NOFO Perfo rmance data report ed toR EDCa.!! 2014-20 18 Closeout Report & 2018 Perfo rmance Measures Due Aug 1 Q. What is the application due date? A. The grant applications are due on May 10, 2019 at 11:59 p.m. ET. and must be submitted into Grants.gov. A curtesy copy of the application should also be uploaded into REDCap. Q. What is the difference between a Project and a Program? A. Starting in 2019, recipients will see a differentiation between public health “programs” (see detailed program listing below) and public health “projects” (e.g., mycotics, Legionella, parasitic diseases, rabies). The new NOFO framework establishes a stronger focus on public health programs while retaining the ability for recipients to work on discrete projects important to the health and wellness of their populations. Compatible cross-cutting activities from the prior NOFO project areas have been merged into four robust public health programs: o o o o Cross-cutting Epidemiology and Laboratory Capacity Program [formerly 4 discrete projects (A, B, D, and F)] Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases [formerly 7 discrete projects (I1, I2, I3, I4, I5, I6, and Z)] Healthcare-associated Infections (HAI) and Antibiotic Resistance (AR) [formerly 6 discrete projects (K1A, K1B, K1C, K1D, K2, and K3)] Vector-borne Diseases [formerly 3 discrete projects (M1, N1, and N2)] Programs are defined by an integrated approach to the 3 core areas: (1) surveillance, detection, & response; (2) prevention & intervention; and (3) communication, coordination, & partnerships, and provide funding support to a majority of jurisdictions. Projects are discrete activities that are limited in scope and number of jurisdictions funded. Projects may not include disease-specific efforts to prevent, mitigate, improve coordination between epidemiology and laboratories, integration, or response. Q. When should we submit our Close-Out Reports? A. A closeout report is lengthier than a typical progress report captured in a continuation year and includes the achievements and progress made over the entire past project period, including reporting on special funding such as Ebola and Zika. ELC will provide templates, guidance and submission information Centers for Disease Control and Prevention 29 TX-DSHS-19-1309-A-001636 for the closeout reports by August 1, 2019, including guidance on performance measure reporting for BP5. Closeout reports will be due October 29, 2019. Q. How should personnel be requested where individual’s effort is split across multiple programs and projects? A. To demonstrate true need, we would recommend requesting positions and percentages of effort in the respective program and project budgets. If a relevant position has been supported in a specific project in FY2018, placing the request for financial assistance in the same project in the FY2019 NOFO could be done by indicating ‘C’ (continuing) in the budget template so long as it does not exceed the level previously supported (e.g., 25%, 50%, etc.). If the remaining portion of the position is intended to do work in another new project, then the position would also be listed in the new project and indicated as ‘N’ (new) because there was not financial support in this area during FY2018. Please be sure to add a note in the budget justification section to indicate the position was included in two places in the application. Also, please provide justification about the work proposed, paying special attention to where additional efforts are requested, and the specific results of staff relevant to each project they are split across (copying and pasting the justification from one project into another project would not be sufficient in terms of justification). ELC Application Templates Questions Q. What needs to be included in the overall Evaluation Plan that is referenced in the 2019 ELC NOFO? A. The requirement for an overall Evaluation Plan listed in the 2019 ELC NOFO is an artifact of new cooperative agreement elements which are hard-coded into the system. Given that the ELC portfolio consists of various programs & projects which each have evaluation plan components, the hard-coded requirement is redundant and less useful for ELC. Therefore, as part of the supplemental information, ELC is providing a checklist to help ensure the requirements are met without placing unnecessary burden on applicants. Please reference pp. 21-22 of this document for the DMP Checklist. Q. How do we address the needs assessment requirement to identify gaps and/or training needs in epidemiology and laboratory? Is there a particular assessment tool ELC wants us to use or are we to develop our own? A. Currently the ELC is working with partners (i.e., CSTE, APHL) to complete a list of competencies which will be used to develop a training repository on the CDC TRAIN platform. A standardized training assessment will be developed and provided to Recipients by ELC. The assessment will likely be completed by October 2019, and ELC will require Recipients to use this tool to complete the needs assessment activity under the Cross-cutting Epidemiology & Laboratory Capacity Program. In the work plan, applicants can refer to using the ELC training assessment tool to complete the activity. Q. The application template for the Cross-cutting Epidemiology and Laboratory Capacity Program only has three (3) ‘other’ activity options, is there a way to insert additional activities for priority requests? Centers for Disease Control and Prevention 30 TX-DSHS-19-1309-A-001637 A. During the 2019 ELC Annual Meeting, there was a session on building a strong work plan which addressed the notion of ‘more is better’. Specifically, a strong work plan is one that has specific, measurable, achievable, realistic activities that can be achieved in the 12-month timeframe inherent with the budget period being funded. It is better to have a well-developed work plan that has targeted activities rather than have a work plan that includes numerous unrelated activities which may not address the priorities outlined in the NOFO guidance. Because the nature of the Cross-cutting Epidemiology and Laboratory Capacity Program is one of flexibility, there are a few (i.e., three) ‘other’ options where additional activities can be added so long as they related to the overarching strategies and ELC Overall Roadmap. In the rare instances where the three (3) ‘other’ options under the particular strategy are not sufficient, there are additional solutions. (a) The application template affords three (3) ‘other’ options per strategy, across all eight (8) strategies. This means that there is a total of twenty-four (24) ‘other’ options in the application template. If the three (3) ‘other’ options in the strategy being addressed are insufficient, then use one of the ‘other’ options in another strategy. To avoid confusion and ensure reviewers give proper credit, please note in the implementation plan which strategy/activity the entry addresses. (b) If the twenty-four (24) ‘other’ options still do not provide adequate room to address all planned activities in the budget period, there are overflow text boxes on the application template (under the ‘Approach’ tab) which can be used. If electing to use this option, please format the entries to correspond to what is listed on the ‘Work Plan’ tab (e.g., implementation plan, activities, milestones, etc.). Q. The new ELC NOFO (CK19-1904) does not seem to have continued support for activities under the current ELC Cooperative Agreement (i.e., CK14-1401), for the section on Public Health Laboratory Sustainability (Project F in CK14-1401). For those funded for lab sustainability, how can requests for continued financial support be made in the new ELC NOFO (CK19-1904)? A. The new ELC NOFO (CK19-1904) is not only a new 5-year funding announcement but also a restructuring of various infectious disease projects and activities to align better with current CDC programmatic goals and priorities. In terms of the Public Health Laboratory Sustainability section (Project F in CK14-1401), many of the activities have been incorporated into the newly defined activities in the Cross-cutting Epidemiology and Laboratory Capacity Program (section A of CK19-1904) in the 2019 ELC NOFO. While there may not be a one-to-one match, former activities under the lab sustainability project, if a priority for the jurisdiction, can be incorporated into the implementation plan when responding to the new activities within this section. Additionally, there are the three (3) ‘other’ options per strategy which allows for a customized activity to address work plan activities that do not logically fit into the pre-populated ones in the application template. Q. How can meetings (e.g., ELC Annual Meeting, CSTE, APHL) be addressed in the work plan or should they? 1111 A. Meetings, trainings, etc. are understood to be important and attendance is supported by the ELC. It is also appreciated that some jurisdictions are required to have documentation of the importance of Centers for Disease Control and Prevention 31 TX-DSHS-19-1309-A-001638 meetings in order to obtain travel approvals. While meetings, trainings, etc. are not stand-alone activities they can be elements listed in the implementation plan for a more overarching activity (e.g., staff development, workforce training, etc.). The activity could have elements such as assessing training needs; attending meetings/trainings (e.g., ELC Annual Meeting, CSTE, APHL) to stay current on latest guidance, practices, etc.; taking information back and sharing with staff not able to attend; etc. As a reminder, milestones should reflect discrete points in the budget period that can be used to measure progress in completing the overarching activity (e.g., staff development, workforce training, etc.). One caveat, if in the 2019 ELC NOFO a particular program/project section specifically requires the listing of attending a meeting, etc. as an activity then to meet the requirements and ensure a strong application score, please follow the specific guidance as outlined in the NOFO language. Q. If a jurisdiction (e.g., a city) does not have the necessary infrastructure (e.g., lab testing) internally but relies on another jurisdiction (e.g., the state) how is this best reflected in the application? Also, is there a way for the benefiting jurisdiction (e.g., a city) to ask program reviewers to consider awarding funds to the partner jurisdiction (e.g., state) to help cover the extra costs for the support being provided? Can a recipient request funding in the budget and then ask the funding be awarded to another jurisdiction? A. Using a city/state relationship as an example, if the city has an established agreement/relationship whereby the state provides services (e.g., laboratory testing) which are necessary elements in the application then this should be noted in order to ensure that reviewers understand the resources are in place to meet the requirement. One potential way to demonstrate this relationship would be for the city and state to have a letter of intent/commitment, memorandum of understanding, etc. that both applicants would upload as supplemental material to their completed application. In terms of funding, the city would not put the request for financial assistance in the city’s budget template and then ask that the funds be directed to the state instead of the city. Requests for financial assistance can only be made by the jurisdiction in which the funding, if approved, will be awarded. In this case, the state would make the request for financial assistance noting the additional laboratory costs associated with providing testing services to the city. To strengthen the request, the city could provide a letter of support to the state which, in turn, would include it in the application as supporting documentation. Q. Are we submitting a progress report this year? A. In a typical ELC continuation application, recipients are required to report on the activity-level progress and performance measures for each project. This is a new competitive NOFO, with a new program/project structure, new performance measures, and new priorities, and therefore, activitylevel progress reports will not be collected on the 2019 activities until the 2020 application. Performance measures for CY 2019 will be collected separately on March 31, 2020. Centers for Disease Control and Prevention 32 TX-DSHS-19-1309-A-001639 Q. Are there character limits within the templates? A. While we ask that application template character limits are observed, there is not a hard limitation in the application template. We encourage responses within the template are written as concise as possible. Q. Are the application templates the same as last year? A. No, here is a list of some of the changes: • New project period requires additional problem statement, justification, and capacity narratives for each program and project o Enter these narratives on “approach” tab in each template. • Performance measures will NOT be collected with application. o To ease the burden on jurisdictions during the 2019 competitive year application, ELC has delayed the collection of activity-level progress reports and CY 2018 performance measures until the closeout report, which will be due October 29, 2019. • The structure of the NOFO guidance in an intentional effort to reflect the collaborative work between epidemiology and laboratory staff necessary to achieve the overarching strategies. • Therefore, the activities names are hard coded. • Work plan details are not pre-populated, as this is the first of a five year period of performance • Use of "other” activities are not a standard option across programs and projects. Where “other” activities are not included in the templates, please align all activities to the published strategies and activities on the NOFO. • Activity-level progress reports will NOT be collected with application. o Major achievements and progress in prior project periods can be described under applicant capacity on “approach” tab in each template. Q. Can ELC send unlocked application templates? A. ELC has provided the unlocked Word document “Companion Tools” to be used as working documents for applicants. The official Excel application templates are locked to maintain the integrity of the document. If using Companion Tool or other working document, please note that text should be pasted in the formula bar of the official Excel template (see above, p. 12). Please ensure you follow the instructions on the submission process in this document (p. 21). ELC Budget Template Questions Q. Should existing personnel be designated as “Continuing” or “New” on the budget? A. Please denote the existing ELC-funded positions that are planned to continue work in the upcoming Budget Period 1 by using the continuing ‘C’ designation in the budget template. Also, please keep in mind that the use of ‘C’ should only apply to the level of funding previously supported. So if the position was funded in the FY2018 BP5 at 75% then the ‘C’ should be used for any portion up to 75% for FY2019 Centers for Disease Control and Prevention 33 TX-DSHS-19-1309-A-001640 BP1 requests. Any amount over 75% would need to be listed on a separate line and indicated by ‘N_(priority level)’. As with any year of the ELC Cooperative Agreement, support to these positions are not guaranteed, but this information is helpful for programs to understand the current capacity in place when making FY2019 funding determinations. Q. Is the way to use ‘C’ (continuing) as opposed to ‘N’ (new) the same in making personnel versus nonpersonnel requests in the budget template? A. Prior guidance (above) for Personnel support remains unchanged. To summarize: a. If it is the same position, same level of funding = ‘C’ b. If it is a new position in the program/project = ‘N’ c. Same position, new level of funding (e.g., increasing from 75% financial support to 100% financial support) i. Same level portion (i.e., 75%) = ‘C’ ii. Additional support requested (i.e., 25%)= Separate line entry and marked ‘N’ Non-Personnel requests have started to create a need for consistency in guidance; therefore: a. Contracts (non-personnel), maintenance/service agreements, etc. can have the designation of ‘C’ (continuing) if the request received financial assistance in the prior budget period. The use of ‘C’ would not be applicable for those non-personnel items that were funded as one-time only funding or through post-award actions (e.g., carryover, redirection, etc.). b. Travel, if it is a required element of a position request that also has a ‘C’ designation, can be denoted as ‘C’ (continuing). For example, if a regional epidemiologist is a position that received financial support in the prior budget period and the request is for continued funding in the upcoming budget period; plus, the travel in the budget is required for the activities of the position to be completed then the travel can also be designated as ‘C’. If the travel is to attend various meetings, conferences, trainings it should be designated as ‘N’ (new) even if it was requested and supported in the prior budget period because this travel would be part of new activities in the new work plan, as opposed to an element under a previous-supported position. - Q. In which program or project should I request support for cross-cutting training and peer-to-peer travel? A. It is recommended that any training/travel request in the budget relates to an activity in the work plan. Travel and training requests made in the Cross-cutting Epi & Lab Program should link to crosscutting outcomes. For trainings and travel specific to a program/project, please include these requests in the specific program/project application template. For the ELC Annual Meeting: • If the request if for the ELC Governance Team members to attend the ELC Annual Meeting, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For specific trainings or conferences, such as CSTE, Public Health Informatics, APHL, etc. Centers for Disease Control and Prevention 34 TX-DSHS-19-1309-A-001641 • • If the request is for cross-cutting epi &/or lab staff travel to travel to a specific conference, it may be requested in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If the request is for program/project-specific staff, the request should be made on that specific program or project application template. For Peer-to-Peer Site Visits • If the Peer-to-Peer request is for cross-cutting epi &/or lab staff to visit another jurisdiction to either learn or share best practices, then the request may be placed in the Cross-cutting Epi & Lab Program (Program A in the ELC NOFO) budget. • If the request is for program/project-specific staff, the request should be made on that specific program or project application template. Q. Can requests for laboratory costs simply be entered into the budget template or does something also need to be added to the application template? A. In order to apply for funding an application must be submitted, which includes the completed application template & budget template. The application template is the one that includes the approach & work plan. In the work plan, there needs to be an implementation plan, an activity, and related milestone(s) which support the request for financial assistance. In the work plan, the activity could be at a higher level and incorporate both epidemiology & laboratory efforts necessary for achievement. Regardless, there needs to be something in the work plan that supports the financial request. In the budget template, the specifics about the laboratory requests for financial support can be detailed. In the justification section for each line item, information can be included which links the request back to the Strategy/Activity in the work plan. Q. For contractual requests, what information is needed and how do we provide it in the application? A. For details about the elements that need addressing pertaining to financial assistance that will go into contractual mechanisms, please see the OGS Budget Preparation Guidance which can be found at: https://www.cdc.gov/grants/documents/budget-preparation-guidance.pdf If the six elements are known at the time of application, they can be entered in the budget justification section on the budget template; or, they can be addressed on a separate document and uploaded as an attachment to the completed application. If not all the elements are known at time of application, then ‘TBD’ can be entered in the budget template; however, please keep in mind that the missing information will need to be provided to OGS within 30 days post award in order to receive the required priorapproval before entering into a contractual agreement. Q. Can a request for a position be placed at 100% under two programs/projects to ensure that the position is funded? For example, we need a position funded to primarily do HAI outbreak response work but not sure the HAI/AR Program will fund given the focus is on only three defined positions. As a backup, we would also like to place under the Cross-cutting Epi & Lab Program but this would mean the request exceeds 100% which we heard at the ELC Annual Meeting is not allowed. A. It is true that a position cannot be funded for more than 100% across all federal funding sources (e.g., ELC, PHEP, etc.). Additionally, requesting more than 100% funding for a position in the ELC budget template in one program/project is not permitted due to the data quality checks built into the tool. Understanding the intent of the request is the critical part in ensuring that the entries will not be seen as Centers for Disease Control and Prevention 35 TX-DSHS-19-1309-A-001642 violating the 100%-rule. If a position is requested in a program/project (e.g., HAI/AR) at 100% but there is uncertainty that the funding program will provide the requested financial assistance, then a second request can be made in the Cross-cutting Epidemiology & Laboratory Program. The way this type of request is made is by noting in the budget justifications section, at the beginning of the entry, that the position is also being requested in the other program/project. This will alert reviewers and the ELC Project Officers that the intent is to increase likelihood of funding, not that a duplicative funding attempt is being made. Q. If a position (e.g., epidemiologist, laboratorian) does work in various areas (e.g., food, influenza, etc.) should the position be split across the different projects/programs impacted, like has been done in previous budget periods, or should the request be placed in Project B: ELC Leadership, Management, & Administration because it is cross-cutting? A. If the position is providing support to complete activities in two or more programs/projects and has been funded in those sections in the previous budget period, keeping them in the same programs/projects allows for designating them as ‘C’ (continuing) positions. There is the opportunity to transition the position into the Cross-cutting Epidemiology & Laboratory Program; however, listing the position there would necessitate noting the position as ‘N’ (new) given that the position had not previously been supported in this section. It is important to keep in mind that while there is no limit on the number of position requests made in the Cross-cutting Epidemiology & Laboratory Program section, there is a finite about of funding available for this program. While application to the ELC Leadership, Management, and Administration Project is encouraged, the intent of the project under the Cross-cutting section of the 2019 ELC NOFO is to provide dedicated resources for the optimization of ELC funding through leadership, coordination, and fiscal management. While the responsibilities of the positions in this section will function across the ELC portfolio, it is for the purpose of leadership & management rather than assisting in the completion of various activities in work plans across programs/projects. Q. What are some of the new ELC Budget Template Features? A. There are two significant changes this year within the budget template. The improvements are: • The SF-424A Excel form is located in the 1st tab prior to the MENU worksheet. It is designed to be analogous to and match the layout and function of the official SF-424A PDF form. Notice: Section B of the form, automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This form is locked in the budget template and auto-populates across all workbook tabs, so direct data entry is unnecessary. This page of the budget workbook can be submitted directly to www.grants.gov to satisfy the SF 424A requirement, or applicants can submit their own populated 424A. • The State/Local/Both Public Health Allocation Column. This is a new requirement in the budget for applicants to indicate if the funding requested will be expended by the jurisdictional Health Department, or expended by local or regional health departments in the jurisdiction. Applicants should indicate by every line item if the cost will be expended at “state,” “local/regional,” or “both.” If funds are mixed, applicant should select “both,” and also include an estimate of the Centers for Disease Control and Prevention 36 TX-DSHS-19-1309-A-001643 total percent which will be allocated to local/regional health departments. It is not necessary to estimate the funding percent for each local jurisdiction, please just estimate the total amount of funding that will support efforts at local and regional levels. Please note that local/regional is used here interchangeably to apply to subordinate or decentralized health departments or laboratories within the jurisdiction, and does not refer to regional laboratories that support multiple jurisdictions. Q. How should applicants distinguish laboratory requests from epidemiology requests, where separate budget tabs are not available? A. Separate epidemiology and laboratory budget tabs exist in three of the four programs but not in the projects. There are a few areas in the budget template where the laboratory requests can be clearly noted. Applicants can use column C (‘classification’, when making personnel requests); column H (program/project component); column K (budget justification) to assist clearly noting which financial requests involve laboratory support. Q. How should applicants use prioritization (categories 1-5) for personnel in the budget? A. This prioritization N_01..N_05 is designated for both new positions or new non personnel cost categories entries. Applicants are given the option to label new requests by their priority and preference to the jurisdiction. N_01 would denoted highest priority. For priority requests beyond five, please use the “N” indicator provided for selection. Prioritization does not guarantee funding, but it does helps CDC understand jurisdictional priorities when making funding determinations. Q. In regards to budging for contractor support, do we request the annual salary or the salary according to the hours worked outside of holiday pay? A. For annual salary (column O in budget template) you would enter the actual full year salary of the contracted position. In the percent FTE requested (column P), as well as the number of months requested (column Q), you would enter the percentage of the position and number of months anticipated for completing the scope of work. In salary requested (column R), you would take the percentage of FTE requested and number of months, and divide it into annual salary to determine the actual amount of salary support being requested. The request should not include more than 100% of an individual’s salary (column O). Q. Can ELC send unlocked budget templates? A. No. The budget template contains many embedded formulas, data validation functionality, and summation tools. To ensure the integrity of this document, this document cannot be shared in an unlocked form. Q. Can multiple people work in the budget workbook at the same time? A. Yes, this is possible. Applicants can setup a share mode inside the template to allow for multiple user access. Applicants may reach out to John Achim (vxu3@cdc.gov) or the ELC mailbox (ELC@cdc.gov), for assistance or may refer the following link for guidance: https://www.ablebits.com/office-addinsblog/2017/08/02/excel-shared-workbook-share-file-multiple-users/#share-excel-file-multiple-users Centers for Disease Control and Prevention 37 TX-DSHS-19-1309-A-001644 Submitting Your Applications Questions Q. Where do I submit my completed application? A. Applicants must submit their final grant applications to www.grants.gov and their ELC courtesy copy application should be submitted via REDCap. Q. Are recipients still required to submit applications to GrantSolutions? A. No, because this is a new cooperative agreement, all applications must be submitted via www.grants.gov. Q. Are we still required to upload a single file of our application in Grants.gov? A. Yes, this is still required and ELC will provide assistance with compiling your application into a single file if needed. This guidance can be found in the file repository within REDCap. REDCap Questions Q. How do I gain access to REDCap A. In order to gain access to REDCap all recipients are required to have a SAMS account. Through their SAMS account recipients will be able to log into their REDCap account. If recipients don’t have a SAMS account, please contact Char Njoroge (wkv2@cdc.gov) or Megan Light (wpa8@cdc.gov). If you already have a SAMS account but do not see REDCap on your SAMS profile, please send an email to Char Njoroge or Megan Light as well. Q. What should we submit via REDCap? A. The following documents should be submitted via REDCap, as your courtesy application to ELC: • Application Templates • Success Stories (at least one) • Budget Template Q. What resources will be available for recipients to complete applications? A. The ELC will release the following resources to assist recipients with completing and submitting their grant application: Centers for Disease Control and Prevention 38 TX-DSHS-19-1309-A-001645 Webinars: • • ELC Kick-Off Webinar: Thursday, March 14, 2019, 3:00 p.m. – 4:30 p.m. ET Healthcare-associated Infections and Antibiotic Resistance Program Webinar: Friday, March 15th at 2:00 – 4:00 pm ET. • ELC Budget Webinar on Tuesday, March 19, 2019 at 3:00 p.m. – 4:30 p.m. ET. This webinar will provide important information related to the budget template that will accompany your ELC FY 2019 NOFO Application. • Vector-borne Disease Program Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:00 p.m. ET. • Health Information Systems Webinar: Wednesday, March 20, 2019 at 3:00 p.m. – 4:30 p.m. ET. • Food, Water, Enteric, and Environmentally Transmitted Disease Program Webinar: Friday, March 22 at 3:00 p.m. – 4:00 p.m. *Slide decks from each presentation listed above will be available in the File Repository of REDCap. Guidance Documents and Resources: • • • • • Frequently Asked Questions (FAQs) ELC Application and Monitoring Portal 2019 - 2020 User Guide Companion Tool (unlocked word document) to accompany each application template ELC Supplementary Information for FY19 NOFO Application Single-File Conversion Guidance Q. How can I access the recorded kick-off webinar? A. Webex provided the following instructions to access the recorded webinar. Please note that this is an extremely large file, and may be difficult to download, which is why we are not able to share the file directly. DOWNLOAD INSTRUCTIONS: Click on the link(s) below, or if your email program does not allow linking, copy and paste the link(s) into the address field of your Internet Browser. ELC FY19 Kickoff Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=7b90ceda407b62aa6fa9c7a621749922 PWXW8757468-20190314 1905-1 03/14/2019 14:05:06 GMT-06:00, Central (Chicago) 77 Minutes ELC Budget Template Webinar Recording: https://resnet-garm.webex.com/resnetgarm/lsr.php?RCID=a3af0ca7e2593906b14a5c242b6e32db PWXW8824363-20190319 1905-1 03/19/2019 14:05:30 GMT-06:00, Central (Chicago) 76 Minutes • • Once you have been redirected to the Download page, select the "Download" button. When given the option to "Open" or "Save" the file; select the arrow next to the "Save" button then select "Save As". Centers for Disease Control and Prevention 39 TX-DSHS-19-1309-A-001646 • Once the "Save As" window appears, choose the location where you would like to save the file and select the "Save" button. ** Please download your recording within 30 days of the date of your call. After that time, it will be deleted from the server and no recording backup is maintained past this time frame. ** If you need assistance, please contact us at the following email address: cmt-services@one.verizon.com. 7. Program-Specific Frequently Asked Questions and Guidance Project C: Health Information Systems Capacity Program F: Foodborne, Waterborne, Enteric, and Environmentally Transmitted Diseases Program G: Healthcare-associated Infections and Antibiotic Resistance Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent and Respond Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats Centers for Disease Control and Prevention 40 TX-DSHS-19-1309-A-001647 ELC Health Information Systems Application Information The following information is provided to help jurisdictions complete the ELC HIS application. Please reach out to edx@cdc.gov for any questions regarding the ELC HIS application. The application templates this year are similar to last year. Please note: 2018/Budget Period 5 (BP5) activity-level progress reports and BP5 performance measures will not be collected with the new NOFO application, and will be collected in close-out reports in late October 2019. The application template for the FY19 NOFO includes four tabs (sections): 1) Home Page 2) Approach 3) BP1 Work Plan and 4) Guidance. An updated Budget Template will be used this year. Home Page The Home Page, as shown below, provides instructions on how to complete, print and PDF your application template, and provides space for contact information for the person completing the application template. Select a Jurisd iction) First Name : Last Name : Email: Phone : Posit ion/ T"itle : Project lead 's Contact tnrormatlon Alternate POCContact tnro (Optlonal) Instructio ns.: Please proc eed to the Approac h a nd then BPl Work Pla n ta bs to complet e all a ct ivities and fields . Printi ng or Uploading t o Grant Solutions : Use the button to t he right o expo rt the oo l o a PDF. Once in PDF orm at, you may pr int, or sa ve and upload , s ect ions o th e to ol by s pecifying th e des ired pag e numbe rs during prin ·ng. Depending on the version of Microsoft Excelyo u are using, you may ob ta in bd t u results by print ing to the "Microsoft Print to PDF" printer item (under File, Print) . Make PDF Spell Check: Use the follow ing bu tton to run s~ ll check ac ros s th e ent ire documen t. Note tha th e fo rm may freeze if spe llc heck process is inter ru pted or ca nceled befo re complet ion. Spell Check Submission : Please refer to i:uidance provided by the ElC team for subminion of application templates to Grants.gov and REDCapELCApplication and Monitoring Portal. Supporting Documentation Documents can be included to support information in the application (e.g., document with the name and address of hospitals/facilities identified to be onboarded for syndromic surveillance, organizational charts, workflow diagrams). You may upload documents to the supporting documentation section of the ELC Application and Monitoring Portal 2019–2020 REDCap project located at the bottom of the Completed Application Templates page. Update to HIS Tier 1 Requirements in NOFO NOTE: There is a typo in the Tier 1 summary listed for Project C (page 52 of the NOFO). It should reflect the required activities listed in the Project C section. Specifically: 1 TX-DSHS-19-1309-A-001648    Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. 2018 Application Work Plan vs 2019 Application Work Plan The differences between the information requested in the previous and the new ELC HIS application are listed in the following chart. Although Strategy 1, Enhance Health Information Systems Workforce, is no longer a strategy, ELC HIS is committed to providing cross-cutting flexible IT/informatics personnel to accomplish the strategies and activities. BP5 (2018-2019) I: Enhance Health Information Systems Workforce a. Designate a public health information systems specialist with flexible responsibilities… b. Develop and sustain core personnel needed to support integrated surveillance systems… c. Develop and sustain personnel resources to support and advance electronic data exchange… d. Increase public health informatics and information technology skills…through training… II. Advance Electronic Information Exchange Implementation a. Increase the percentage of lab reports received through ELR. b. Automate the use of all ELR. c. Increase ELR based on Meaningful Use (MU) standards. d. Increase public health laboratory capacity for electronic data exchange. e. Participate in the ELC Health Information Systems Implementation Support and Monitoring effort f. Implement new HL7 NNDSS Case Notification Messages. BP1 (2019-2020) No longer a separate strategy for HIS. See guidance below for including personnel and workforce in Applicant Capacity I. Strategy 1h: Advance Electronic Data Exchange… I.a.i. Maintain existing ELR transmissions (required) I.a.ii. (Required for jurisdictions below 75%) Increase ELR… I.a.iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way I.a.iv. Develop or enhance ELR data quality assurance processes No longer included as a separate activity I.c. Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. I.d. Advance electronic data exchange for Public Health Laboratories. No longer a separate activity for HIS. See guidance below in Applicant Capacity. I.b.i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (required) 2 TX-DSHS-19-1309-A-001649 g. Implement electronic case reporting (eCR). h. Create the capacity to transfer ELR messages and eCR messages between jurisdictions… III. Sustain and/or enhance integrated surveillance information systems I.e.i. Implement electronic case reporting (eCR) I.f. Advance electronic information exchange between jurisdictions II. Strategy 1i: sustain and enhance information systems… II.a. Maintain existing information systems… a. Maintain existing surveillance information including the personnel and operating system. environment/supporting software (required) b. Implement (if appropriate) a new/replacement II.b. Implement (if appropriate) new/replacement integrated surveillance information system. information systems. c. Enhance existing integrated surveillance II.c.i. Enhance existing information system(s) by information system(s) by adding or improving adding or improving functionality for Integrated functionality… surveillance information system; II.c.ii. LIMS; II.c.iii. Syndromic surveillance information system d. Move, or explore the efficiencies of moving, II.d. Implement additional innovative an existing or new integrated surveillance enhancements that improve analysis, enable labinformation system to a cloud-based/hosted epi collaboration, or increase the sustainability or environment. efficiency of systems… e. STD surveillance II.c.i.b. Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. II.c.i.c. Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. II.d. Innovative enhancements that improve analysis, enable lab-epi collaborations or increase sustainability or efficiencies of systems. II.e. Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. Approach The Approach tab (new) is designed to capture how the applicant will address the public health needs for their jurisdiction and/or the population they serve by clearly stating the problem, providing justification on how your jurisdiction will address the identified problem through activities, outlining the resources that will be used to address this problem through the suggested activities and how this entire plan will be evaluated for the current year. Under the Approach tab, you have fields for the Problem Statement, Justification, Applicant Capacity, and Evaluation Plan 2019. Additional information is provided below to assist with the Applicant Capacity and the Evaluation Plan for 2019 sections. Applicant Capacity Applicant capacity should include information to address the jurisdiction’s current capacity to successfully implement the proposed strategies and activities including staff and infrastructure in place that will be sustained or enhanced. This section should include staff for supporting flexible IT resources, to support electronic data exchange and integrated surveillance (previously included in Strategy 1) to 3 TX-DSHS-19-1309-A-001650 implement, maintain, or enhance integrated surveillance information systems, and the infrastructure and support to advance electronic data exchange (e.g., ELR, case notifications, syndromic surveillance, eCR). Supporting documentation (e.g., organizational chart, pictures or graphics of system processes) may be included to support the narrative. Be sure to also include information to support the following cooperative agreement requirements (page 83 of ELC NOFO) in this section:  Designate a person with overall responsibility for HIS activities (i.e., lead public health information systems specialist) and personnel responsible for each activity. This should include key personnel resources in IT, public health informatics, surveillance, and public health laboratories responsible for the implementation, enhancement, and maintenance of:  Integrated surveillance system  Electronic Laboratory Reporting  Syndromic Surveillance  Participate in ELC HIS implementation, support, and monitoring efforts.  Participate in Technical Assistance consultation assessment to identify priorities.  Work with CDC to measure key aspects of implementation (e.g., ELR volume at least once during the project period, HL7 case notifications sent to CDC, emergency departments (EDs) onboarded and sending data to CDC BioSense).  Participate in efforts to define consistent ways to link surveillance data to laboratory findings from public health labs and CDC labs for all conditions. Evaluation Plan for 2019 Describe the plan and the ability to collect the necessary data to report on each of the performance measures associated with the proposed activities (see table below, information in red is required) and the cooperative agreement requirements for measuring key aspects of implementation (e.g., percentage of ELR volume, HL7 case notifications sent to CDC, Emergency Departments onboarded and sending data to CDC BioSense). Activity Maintain and enhance Electronic Laboratory Reporting (ELR). Implement New NNDSS Case Notification Messages Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED)…. Establish electronic test ordering and reporting (ETOR) using HL7 messages with 1 or more hospitals or public health labs. Performance Measure Percent of lab report volume received through ELR Percent of conditions for both state reportable and nationally notifiable conditions that use the new HL7 format Percent of emergency departments (EDs) sending HL7 Promoting Interoperability (formerly MU) compliant syndromic surveillance messages to the health department and BioSense Platform1 Number of hospitals and public health labs with established electronic ordering and reporting (ETOR). 1 Required if funded for Syndromic Surveillance. If jurisdiction is only using CDC BioSense, health departments do not need to receive the messages directly. 4 TX-DSHS-19-1309-A-001651 Enhance systems to automated processing and use of ELR Percentage of STD case investigations (e.g., Chlamydia, Gonorrhea) auto-created from ELR. For the first year of the cooperative agreement, there is not a separate tab for your Progress Report. The progress report and performance measures will be captured later in the year in a closeout report. Highlights and additional information to describe proposed activities, including baseline information, can be included in each activity’s Implementation Plan under the BP 1 Work Plan. ELR volume will be collected once during the 5 year cooperative agreement for jurisdictions above 75% ELR. For jurisdictions below 75% ELR, volume will be collected annually as it has been in the past. CDC reserves the right to request ELR volume during the cooperative agreement as necessary for inquiries and funding justifications. CDC would provide guidance and ample notice in the event of a request. We recommend documentation of the volume calculation methodology at your jurisdiction to ensure that a volume request would be completed accurately and within the needed time frame. BP (Budget Period) 1 Work Plan The BP1 Work Plan section of the application template is where the applicant will outline the proposed activities, implementation plans, and milestones for Budget Period 1 (BP1). The BP1 Work Plan section is very similar to last year. Key differences include all activities are built into the template (no drop-down option to select activities), and all activity sections are expandable/collapsible for easy navigation. All required activities need to be included in the application. All other activities included in the application should be based on jurisdiction need and capacity. All implementation plans for each area should highlight successes, how barriers and challenges will be addressed, and how achieving identified milestones improve performance. Additional information to assist with completing the application for selected activities is listed below. NOTE: All activities or implementation milestones may not be included in the examples of implementation plan or milestones (i.e., development of process to enhance ELR data quality and assurance, etc.). Strategy 1h: Advance Electronic Data Exchange Electronic Laboratory Reporting a.) Maintain and enhance Electronic Laboratory Reporting (ELR) to enable public health agencies to receive reports from laboratories in a more efficient electronic format. i. (Required) Maintain existing ELR transmissions ii. (Required for jurisdictions below 75%) Increase ELR - propose and execute a plan to increase the volume and percentage of lab reports received through ELR over the next year iii. Develop and enhance processes so that ELR delivered to health departments enters systems in an automated way (vs. re-keying or manually uploaded). iv. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. Implementation Plan may include: i. Plans to maintain ELR, including baseline and target percentage of ELR volume a. Jurisdictions above 75%: Continue to establish ELR with labs, as appropriate 5 TX-DSHS-19-1309-A-001652 ii. iii. iv. Jurisdictions below 75%: Propose and execute a plan for the next year to increase the volume of ELR to reach 75%, move to next quartile (i.e., 50%), or have a minimum increase of 10%. The plan should include: a. Highlights and successes with onboarding over the past year b. High level summary of labs to be onboarded including estimated increase in ELR volume c. How barriers and challenges will be addressed Enhanced processes for ELR to be entered into surveillance system in an automated way. a. This may include efforts for accepting CDC ELR. Develop or enhance ELR data quality and assurance processes to improve timeliness of reporting, adherence to the implementation guide, mapping to standard codes (LOINC/SNOMED), etc., and provide feedback to reporting facilities. a) Maintain and enhcnce Electronic Laboratory Reporting (ELR}to enable public health agencies to rece ive reports from labo rator ies in a more efficient electronic format. Hide A:t ivity Expand Act ivity BP Imp lem ent at ion Plan 11000 char) The goa l for BP1 is to increase the a nnu a l ELR percentage from 6~% to 75 %. Act ivit ies inc lude va lida t ing the str ucture a nd conter t of messages . a nd pr ovid ing t ime ly a nd acc ura te feed bac k for message refinement. We success fu lly onboa d ed La bcorp with min ima l iss ues a nd our la rgest hos p ita l system cons ist ing of SO fac ilit ies . We a re ta rget ing bet.veen 4 a nd 5 systems to move from Accepta r ce Tes t ing to Prod uct ion for eac h qua rt er. ELR vo lume percentage will be s ign ifica nt ly impac ted by Ques t a nd tva yo go ing live. Ques t a nd Ma yo contr ibute a ppr oxima te ly 10% of report s se nt to the sta te hea lth depa rtm ent Mos t of the rema in ing hos p ita l systems ha ve outsta nd ing cha llenges . Cha llenges inc lude incorr ect message structure. vendo r incons istenc ies . miss ing res ults. a nd LIS upgrades or switches . Co n t inu ed ELC H IS f:'-PPOrt for t h e !:t a ff w h o !:u pp o rt ELR o n b oa r d ·n s a n d m a in t en a n ce if: c r it ica l t o br in g onboa rd ing goa ls to fru it ion. The fo llowing sta ff ma nage a nd coord ina te ELR onboa rd ing tas ks: John Smith • ELR coo rd ina tor for our jur isd ict ion Jaso n Ha ll • Message Va lida tor Miche le Hoo ver • Surve illa nce System ma nage r Milestones:     List of specific facilities that you plan to onboard. Examples of how to complete that would be: o Facilities per quarter on each row o Facilities by lab type (e.g., hospitals/hospital systems on 1 row, large reference lab on the next row, etc.) o Hospital systems per row You do not have to list each facility individually per row, there are options of how to relay this information as listed above. Enhancing ELR data quality and assurance processes, as applicable. Jurisdictions above 75% should continue to onboard new labs, as appropriate, to improve volume of ELRs received. 6 TX-DSHS-19-1309-A-001653 BP Mile:stones1255char) Our ju ri sd i cti on w ill mov e t he a ll ow i ng h os pit a l syst e ms ro m t est to pro d ucti on : Bapt i st Hea lt h Chil d re n's Hea lt hca re HCA Hamil to n Hosp,it a l Syst em These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,erce nt age by S p ercent age po i nt s. Our ju ri sd i cti on w ill mov e t he a ll ow i ng re ere n ce l ahs i nto pro du cti o n: Quest Di ag nost i cs Mayo Cli n i c Dept . o Lab Med Pat h ol ogy These acili t i es a re a nt i ci pat ed to i mp act t he ELR vo l ume p,er-ce nta ge hy 10 percent age po i nt s. Our ju ri sd i cti on w ill cont i nu e to mo nitor ELR da t a q ua li ty vi a -custom a b l ea u das hbo ards a nd mo nt h ly a udit i ng re port s. W e w ill add ress da t a q ua li ty iss ues see n i n ,curre nt o nbo arded f eeds . W e w ill cont i nu e to e nsure t h at ELRs are de li ve red a utom at i-ca ll y to ou r i nt egrat ed surve ill ance syst e m. PersonResponsible ELR Coo rd i nator Message Va li da tor Surve ill a nce Syst em Ma nage r Achieveby Date July2020 ELR Coor d i nator Message Va li da tor Surve ill ance Syst em Ma nage r Febr ua ry 2020 Surve ill a nce Syst em ma nage r July 2020 I Surve ill a nce Syst em ma nage r July 2020 r.;- NNDSS Case Notifications b.) Support CDC’s ability to monitor, control, and prevent diseases and other health threats by standardizing the reporting of surveillance data (required for all reporting jurisdictions). i. Implement New National Notifiable Disease Surveillance System (NNDSS) Case Notification Messages (a) Extract, translate and transmit the data for conditions contained in 5 additional finalized HL7 Nationally Notifiable Message Mapping Guides using the new HL7 case notification structure and retire the corresponding legacy formatted transmissions. (b) Use the CDC NNDSS onboarding process to receive approval for the new HL7-based case notifications before production transmissions are initiated or legacy transmissions are retired. Implementation Plan may include:   List of MMGs previously onboarded and in progress. Plans to implement and onboard at least 5 additional new HL7 Message Mapping Guides including: o Highlights and successes with onboarding o High level summary of MMGs to be onboarded in Yr01 o Description of barriers and challenges and how they will be addressed A list of finalized MMG and Artifacts and event codes (included under MMG Related Documentation) are available at NNDSS HL7 Case Notification Resource Center. Additional resources and information to request technical assistance are available at the NMI Technical Assistance and Training Resource Center. 7 TX-DSHS-19-1309-A-001654 b) Suppo rt CDC'sabilit y to monit or, cont rol, and preven t diseases and ot he r healt h t hreat s by standa rdizing the repo rt ing of surveill'ance dat a (requi red fo r all repo rt ing ju risdictions). Hi de Act iv ity Expand Act iv ity BP Implementa t ion Plan (1000 char) W e p l a n t o i mp l ement case n ot i i cat i o ns o r 5 i nal i zed HL7 Nat i o na ll y Not i i ab l e MM Gs: M ump s, Pert uss i s, Va r i cell a, Hepat it i s, S. D an d Co ngen it a l Sy p h ili s. Gen v 2 and Ar b ov i r a l 1.3 w ere on boa rded an d dat a i s bei ng t ra nsmitt ed success u ll y to CDC. Key pro cesses l ea d i ng u p to on bo ard i ng i ncl u de i na li zat i o n of t he MM G (so me a re i n p il ot st age). ga p an a ly si s a nd page devel opm ent , da t a port i ng , a n d da t amart dev el opm ent. he l att er i s p a i red wit h d i sease-s pecif i c mo d u l e i mp lement at i o n to ensu re da t a av a il abili ty . Each MM G i s est i mat ed to t a ke 3 mo nt h s rom ga p a na ly si s t o HL7 on boa rd i ng. As new MM Gs a re-read y fo r p il ot t est i ng, t he Su rv eill an ce Sy st em M an ager w ill o rga ni ze t he pr oj ect t ea m a nd ma nage t he ov era ll i mpl ement at i o n sc hed u l e. S.ig ni i ca nt new w or k d u r i ng t h i s per i od w ill be needed to mo d ify o u r su rv eill an ce sy st em t o co mp l et e-MM G i mp l ement at i on . MM G i mp l ement at i o n w ill be-p r i ma r il y managed by t he su rv eill an ce sy st em manager . Milestones:   Guides in progress. Examples of how to complete that would be: o Each line can be its own MMG along with steps for implementation o Grouping prioritized MMGs per row o Grouping MMGs by quarter These are not the only options, only examples of how it can be done based on your jurisdiction’s preference. BP Milesto11es(255 cl1art Ach.ieve by Date Perso11Respomi.ble I mp l ement M ump s, Pert uss i s and Var i cell a MM Gs Surv eill ance Sy st em manager Oct ober 20 19 I mp l ement Hepat it i s MM G Surv eill ance Sy st em manager Janu ary 2020 I mpl ement S D and Congenit al Sy phili s MM Gs Surv eill ance Sy st em manager Apr il 2020 Ensure our surv eill ance sy st em has t he req ui r ed updat es Surv eill ance Sy st em m anager July 20 20 to i mp lement add it i ona l MM Gs. Att end ongo i ng eSHARE webi nar s and st ay up t o dat e w it h Surv eill ance Sy st em manager July 20 20 MM G nat i onal pro gr ess v i a NM I Not es Syndromic Surveillance Note: All ELC recipients are eligible to apply for syndromic surveillance activities. c.) Collect and use syndromic surveillance data to validate and monitor harmful effects of exposures to diseases and hazardous conditions. i. Increase coverage and number of facilities submitting syndromic surveillance data to the BioSense Platform according to jurisdictional needs (a) (Required for any jurisdiction applying for Syndromic Surveillance funding) Onboard new, and maintain existing, data transmissions to the NSSP BioSense Platform for emergency department (ED) and urgent care facilities with messages that include the NSSP priority 1 and 2 data elements. ii. (Required for any jurisdiction applying for Syndromic Surveillance funding) Participate in the NSSP Community of Practice and other efforts to strengthen syndromic surveillance practice and use. This may include participation in meetings, workshops, and trainings; development of collaborative projects; increase use cases and practical applications by public health 8 TX-DSHS-19-1309-A-001655 programs; share lessons learned and best practices, and providing feedback on the BioSense Platform. (a) Develop or enhance data quality control and assurance processes (b) Enhance timeliness of messages sent to jurisdiction systems and to NSSP BioSense Platform. iii. Enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements. iv. Develop or enhance syndrome monitoring and response protocols. v. Develop at least two collaborative projects (one with a CDC program) where syndromic surveillance can be used to address health department surveillance data needs. Projects done in collaboration with CDC should include sharing the syndromic data with the CDC program through the BioSense Platform. Implementation Plan should include: i. ii. iii. iv. v. If currently sending data to the NSSP Platform: Propose and execute a plan to maintain or onboard new emergency department (ED) or urgent care facilities and send data to the NSSP BioSense Platform, with a focus on HIDTA counties. Include: a. Successes with onboarding facilities in the past year. b. High level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal to submit additional information as needed regarding facilities. c. How barriers and challenges to onboarding will be addressed. If currently not sending data to the NSSP BioSense Platform: Develop and execute a plan to onboard new or existing facilities data to the BioSense Platform, with a focus on HIDTA counties. Include: a. Current facilities sending data to the jurisdiction system. b. As appropriate, high level summary of facilities to be onboarded, including name, address and estimate of how coverage will increase with the onboarding of the facility. Utilize the supplemental information section in REDCap’s ELC Application portal as needed to submit additional information regarding facilities. c. How barriers and challenges for onboarding will be addressed. Plans to enhance completeness and validity of data, focusing on NSSP Priority 1 and 2 data elements, including data elements and the facilities/systems who will be contacted to address issues. Plans to enhance timeliness of messages sent to jurisdiction systems and NSSP BioSense data, including identification of facilities/system identified who will be contacted to address issues. Identify specific syndrome monitoring and response protocols that will be developed or enhanced. Development of at least two collaborative projects (one with a CDC program). Collaborative projects include:  Working with any public health partners including local health departments, other state health departments, and program areas (e.g., injuries, hepatitis, HIV, other infectious diseases, opioids).  Potential projects could include using syndromic surveillance data to assist with: o Public health investigation o Providing information to provide communications for decision makers, health providers, media, etc. o Development of additional specific surveillance activities based on syndromic data 9 TX-DSHS-19-1309-A-001656 o Identification of need for public health intervention See https://www.cdc.gov/nssp/success-stories.html for examples of collaborative projects. Hide Act ivity Expand Act ivity BP Implementation Plan (1000 char) Our j urisd ict ion has be-en us ing syndrom ic s urveill a nce (SyS) s ince 2009 a nd a re a mem ber of t he NS.SP Commun ity of Prac t ice. We curr ent ly se nd t o BioSense a nd have 25 eme rge ncy de pa rt ments a nd 10 urge nt ca re centers s ubmitt ing syndrom ic s urveill a nce da t a t o our HIE (se,e s upp leme nt a l info rma t ion or t he list of on boa rded fac ilit ies ). We will priorit ize increas ing t he nu mber of bot h eme rge ncy de pa rt me nt s a nd urge nt ca re centers t hat s ubmit syndrom ic s urveilla nce da t a t o t hough t he st at e HIE a nd will oc us efforts on high intens ity drug tr a fficking a rea (HIDTA) co unt ies . As mo re ac ilit ies a re onboa rded , we a nt icipat e increas ing our coverage . As a co lla borat ive project. we pla n t o increase s urveill a nce of ILi by working wit h t he de pa rt ment o ed uca t ion t o obta in data t o tr ac k sc hoo l a bse nte,eism . Milestones:      Identify which facilities to be onboarded including name and address of facility and how targeted facilities will increase coverage once onboard Specific data elements and facilities/systems identified to address issues with data quality Specific syndrome monitoring and response protocols that will be developed or enhanced Ensure/improve timeliness of reporting to BioSense platform Key milestones for collaborative projects BP Milestones (255 char) Perwn Responsible On boa rd 5 eme,rge ncy depa rt me nt s a nd 5 urge nt ca re Sy nd rom ic s urveill a nce Achieve by Date ce,nt ers (se,e de t a il ed li st o t a rge,t ed ac ilit ie,s in coo rd in at o r July 2020 s u pp leme nt a l info rma t io n) W ork wit h Best Hea t h Ca re syst em t o add ress da t a Sy nd rom ic s urveill a nce q ua lity iss ues ide nt i ied us ing a b lea u das h boa rd (see coo rd in at o r July 2020 s u pp leme nt a l infor ma t io n for li st of da t a e leme nt s ) Ens u re all da t a a rr ives at j u risd ict io na nd NS.SP Biose nse Synd rom ic s urveill a nce p la orm wit h in 8 ho urs . o rece ipt a t st at e hea lt h coo rd in at o r M arch 2020 depa rt me nt Cont inu e t o pa rt icip-at e in SS-re lat ed tr a in ings , Sy nd rom ic s urveill a nce w o rks ho ps a nd nat io na l web in a rs coo rd in at o r Ens u re rece ipt of sc hoo l abse nt ee ism da t a wit h 3 la rges t Sy nd rom ic s urveill a nce sc hoo l d ist ricts in o u r j urisd ict io n July 2020 December 20 19 coo rd in at o r Public Health Laboratories d.) Advance electronic data exchange for Public Health Laboratories. i. Create and send ELR based on Promoting Interoperability [formerly Meaningful Use (MU)] standards for all reportable conditions to or within the public health department. ii. Map local test, result, and specimen source codes to LOINC and SNOMED standards. iii. Establish electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. 10 TX-DSHS-19-1309-A-001657 Implementation and Milestones:    This section is for enhancing electronic data exchange for Public Health Laboratories including: o Plans for working to send PHL ELR messages for all reportable conditions. o Mapping local codes to LOINC and SNOMED standards o Establishing electronic test ordering and reporting (ETOR), using HL7 messages, with one or more hospitals or public health labs. This section is for HL7 messaging for ETOR activities. o If ETOR is proposed using a web portal, that activity should be included in Strategy 1i, activity C. This activity can include regional labs and state public health labs, but does not include CDC Labs. LIMS activities and milestones should not be included in this activity. LIMS enhancements should be included under Strategy 1i, Sustain and enhance information systems. d) Advance electronic data exchange for Public Health Laboratories . Hide Activity Expand Activity BP Implementation Plan (1000 char) Develop and im ple m ent an ETORinterfa ce wit h a loca l hosp ita l syste m, which se nt nea rly 3,000 STD repo rts to t he state public hea lt h lab in 2018. This will improve data qua lity , efficiency, and a llow t he state lab to de live r ELRsto our integ rated surv eillance syste m . We will also deve lop a pub lic hea lt h lab networ k wit hin ou r juri sdict ion's 12 reg ional pub lic hea lt h labs to improve electro nic data excha nge. Update t he LIS wit h new test codes and map t he m to LOINC codes fo r HL7 2.5 .1 trans miss ion pur poses . New test codes shall be ma ed wit hin 14 da softest code u date . BP Milestones (255 char) Person Responsible Develop and imp leme nt ETORinterface with loca l hospita l PHL Ma nage r s ste m wit h hi h vo lume of STD re orts Map new test codes to LOINCstandards PHL Ma nage r Achieve by Date July 2020 July 2020 (Select Date] [Select Date] (Select Date] Electronic Case Reporting e.) Advance electronic information exchange between electronic health records and public health. i. Implement electronic case reporting (eCR) (a) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for conditions published in the Reportable Condition Trigger Tables and use Reportable Conditions Knowledge Management System (RCKMS) for public health reporting decision support. (b) Develop a project plan and begin implementation of eCR with one or more clinical partners and their EHR vendors for Chlamydia and Gonorrhea. Technical guidance on electronic case reporting for Gonorrhea and Chlamydia is available in a document named “Advancing ECR of STIs: Technical Guidance for Public Health Departments.” This document allows jurisdictions to choose different technical architecture of implementation while providing consistent guidance on the science of STI reporting. ii. Participate in national efforts by engaging in the: 1) discussion and development of eCR standards by participating in the HL7 Public Health Working Group; and 2) development and 11 TX-DSHS-19-1309-A-001658 updates to default reporting specifications and trigger codes by participating in the CSTE RCKMS vetting process iii. Participate in the RCKMS to author jurisdictional reporting criteria and maintain reporting specifications Implementation Plan and Milestones:  Describe a plan that includes details on partners and vendors and the data format that will be   used to send eCR (includes i.a. and i.b.). Plans for participation in national efforts High level overview of which conditions will be authored in RCKMS. e) Advance electronic information exchange between electronic health records and public health Hide Activity Expand Activity BP Im lementation Plan 1000 char Our ju risdict ion will part icipate in national eCR efforts. For 2018-19, our ju risdict ion part icip ated in RCKMS author ing for at least one set of RCKMSdisease-specific report ing specificat ions. This occurred with the establishment of Jurisdiction Adm i ni strator(s) , RCKMS accounts for relevant authors , and RCKMS tra ini ngs. We have selected 2 pi lot facili t ies and the ir respect ive EHRvendors (Epic and Sunquest ) who are exp lor ing the ir abili t ies to use tr igger codes . These pil ot sites are high volume faciliti es that have successfull y onboarded for ELRin the past. Our j urisdict ion inte nds to util ize the AIMS Hub to rece ive elCRs, whi ch with we have already estab li shed a connection. Our surveillance system will be enhanced to consume elCR , which is planned for the 3rd quarter of the BPl . We will cont inu e to stay up to date on national eCR progress and participate in the monthly eCR workgroup led by another ELCapp lic ant. BP Milestones 255 char Ensure necessary survei ll ance system enh ancements are comp leted to consume elCR formats Work wi th 2 pil ot facili t ies to send test elCRs to our surve ill ance system . Move 1 pilot facili ty into production for elCRsto be sent for STDcond it ions. Person Res nsible Surveillance System Manager Achieve b Date December 2019 Surveillance System Manager April 2020 Continue to part icip ate i n eCR workgroup meet in gs and w eb in ars. Stay up to date on nat iona l eCR efforts and Digital Bridge pilot project. Surveillance System Manager July 2020 Author at least 1 rule in RCKMS Surveill ance System Manager July 2020 Ensure stab ili ty of app licat ion where facili t ies can register Surveillance System Manager their int ent to send elCRs to the health dept . July 2020 Electronic Information Exchange between Jurisdictions. f.) Advance electronic information exchange between jurisdictions. i. Create the capacity to transfer ELR messages and eCR messages between jurisdictions. These transfers refer to the electronic sending of ELR and case data between two jurisdictions for a lab report or a case that was reported to one jurisdiction but belongs to another jurisdiction. Implementation and Milestones should include:   Partnering states, bidirectional/unidirectional, via AIMS or direct connection o Although the example given does not specify which partner will collaborate on interstate data exchange, be specific about who you’re proposing to work with. This activity is strictly referring to interstate (state to state) exchange and not intrastate (e.g., city to state). If you need assistance with intrastate exchange, you can submit an ELR Technical Assistance request. 12 TX-DSHS-19-1309-A-001659 f) Advance electronlc informa ,tion exchange between juris-dlctlons. Hi de Act ivi ty Expand Act ivity BP Implementation Plan 11000 char) ·w e w ill cont i nu e to , w ork w ith ne ighb or i ng sta t es t o exp l ore exchange o both ELRs and eCRs. W e have an esta bli shed mechani sm w ith t he AIMS hub , so i partn ers are w illi ng, w e are ab l e speci i c to ELRs. We have esta bli shed a bi di rect i ona l ELR ee d w ith 1 neighb ori ng ju ri sd i cti on vi a AIMS. Est abli shi ng th ese i nte rf aces w ill repl ace paper report s bei ng hand-e nt ered i nto our surveill ance syst em, and w ill i ncrease our ELR percent age. BP Milestones 1255 char) W ork w ith 2 neighb ori ng ju ri sd i cti on s t o se nd and receive ELRs vi a AIMS Monit or th e onb oa rd ed ELR eed al read y esta bli shed w ith a neighb ori ng ju ri sd i cti on Person Responsible Achieve by Date ELR Coordi nator Febr uary 2O:ID ELR Coor di nator Ju ly 2020 Strategy 1i: Sustain and Enhance info systems Maintain Information Systems a.) Maintain existing information systems (e.g., integrated surveillance information system, LIMS, and syndromic surveillance information system), including the personnel and operating environment/supporting software necessary for them to function. Implementation Plan and Milestones should include:  Maintenance needs for surveillance system, LIMS, syndromic surveillance system, and any supporting software. a) Maintain existing information systems , including the pers-onneland operating environment/supporting s-oftware necessary for them to function. Hi de Activi ty Expand Activity BP Implementation Plan (1000 char) W e w ill cont i nu e our mont hly meet i ngs w ith our surveil ance syst em cont racto r t o tr ack de li verabl es, and to revi ew and pr i or it i ze w ork. We w ill cont i nu e month ly i n-house devel opm ent meet i ngs, te chn i cal t ea m meet i ngs, use r group meet i ngs, and tr ai ni ngs . Mai nt enance o our syst em i ncl udes se rver and sof tw are upgrades . We w ill need to mai nt ai n un di ng or our surveill ance syst em cont racto r as w ell as our softw are li cense or th e too l s th at make usi ng t hese syste ms se cure and sust ai nabl e. Due t o exi st i ng i ssues w ith t he t rai ni ng portal, th e surveill ance syst em t ea m pl ans to rebu il d th e use r app li cat i o,n and dat ab,ase . An up dated tr ai ni ng envi ronment w ill p-rovi de a bett er un de rst andi ng o t he syst em and dat a quali ty expectat i on s. ·w e have st arted a pr ocess to docum ent_, eval uat e, and i mp rove th e oll ow i ng pr ocesses : use r tr ai ni ng, enr oll ment , access mo di i cat i on, dea ctivat i on, and BP Milestones (255 char) Mai nt ai n surveill ance syst em vendo r cont racts Mai nt ai n t rai ni ng port al ·or syst em use rs b,y up dat es use r ap,pli cat i on and data base Mai nt ai n i nteg rat i on engi ne and tr ansport i nt erf aces (SF P and PHINl'v1S eeds ) Mai nt ai n LIMS Mai nt ai n syndro mi c surveill ance syst em Person Responsible Achieve by Date Surveill ance Syste m Manage r Surveill ance Syste m Manage r July 2020 Ma rch 2020 Surveill ance Syst em Manage r July 202!0 Surveill ance Syste m Manage r and PHL manager Surveill ance Syste m manage r and Syndromic Surveill ance coor di nator July 202!0 July 202!0 13 TX-DSHS-19-1309-A-001660 b.) Implement (if appropriate) new/replacement information systems. Implementation Plan and Milestones should include:    Justification for transitioning to a new system Detailed work plan of requirements for replacement system How the plan for replacement will impact the particular program or jurisdiction 1:1)Implement (if appropriate) new/replacement information sy~ems . Hi de Activi ty Expand Act ivi ty BP Implementation Plan (1000 char) Our ju ri sd ict i on w ill exp l o-re th e po ss i b•ili ty o, repl ad ng our current Lead surveill ance syst em w ith a modul e w ith i n our i nt egrat ed surveill ance syst em. Our current syst em i s i ncapabl e o, p,rocess i ng HL7 messages and i s over 2Dyea rs ol d. Like many oth er ju ri sd i cti ons, Lead i s a high vol ume condit i o-n and tr ansit i oni ng to , th e i nt eg rat ed syst em w ill pos it ively i mpact da t a proc ess i ng, t i meli ness and BP Milestones (255 char) S.ch ed ul e at l eas t 4 de mos or th e Lead pro gram t o Achieveby Date PersonResponsible Lead Prog ram and S.urveill ance November 2019 get a th oro-ugh un de rst andi ng o, oth er surveill ance S.yst em Manage r syst em opt i ons and capabili t i es Com pl et e RFP pr ocess Lead Prog ram and S.yste m Manage r Deve l op, and t est Lead m odul e Lead Prog ram and S.yst em Manage r Go li ve w it h repl a-cem ent Lead mod ul e Lead Prog ram and S.yst em Manage r Po,st -pro ducti on bu g ix es and syste m eval uat i on Lead Prog ram and S.yst em Manage r S.urveill ance December 2019 S.urveill ance April 20 2:0 S.urveill ance June 20 2:0 S.urveill ance July 2:020 Enhancing Information Systems c.) Enhance existing information system(s) by adding or improving functionality. Prioritized enhancements are listed below, but other enhancements may be requested. i. Integrated surveillance information system: (a) Enhance systems to enable the automated processing and use of eCR (and if desired, Reportability Response) documents. (b) Transition STD surveillance into the existing or new integrated surveillance information system along with appropriate legacy data migration. (c) Transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. If using a standalone CS database, migrate CS surveillance into an existing integrated information system. States using NBS version 5.3 or newer should use CS module available within the system. (d) Enhance systems to enable the automated processing and use of ELR, including complete susceptibility findings. ii. LIMS (a) Enhance system to enable the automated processing and use of HL7 electronic test orders. (b) Consult with CDC to evaluate options for implementing and integrating a web portal to support electronic test ordering and reporting (ETOR). iii. Syndromic surveillance information system 14 TX-DSHS-19-1309-A-001661 (a) Explore, evaluate, and incorporate new data sources at your jurisdiction that can enhance syndromic surveillance. Implementation Plan and Milestones should include: For the integrated information system  Provide a high level overview of plans to enable automated processing and use of eCR documents.  Describe a plan for transitioning STD, including legacy data, into an existing or replacement system and how the plan will impact the STD program.  Describe how the jurisdiction will transition from hard copy reporting to electronic reporting of congenital syphilis (CS) cases. Hard copies of congenital syphilis case report forms will no longer be accepted by CDC’s STD program.  Describe a plan for being able to automatically process and use full ELR, including complete susceptibility findings. For LIMS  Include LIMS maintenance and upgrade activities or LIMS replacement plans.  Provide a high level overview of plans to enable the automated processing and use of HL7 electronic test orders.  Prior to the development of a new web portal to support electronic test ordering and reporting (ETOR), plan to include a consultation with CDC to evaluate options. For Syndromic Surveillance  Develop a plan to identify additional data sources to be added to the jurisdiction data system and how they will be used. c) Enhance existing information system(s) by adding or improving functionality. Hide Act ivi ty Exp and Act iv ity BP Im lementation Plan 1000 char Our j urisdiction is curr ent ly on t he lat est v ersion release of ou r int egrat ed surve ill ance syst em . Enhancemen t act ivit ies w ill be focused on t est ing and imp leme nt at ion of surve ill ance sy st em upg rades; and upda t es and dev elopme nt of Tableau dashbo ards. The surve ill ance syst em manageme nt t eam is curr ent ly w orking on dat a ro ut ing en hancemen t s w ill aut oma t e curr ent manua l assignmen t s, facili t at ing dail y inclusion of ne w codes and fac ili t at ing qua lity assurance on all exist ing code comb inat ions . Toget her t hese efforts w ill imp rove f unct iona li ty and dat a qua li ty fo r ou r use rs, and improve pub lic healt h response and analysis.The nex t ve rsion release wi ll ensu re t hat elCRsand ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em . The curr ent STD surve ill ance syst em is no longe r supp orted by CDCso plans w ill be made t o m igrat e STD surve ill ance int o ou r int egrat ed surve ill ance syst em . The PHL LIMS syst em w ill be upg raded t o t he lat est ve rsion w it h t he assist ance of t he PHL vendo r. BP Milestones 2!.5 char Upgrade t o t he lat est ve rsion release fo r int egrat ed surve ill ance syst em ; Cont inue t o ensu re all ELRs are aut oma t icall y processed int o ou r int egrat ed surve ill ance syst em Person Res nsible Surve ill ance Syst em Manage r M igrat e STD surve ill ance from legacy syst em t o t he int egrat ed surve ill ance syst em Upgrade PHL LIMS t o lat est ve rsion Enhance synd rom ic surve ill ance syst em t o inco rpo rat e ne w dat a sou rces Transit ion any rema ining hard cop ies of congen it al syph il is case report fo rms t o an electron ic f eed STD Prog ram and Surve ill ance Syst em Manage r PHL Manage r Syndrom ic Surve ill ance Coordinat or STD Program and Surve ill ance Syst em Manage r Achieve b Date January 2020 July 2020 July 2020 July 2020 December 2019 15 TX-DSHS-19-1309-A-001662 Innovative Enhancements to Improve Collaborations with Lab and Epi data. d.) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Illustrate projects: i. Enable lab-epi collaboration by identifying and implementing a universal case identifier (or similar linking variable) to include with laboratory and case data transmission (e.g., patient identifier that links data from health systems; identifier to link PulseNet data to case reports). ii. Develop systems or tools for public release of public health data. iii. Explore the efficiencies of moving an existing or new information system to a cloudbased/hosted environment. iv. Identify software or platforms that enable the integration and visualization of surveillance and laboratory data. v. Identify solutions to integrate AMD data with surveillance data for analysis or visualization. Implementation Plan and Milestones should include:  Any other projects or enhancements that promote collaboration or efficiency. For example, universal patient IDs, moving a surveillance information system to a cloud-based/hosted environment, data sharing/release, epi-lab data integration, or data visualization. d) Implement additional innovative enhancements that improve analysis, enable lab-epi collaboration, or increase the sustainability or efficiency of systems. Hide Act iv ity Expand Act iv ity BP Im lementation Plan 1000 char Our j urisdiction needs modern and af fo rdable t echno logy solut ions t o de li ve r produ cts and serv ices t o ou r prog rams. We have been w orking w it h Amazon on t he Amazon Cloud Com put ing (AWS) dat a cent er m igrat ion . We w ill com plet e a proo f of conce pt , m igrat ing in t est mode a num ber of app li cat ions . Our surve ill ance syst em , int egrat ion eng ine and ot he r supp ort ing infras t ructu re t echno logies w ill be moved t o AWS. This w ork w ill requ ire us t o exam ine and add ress any surve ill ance syst em security concerns , and updat e curr ent processes and archit ectu re t hat won 't be supp orted in AWS. BP Milestones 255 char Deve lopmen t of M igrat ion Plan t o Amazon Web Service (AWS) Cloud and com plet e m igrat ion Im pleme nt updat es t o ELR Tableau dash boards on a quarte rly basis Achieve b Date Person Res nsible Surve ill ance Syst em Manage r July 2020 Surve ill ance Syst em Manage r and prog ram leads July 2020 [Select Date ) Advanced Molecular Detection (AMD) Technical Infrastructure e.) Increase HIS capacity to support Advanced Molecular Detection (AMD) activities. i. Implement management and analytic software ii. Increase network bandwidth and computing power and/or use cloud infrastructure to support AMD initiatives This section is focused on providing support for the technical infrastructure needed to support AMD. It does not include diagnostic equipment, sequencers, testing supplies, or personnel using the data. All laboratories that submit reportable lab findings to public health via ELR should submit reportable antimicrobial resistance (AR) laboratory findings via ELR, with messages conforming to nationally 16 TX-DSHS-19-1309-A-001663 accepted standards, validated for accuracy and completeness of content and structure when sent or received. Laboratories that are not currently reporting via ELR are encouraged to do so, especially as electronic reporting of AR is a compelling reason to develop this capacity. Additional information is available through the CSTE’s Best Practices for Surveillance of Antimicrobial Resistance via Electronic Laboratory Reporting and the Antimicrobial Resistance Surveillance Task Force Year 2 Report and Recommendations. Implementation Plan and Milestones may include:     Procuring Cloud Infrastructure (e.g., cloud storage, computing processing) Increased bandwidth for network infrastructure Specialized software to assist in using AMD data with epi data Increase in-house computing processing and storage e) Increase HIS capacity to support Advanced Molecu lar Detection (AMD) activities. Hide Act ivi ty Expand Act ivi ty BP Im lementation Plan 1000 char In ou r wo rkplan t o t ransit ion t o t he AWS (see prev iou s activ ity ), w e w ill inclu de clou d procu rem ent fo r st orage of AMD dat a. BP Milestones 255 char Wo rk w it h procu rem ent t o acquire add it iona l st orage fo r AMD dat a Person Res nsible Surve ill ance Syst em Man ager Achieve b Date .luly 2020 [Select [Select [Select [Select Date ) Date ) Date ) Date ) Guidance The Guidance tab of the application template provides a link which will open the respective FY19 NOFO Guidance section, for applicant reference. The link should open a PDF in a new window on your desktop, that might appear behind the Excel template file. Additional Budget Information The FY19 Budget Template is similar to last year with some key enhancements and new columns including:   Instructions Tab: Provides instructions for all fields within the ELC Budget Template New SF-424 Feature: Section B of this form automatically compiles and calculates the requested financial amounts, per cost category, as entered by the applicant in all project-specific tabs. This tab will autopopulate as applicants complete their detailed budgets, and can be printed and submitted directly to Grants.gov to satisfy the SF-424 requirement. 17 TX-DSHS-19-1309-A-001664 Budget Requests for Personnel Budget requests to support cross-cutting health information personnel can be requested in multiple area of the ELC application. The major areas where flexible IT and health/laboratory informatics personnel may be included are in one or a combination of the following: • A: Cross-Cutting Epidemiology and Laboratory Capacity • Personnel supporting cross-cutting epidemiology and laboratory informatics activities • B: ELC Leadership, Management, and Administration • Leadership and Management positions assist in the leadership, management, coordination and administration of the ELC Cooperative Agreements, including integration of epidemiology, laboratory, and health informatics activities. • C: Health Information Systems Capacity • Personnel who only work on ELC HIS activities In the budget justification, applicants should indicate the areas of the application where the same personnel are being requested in multiple areas as a safeguard. This will avoid duplication of funding. Budget Requests for Training, Meeting Participation, and Peer-to-Peer Travel If travel to conferences/meetings and participation in trainings is requested for ELC Governance Team members, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If travel to conferences/meetings and participation in trainings is requested for HIS staff, not the HIS person of contact on the Governance Team, then the request would should be included in the Health Information Systems Capacity (Project C in the ELC NOFO) budget. Similar to the conference travel and training requests, if Peer-to-Peer travel is a request for epi or lab staff to visit another jurisdiction to either learn or share best practices, the request could be placed in the Cross-Cutting Epi & Lab Program (Program A in the ELC NOFO) budget. If Peer-to-Peer travel is a request for HIS staff to visit another jurisdiction, then the request would need to be entered on the Health Information Systems Capacity budget. 18 TX-DSHS-19-1309-A-001665 Notes and Q + A from 3/20 ELC HIS Application Guidance Webinar: ETOR:       Using a web portal with an LIS system is another way to implement ETOR without using HL7 messaging Letters of support from hospitals for ETOR work is not necessary, but can be included in the application in the supplemental Q: Does ETOR through state HIE count as one connection with a hospital? A: Yes Examples of ETOR: If you are receiving HL7 format and it’s going into LIMS system, it counts as ETOR. If data is being keyed in and transformed into HL7 and then going into LIMS system, it also counts as ETOR. Try to limit ETOR connections to hospitals and “other” type labs. Public health clinics do count as ETOR, but we are trying to limit the field for ETOR connections. Q: If ETOR is already up and running and we want to sustain that connection, should we list this work as a project in the application? A: Yes, include this work in the application or include it in the measures. Syndromic Surveillance:      The Syndromic Surveillance activities are NOT required. However, if you do apply for Syndromic Surveillance activities, there are some activities that are required. All previous NSSP funding will be moved into ELC. We are hoping for level funding and should have additional 1-year dollars to help with syndromic surveillance activities. All ELC grantees can apply for syndromic funding Q: Can you elaborate on the collaborative projects activity in the syndromic surveillance section? o ESOOS is a requirement for funding on the syndromic side (NCIP Co-Ag side), so it does NOT count as a collaborative project on the ELC side. o There are additional examples of collaborative projects above. The syndromic surveillance measure mentions emergency departments (EDs), but urgent care facilities can also be counted eCR:   RCKMS is needed for eCR work: o Activity e, ia is a broad eCR project and requires triggering through RCKMS o Activity e, ib is STD-specific and builds off a pilot already in place. Triggers are implemented at the EHR, therefore RCKMS is not needed. To clarify, there will be no additional work for RCKMS in the new 5 year Co-Ag. Any RCKMS activities that are mentioned in the guidance are the ones that currently exist. RCKMS authoring will eventually expand from the initial 6 conditions. NMI: 19 TX-DSHS-19-1309-A-001666   CDC is currently working with the FDD guide and other larger guides to determine the best strategy to make it more equitable because some guides have several conditions included and some have only one. The FDD guide will count as 2 MMGs if you implement half of the conditions at a time. If you take on all conditions (entire guide at one time) then it would count as 3 MMGs In terms of jurisdictions implementing 5 MMGs, as long as folks are working towards implementation of as many guides as possible, the NMI team is maintaining expectations on how many guides can realistically implemented for each jurisdiction. General Application:    Each activity has 5 milestones hard coded in, they are not expandable. 5 is the limit number of milestones, you don’t have to use all 5 for each activity. If there is no character limit for a section, please try to be as concise as possible AMD:  This AMD activity is about technical support, cloud procurement, increased bandwidth for network infrastructure, specialized software for analysis, etc... It is NOT about sequencers, diagnostic equipment, testing supplies, or staff (i.e. bioinformaticians used to analyze the data). Miscellaneous:     We are using 2018 ELR volume estimates to determine the >75% ELR cutoff for each jurisdiction. Those who are below 75% ELR will continue to provide ELR volume estimates every year in the grant cycle. Q: For advanced electronic data exchange between jurisdictions, is there a preference for push or pull? A: If interested, there are existing mechanisms supported through APHL to assist with transmission but CDC does not have a preference for push or pull options. Q: What does automation of STD ELRs mean? A: STD initiation of investigations from STD ELRs that come in. The system automatically creates investigation bases on ELR details rather than someone manually having to create the investigation. There is an activity referencing PulseNet (under Strategy 1i, activity d: implement additional innovative enhancements that improve analysis…) in the NOFO. Although PulseNet is in the process of being replaced, it is used in the guidance as an example here to help people think through projects that identify a universal case identifier to include with laboratory and case data transmission. 20 TX-DSHS-19-1309-A-001667 2019 ELC Section F: Frequently Asked Questions General Points of Contact Project Area General Questions CaliciNet CryptoNet Cyclospora genotyping Environmental Microbiology FoodCORE FoodNet Integrated Food Safety Centers of Excellence NARMS National Case Surveillance NoroSTAT NORS NREVSS Enhanced OHHABS and GLRI Outbreak Surveillance and Response OutbreakNet Enhanced PulseNet/PulseNet Area Labs Point(s) of Contact Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Jan Vinje (ahx8@cdc.gov; 404.639.3721) Dawn Roellig--lab (iyd4@cdc.gov; 404.718.4134) Michele Hlavsa--epi (acz3@cdc.gov; 404.718.4695) Yvonne Qvarnstrom (bvp2@cdc.gov; 404.718.4123) Jennifer Murphy (iod7@cdc.gov; 404.718.4155) Amy Kirby (agk1@cdc.gov; 404.718.3161) Mia Mattioli (kuk9@cdc.gov; 404.718.5643) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelly Barrett (uzx2@cdc.gov; 404.718.1152), Aimee Geissler (lhq5@cdc.gov; 404.639.7557) FoodSafetyCoE@cdc.gov Elizabeth Sillence (yis9@cdc.gov; 404.639.1541), Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814) Jared Reynolds (uvz6@cdc.gov; 404.639.3519) Erin Stokes (ykt3@cdc.gov; 404.718.1175) Aron Hall (esg3@cdc.gov; 404.639.1869) Karunya Manikonda (hum6@cdc.gov; 404.639.3530) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Aron Hall (esg3@cdc.gov; 404.639.1869) Virginia Roberts (evl1@cdc.gov; 404.718.4871) Jonathan Yoder (jey9@cdc.gov; 404.718.4696) Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Gwen Biggerstaff (fke8@cdc.gov; 404.639.4814), Anna Newton (ivz9@cdc.gov; 404.639.2839 Kelley Hise (kpb6@cdc.gov; 404.639.0704), Efrain Ribot (eyr4@cdc.gov; 404.639.3521) Template-related questions 1. What happened to the ‘other’ option in the activity dropdown? Can we add additional activities and milestones? Are the character lengths in the template hard limits? There is not an ‘other’ option in the activity in the Section F template, except under Tier 3 for the Integrated Food Safety Centers of Excellence. The activities were developed to fit within the overall Cooperative Agreement framework and logic model and represent the activities of a comprehensive 1 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001668 foodborne, waterborne, enteric, and environmentally-transmitted diseases program. We hope that any activity you would like to include in your work plan would fit within the scope of at least one of the more broad activities. In Section F, there is not an option to add additional activities or milestones. The template will not cut off text after 1000 characters for the Implementation Plan. The suggested length is included in all the templates, not just Section F. If text beyond 1000 characters is pasted into the template, it will -not be truncated; however, the box may not expand. Should applicants need to, they can also include supporting documentation as an appendix/appendices. We would recommend referencing any appendices in the Implementation Plan to facilitate review. 2. Why are all the activities marked as ‘required’ and what does that mean for Section F? In Section F, all the Tier 1 activities must be addressed before applying for additional funds under Tier 2, which is why they are marked as ‘Required.’ The intention is for applicants to address/respond to each activity, but not that each applicant should already be able to perform the full range of activities. Additionally, there may be activities in Tier 1 that are outside of an applicant’s jurisdiction or public health authority. If this is the case, an applicant can indicate that a specific activity is not something their jurisdiction is responsible for and this is a sufficient response to address that activity. If an activity is something your jurisdiction has not performed before, but could perform, please write a work plan detailing what implementation would look like and request appropriate resources to conduct that activity. Cross-cutting activities 3. If our jurisdiction does not have minimum data transmission capacity (i.e. Mbps), can we request support to upgrade data cabling to support faster IT connections? If funds to support infrastructure upgrades for data cabling would support improved epidemiologic or laboratory capacity (not just for specific pathogens or transmission pathways), requests may be included in Cross-cutting Section C (Health Information Systems Capacity). For network connection speeds 10Mbps is the minimum upload speed, with 100Mbps the recommended upload speed to efficiently transfer WGS results to CDC. To determine your upload speed, you can use a free website like speedtest.net, to determine both your upload and download speed. If your upload speed is determined to be below the minimum threshold, work with your IT specialists to determine the best options for upgrading your system. This may be an improvement to your network connections within your laboratory building or setting up a separate research network with improved network speeds to transmit your sequence data. It is important to work with your IT specialists to determine the best approach. 4. What if we have WGS/NGS requests that are not limited to PulseNet or NARMS pathogens (or food and water transmission pathways)? If funds to support WGS/NGS activities would support laboratory capacity that is not only for enteric pathogens, requests may be included in Cross-cutting section A (Cross-cutting Epidemiology and Laboratory Capacity). Requests that are solely related to PulseNet and NARMS should be requested in Section F. 2 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001669 Tier 1 Activities Activity II: Enhance Laboratory Workforce Capacity (p 100-101) 5. For Activity II (b.i), are there new MOUs for CaliciNet, PulseNet, and CryptoNet? This is referring to existing MOUs but would also include future updates if they are released. HL7 Transmission of case surveillance data 6. Variations of this activity are found in Strategy 1a, Strategy 1c, and Strategy 1h. Can you clarify how we can respond to these? Should they be treated independent of each other, or should be addressed as a unit? Activity I (pages 99-100) addresses integrating data elements into existing surveillance systems and working with informatics staff to enable transmission of data elements. Activity IV (pages 102-103) addresses collecting and transmitting national case surveillance data, but does not specify sending via HL7. Activity IX (page 107) very specifically and in detail describes sending condition-specific data/national case surveillance data via HL7. Strategy 1a is focused on the workforce capacity needed to develop internal capacity for, and complete or continue implementation of HL7 messages for the data elements specified in Generic Version 2 (GenV2) and the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Responses should include identification of any additional staff or training needed to complete the sub-activities listed. Additional staff may include epidemiologists needed to provide temporary capacity during the labor-intensive onboarding process activities. Strategy 1c is focused on the processes of data collection, reporting, and data cleaning, independent of the data transmission method. Responses for part B should include descriptions of the questionnaires, or when no questionnaire is available, the data elements collected for each of the conditions indicated. Additional information for these conditions can be found in Project F Appendix 1. Strategy 1h is focused on advancing and modernizing information exchange. Responses should indicate if the jurisdiction is planning to implement all or a portion of the FDD MMG. If a jurisdiction is not able to implement the entire guide, they are able to subset the guide into 2 four condition sections and implement one section in the budget period. The response should specify which four condition tabs will be implemented. For the remaining four condition tabs the jurisdiction should indicate if electronic tabular format or traditional mechanisms will be used. (Can we somehow reference the previously provided FAQs here as well?) The response should also include activities related to incorporating all condition-specific data elements in the FDD MMG into data management systems. PulseNet and NARMS Funding 7. Should requests for WGS funding be separated by type or pathogen between PulseNet and NARMS? Requests for WGS personnel, supplies, and equipment for enteric/foodborne pathogens should be combined for PulseNet and NARMS in the Food and Water laboratory capacity budget (F2). It is no longer necessary to specify requests by PulseNet and NARMS, as was done in the previous ELC cycle. Please be sure to continue to requests funds specifically for shipping NARMS routine surveillance and outbreak isolates to CDC for antimicrobial susceptibility testing. 8. How much per isolate should we factor in for sequencing supplies? You should use $125/isolate as an average cost for sequencing supplies. 3 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001670 9. Will PulseNet award funds for serotyping? No, neither PulseNet nor NARMS will provide funds for traditional or molecular serotyping. 10. Will PulseNet fund any PFGE? PulseNet will no longer fund PFGE activities. Waterborne (General) 11. Is there new funding to support the increased number of required Tier 1 waterborne activities? Do these fall under OutbreakNet? These activities would not fall under OutbreakNet, but rather Tier 1, which is intended to reflect the activities of a comprehensive foodborne, waterborne, enteric, and environmentally-transmitted diseases program. Ask for what you would need to in order to complete the activities based on your proposed work plan. 12. Are waterborne activities intended for an epi or a non-epi? What if waterborne activities are a coordinated under a different group? Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. If water testing is conducted by a separate authority in your jurisdiction, a partnership should be in place to ensure these activities can be accomplished. 13. For Activity III (a.ii), is the activity for developing and implementing water related emergency response plans about hurricane emergency response plans and plans in the event of contamination of the drinking water system and boil water emergencies? Or is this related to an infectious disease response such as our plan to deal with a crypto outbreak? (p101) The activity for developing and implementing water-related emergency plans is intended primarily for things like hurricane emergency response plans, plans in the event of contamination of the drinking water system, and boil water emergencies. Essentially, determining whether your general emergency preparedness plans contain plans for a water-related emergency; these types of plans could be used during an outbreak, but they could also be used in any type of water-related emergency. 14. For Activity III (b.iii, page 102), what are some examples of other water related issues? Hurricanes? Flooding? Water-related emergencies like floods or droughts are good examples; health risks that are not necessarily waterborne disease outbreaks. CryptoNet 15. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 1 of Section F? (See Tier 2 FAQs for additional CryptoNet and CryptoNet Regional Laboratory information) CryptoNet is the molecularly-based surveillance system for cryptosporidiosis. Tier 1 includes both epidemiologic and laboratory-based activities: • Epidemiologic activities include collecting and transmitting national cryptosporidiosis case surveillance data to CDC and consider/implement HL7 transmission of these surveillance data to CDC (Activity IV(b), p 102; Activity IX (b), p 107) 4 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001671 • Laboratory activities include ensuring staff are trained to analyze and upload data and identify a point of contact for CryptoNet (Activity II (a and b) p 100-101); procure or maintain lab and data analysis equipment and conduct subtyping or ship specimens to CDC for subtyping (Activity VI (a and g), p 104-105); and work with CryptoNet Regional Laboratories (Activity VIII (b), p 107) Cyclospora genotyping: One of the tier 2 activities included in the ELC grant application is Cyclospora genotyping. Can you tell me if the expectation of this activity is for state labs to conduct genotyping of cyclospora at state labs? Or is it for states to send to CDC for genotyping as we did last year? Both options are available. States can either apply for funds to continue to send samples to CDC for typing, or to perform the typing locally and submit the MiSeq sequencing files for analysis at CDC. Great Lakes Restoration Initiative (GLRI) 16. How do I apply for funding to support Great Lakes Restoration Initiative (GLRI) activities in the 2019 funding cycle? The Great Lakes Restoration Initiative (GLRI; https://www.glri.us/index.php) is a source of support for state needs related to waterborne disease prevention capacity, and is connected to a larger federal program to accelerate protection and restoration of the Great Lakes ecosystem. A state that contains a portion of the Great Lakes basin within its boundary is referred to as a Great Lakes state, and may apply to receive GLRI funds in 2019 through Section II, Part F (page 96). To be considered, the application should include Tier 1 (relevant sections are: I. Strategy 1a, page 99; III, Strategy 1b, page 101; IV. Strategy 1c, page 102; VII. Strategy 1f, page 106; XI. Strategy 3a, page 109; XI. Strategy 3b, page 110) and Tier 2 (XXXIII. Strategy 1c, page 116) strategies to improve public health activities, including surveillance and reporting, related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. GLRI work is focused on the Great Lakes basin and therefore must make a connection to the Great Lakes basin in one of the following ways: 1) Activities are specifically tied to a geographical area within the Great Lakes basin, 2) Activities outside the Great Lakes basin can be connected to activities within the Great Lakes basin, and the benefits/associated necessity of the work outside the Great Lakes basin are articulated. Applicants should be aware that waterborne disease prevention efforts within GLRI include public health activities related to harmful algal blooms (HABs) and fresh water issues relevant to the Great Lakes basin. Funding decisions will take into consideration state prioritization, as defined by GLRI management. GLRI funding may be used to cover the equivalent of approximately 50-75% of a contract position, plus ancillary costs, based on project needs detailed in the ELC applications. Funding must supplement but not supplant other federally-funded work. **Activity IV: Epidemiologic Surveillance and Reporting (p 102-103) 17. For activity IV (c), what is meant by conducting environmental health assessments or inspections and where do we report this info to CDC? Environmental health assessments of a foodborne illness outbreak determine how and why pathogens get into the environment and spread to make people sick. Food safety program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future 5 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001672 ones. Food safety programs can report this information to the National Environmental Assessment Reporting System (NEARS). Similarly, environmental health assessments and inspections can inform waterborne disease outbreak prevention efforts. Environmental health program officials typically conduct these assessments to understand and address the outbreaks’ environmental causes (e.g., contributing factors). Findings can be used to recommend steps to stop outbreaks and prevent future ones. Waterborne disease prevention programs can report this information through the National Outbreak Reporting System (NORS), by entering the findings in appropriate fields and/or attaching the assessment/inspection reports. Additionally, this activity can include completion of an environmental assessment and the associated seafood investigation section of the COVIS form at all restaurants where a Vibrio case-patient indicates they consumed seafood. 18. For activity IV (d), what fungal and parasitic diseases should we explore making reportable? Specifically, for fungal diseases this would be blastomycosis, coccidioidomycosis, and histoplasmosis. Candida auris is now nationally notifiable, and states may wish to make that reportable as well. For additional state-based reporting information please see: https://www.cdc.gov/fungal/fungal-diseasereporting-table.html. Specifically for parasitic diseases, this would be giardiasis and free living ameba infections. 19. For activity IV (e), what is NORS looking for in terms of data completeness? For example, a jurisdiction is entering all details for all foodborne, waterborne, animal contact, and environmental outbreaks but only those person-to-person outbreaks for which there is decent data. Would they rather have all person-to-person outbreaks even if the data quality is lower for the majority of those? Only five variables are required to create an outbreak report in NORS: the state-assigned outbreak ID (or state ID), date first ill, estimated number of primary ill, state of exposure, and the primary mode of transmission. We encourage all states to report all foodborne, waterborne, and other enteric illness outbreaks even if that is all the information available to them. We strongly encourage additional information to be reported if available but we fully recognize that state and local health departments may not have access to detailed information for all outbreaks. During data cleaning for person-to-person, animal, environmental and unknown modes of transmission, NORS staff checks for values in other questions, such as age/sex and setting, but these can all be set to “unknown” if that information is not available. Entering “unknown” will satisfy the data checks, as it lets NORS staff know that the information is unavailable rather than assuming it was omitted. If data entered is illogical or unclear (such as entering an etiology as “confirmed” but not having any labconfirmed cases), NORS staff are more likely to follow up with you directly to ensure the data is corrected. We understand that moving to report person-to-person and other non-food/non-water outbreaks is challenging for most states, and we don’t expect 100% of variables to be completed for all reports. Our focus is on seeing more states beginning to report these outbreaks and working towards improving reporting rates and report completeness. We also plan to release an integrated data cleaning feature within the NORS interface sometime next month. More details are coming soon, but we do expect that this will allow states to more easily keep up with data checks as reports are entered and finalized, making the year-end data cleaning process much less burdensome. 6 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001673 20. For activity IV (e), what is the timeliness factor for NORS reports? For example, a jurisdiction strives to get NORS reports started within 60 days of initial onset for foodborne and most waterborne disease outbreaks but wanted to know if there is a target/goal that CDC wants to achieve for reporting outbreaks associated with person-to-person, animal, and unknown modes of transmission as well. CDC has not included a timeliness target/goal for NORS reports in the 2019 ELC NOFO, placing a greater emphasis instead on improving reporting rates and report completeness. In general, states/territories are asked to determine when and how (e.g., manually entry, NORS Direct) to initiate, as well as update and finalize NORS reports. Ultimately, we would like to have all reports entered before data cleaning begins. These dates are staggered by the NORS primary mode of transmission. Additionally, states/territories may want to consider the ELC timeline so that reports are included in the metrics that CDC NORS staff will provide back in 2020. 21. For activity IV (e), what does environmental contamination mean? Activity IV (e) is specific to outbreak reporting via the National Outbreak Reporting System (NORS). This activity lists all of the primary modes of transmission available for selection in NORS. In this context, “environmental contamination” is a reference to a classification of the primary mode of transmission. It is indicating outbreaks of enteric illness associated with environmental contamination other than food/water. This includes exposure to a contaminated environment not attributable to foodborne, waterborne, person-to-person, or animal contact transmission, as defined in NORS guidance. Examples might include contaminated air, soil, or indoor/outdoor surfaces or objects (e.g., dirty linens or surfaces that people touch in bathrooms). 22. For activity IV (e.iii), what does preventative measures refer to? This refers to the prevention measure question in the animal contact section (pg. 4 of the NORS 52.13 form) which asks states to report any prevention measures or recommendations (e.g., handwashing) that were used to help stop the outbreak and prevent additional infections. 23. Should Legionella outbreaks be reported to NORS as waterborne outbreaks? Do you have any guidance about Legionella? All Legionella outbreaks should be reported to NORS if they involve 2 or more cases. The Legionella Team is available to provide guidance and technical assistance if state and local health departments have any questions about how to proceed with the investigation. They can be reached by emailing travellegionella@cdc.gov. 24. For activity IV (h): For Tier 1, is exploring the feasibility of reporting HAB associated event and illness data to OHHABs limited to data entry or could this also be related to supporting surveillance activities? The sub-strategy (IV. Strategy 1c, (h), “Explore feasibility of reporting HAB associated event and illness data (human and animal) to OHHABS”) uses language specific to reporting, however, the data entry involved in reporting is just one component of surveillance work, and we recognize that other actions might be needed to be able to detect, investigate, and subsequently report to OHHABS. We would be interested in states exploring feasibility at all points that they felt were necessary to be able to report effectively into OHHABS. - 7 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001674 Activity IX: Advance electronic information exchange implementation (p 107) 25. For activity IX (a): My state cannot or does not plan to implement all of the condition tabs in the Foodborne and Diarrheal Diseases Message Mapping Guide (FDD MMG). Can we select specific tabs to implement? The FDD MMG can be implemented as the entire guide or in two sections where four condition tabs are implemented at a time. If a state plans to implement the guide in two sections over more than one budget period, please indicate what four tabs will be implemented in the budget period. This guidance does not apply to the FoodNet tab. 26. For activity IX (b): My state plans to transmit core and condition-specific data elements in an electronic tabular format (e.g., *xls or *csv) by email, are there requirements to implement this data transmission method? Transition from traditional mechanisms (e.g., email/fax of individual case report forms) to electronic tabular format can be initiated by contacting the surveillance system point of contact at CDC. CDC POCs will work with states to ensure that the quality and completeness of the data is maintained in the electronic tabular format. Contact Erin Stokes estokes@cdc.gov if you need surveillance system contact information. 27. For activity IX(b. iv) page 107, for cryptosporidiosis, does this mean we should transmit data for all cases submitted for subtyping, then outbreak-associated cases, then sporadic cases? Or does it mean all cases submitted for subtyping AND outbreak-associated cases, then sporadic cases? The second example is the intended activity; if HL7 transmission is not feasible then please assess feasibility to send electronic data following this prioritization: 1) each case for which a Cryptosporidium specimen is submitted for subtyping to CryptoNet AND for each outbreak-associated case 2) sporadic cases for which a Cryptosporidium specimen has not been submitted to CryptoNet. Activity X: Implement health promotion strategies 28. For activity X (a and b) page 107-108, these aren't really in the day-to-day responsibilities for food and waterborne epidemiologists. Is the expectation that epidemiology staff should be doing this, or should we be reporting on meeting with our communications teams to achieve these goals? The intention is to be working with health communications group to make sure that food and water prevention messages are available to their constituents. Applicants are encouraged to ask for funding that will allow them to accomplish the activity (i.e., funding does not have to be limited to an epidemiologist’s salary). For example, waterborne activities could include epidemiologists, communicators/educators, or laboratorians, as appropriate for the activity. 29. For activity X (d) page 108, we're aware of the MAHC and reference it on occasion, we rely heavily on EH partners to implement the details. Should we report here on partnerships with EH or are we expected to spend more time on this? Reporting on partnerships with EH on the MAHC is acceptable. Tier 2 Activities CryptoNet 1. CryptoNet is listed in both Tier 1 and Tier 2 activities. What CryptoNet activities are included in Tier 2 of Section F? (See Tier 1 FAQs for additional CryptoNet information) 8 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001675 Tier 2 CryptoNet includes Activities XIII – XVII (p 110 – 111). These activities include implementing cryptosporidiosis tab in Foodborne and Diarrheal Disease Message Mapping Guide and serving as a CryptoNet Regional Laboratory. Environmental Microbiology 1. For activity XIX (a.i), p111 and XX (a.i), p112, would it be acceptable to respond with environmental testing for Legionella here? What are some of the other environmental waterborne diseases to test for under each of these activities? Legionella sampling alone is not sufficient to meet this strategy. Legionella testing activities are included in other sections of the NOFO. The Section F, Tier 2: Environmental Microbiology activities cover other waterborne infections. Our most common pathogens for environmental testing are Cryptosporidium, E. coli, and Norovirus, though there are others that could fall under this strategy. FoodNet 1. As a FoodNet site, should our FY19 ELC application include activities that are complimentary to activities in the Emerging Infections Program (EIP)? What about FoodNet-NARMS activities? Yes, please work closely with the FoodNet Principle Investigator in your state on the Tier 2 FoodNet section narrative and budgets (Epi and Lab). The Tier 2 FoodNet section narrative and associated budget items should include FoodNet activities tied to NARMS. This includes activities XVI and XVII around collecting standardized data elements associated with antimicrobial resistant infections and case exposure ascertainment (eCEA). If you have further questions related to the FoodNet or NARMS sections please contact Kelly Barrett, FoodNet (email: kbarrett@cdc.gov phone: (404) 718-1152), Aimee Geissler, FoodNet (email: ageissler@cdc.gov; phone: (404) 639-7557), and Jared Reynolds, NARMS (email: jreynolds3@cdc.gov; phone: (404) 639-3519). Harmful algal blooms (HABS) 1. How do I apply for the harmful algal bloom-related funding in Tier 2 for the 2019 funding cycle? FY2019 congressional language provided funding to CDC to “enhance harmful algal bloom exposure activities, including surveillance, mitigation, and event response efforts, with a priority given to geographic locations subject to a state of emergency designation related to toxic algae blooms within the past 12 months.” (Joint Explanation of the Committee of Conference, page 16). To advance this work, Section II, Part F (page 96) of the 2019 ELC NOFO includes a Tier 2 strategy for harmful algal bloom (HAB) surveillance, response, and mitigation (XXXIII. Strategy 1c, page 116). The Tier 2 HAB strategy will support jurisdictions affected by harmful algal blooms and associated illnesses, inclusive of states/territories that have expertise and leadership to share within a peer-to-peer network, in collaboration with CDC. CDC will review applications and prioritize funding for 2-4 jurisdictions, with priority given to those that had a state of emergency declarations related to toxic algae blooms in the 12 months prior (i.e., FY2018; October 2017 through September 2018). Applicants are asked to reference any Tier 1 strategies that would help them to meet state-identified needs to enhance harmful algal bloom exposure activities in one or more of the following areas: surveillance, mitigation, or event response. Two sets of Tier 2 HAB measures are provided (page 121 and page 126). Please note a minor correction and a clarification within the Tier 2 HAB measures on page 126. The HAB measures for surveillance and outbreak data will be calculated by CDC’s Waterborne Disease Prevention Branch rather than by CDC 9 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001676 NoroSTAT staff. The third measure, “Percent of NORS foodborne or waterborne HAB outbreak reports that have corresponding OHHABS reports” refers to the percent of foodborne or waterborne outbreaks that report a suspected or confirmed HAB-associated etiology (e.g., food: ciguatera fish poisoning, algae: Microcystis aeruginosa, toxin: cylindrospermopsin). Additionally, states that received Great Lakes Restoration Initiative (GLRI) funding through ELC in 2018 that may apply for GLRI funding in 2019 are required to include this Tier 2 activity (see Tier 1 FAQ #16 for more information about how to apply for GLRI funding). Tier 3: CoE Activities General Questions 1. Who is eligible to apply to become an Integrated Food Safety Center of Excellence (CoE)? A minimum of five CoEs will be designated. A CoE must be a state health department partnered with one or more academic institutions. 2. How will an applicant’s current capabilities be assessed? A strong CoE application will include a demonstrated ability to • Participate in case-based surveillance, including timely and complete reporting to national case-based surveillance systems (i.e. LEDS, COVIS, NNDSS, Listeria Initiative, etc.) and participation in regular data cleaning processes, as requested. This includes describing a plan for implementation of the FDD MMG (either for 4 condition tabs or the entire guide). • Submit foodborne outbreak reports to NORS. Including, reporting at least 2 outbreaks per million population to NORS each year and finalizing at least 85% of foodborne disease and animal contact outbreak reports within 60 days of the start of annual data cleaning • Conduct laboratory surveillance as well as collaborating with CDC and/or other public health laboratories in the implementation of new approaches to enhance PulseNet-related surveillance. This includes being able to collaborate with other labs in their region (training, troubleshooting, surge capacity, etc.). • Participate in multistate outbreak response activities, including collaborating with CDC and/or other public health agencies. This includes participating in multi-state outbreak investigation conference calls, completing and returning outbreak-specific questionnaires to CDC, and submitting epidemiologic data via SEDRIC during outbreak investigations. 3. Where should CoE applicants describe their health department and academic partner resources to describe their current capabilities? The “Approach” tab of the section F application template should include a description of • The applying health department’s capacity to lead and provide assistance to other federal, state and local health departments (see General Questions #2) • The applying academic partner(s)’ demonstrated knowledge, expertise, and meaningful experience with regional or national food production, processing, and distribution, as well as leadership in the laboratory, epidemiological, and environmental detection and investigation of foodborne illness. 10 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001677 4. What are the minimum activities for a CoE? Applicants are expected to respond to each area in the application; these are all included in Tier 3, Activity XL (a-f) on pages 118-119. There is flexibility in specific projects proposed, and applicants are encouraged to propose other appropriate projects in XL(g) (“Other Activity”) in the narrative template. All proposed projects should be compatible with program goals and build on current capacity and public health needs. Funds allocated to the CoEs through ELC may not be used for research (see question 5). Please see the General Section F FAQ #1 (on page 1) regarding the character lengths in the template. In general, CoE applicants should be able to describe a proposed project in 4-7 bulleted sentences. If an applicant needs to use an appendix(ices) to describe all the projects they are proposing for a given activity, the project descriptions in the appendix should also be 4-7 bulleted sentences, per project. This applies to health department and academic partner projects. 5. Can the CoEs conduct research? Funds allocated to the CoEs through ELC may not be used for research; however, CoEs are encouraged to seek out opportunities to conduct appropriate research activities with non-ELC funding. Research activities funded through other sources should not be described as a CoE sponsored activity in the ELC application, and, instead, a brief description may be included as supporting documentation to the application as an appendix. If a CoE has undergone institutional review to confirm that a project is not research, that documentation should be included in the ELC package. Activities that are determined to be research by CDC will not be funded, so project details are very important to ensure activities aren’t misclassified. 6. How should CoE applicants specify academic funding in their budgets? Academic funding should be requested in the “OTHER REGULAR” portion of the ELC budget template. There must be a clear link between the projects that are proposed in the narrative and funds requested for implementation of those projects. The academic partner funding may be requested under a single budget line or each academic partner project may have a separate budget line. If all academic funding is requested in one budget line, also include an itemized budget in the “Budget justification” column of the budget template; this should include short descriptive titles for each project that should align with the 4-7 bulleted sentences describing each project proposed in the narrative template (work plan) or appendices. 7. Is there a required allocation of budget requests between the health department and the academic partner(s)? FSMA legislation does require that a CoE is based out of the health department. There is not a specific proportion of funding that is required to remain in the health department or be allocated to an academic partner(s). However, a competitive application, and associated budget, would support a strong, balanced partnership between the health department and academic partner(s). Supplemental Projects What supplemental CoE projects are available for funding and where should they be included? 11 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001678 Specific funding may be available for the following projects. If an applicant would like to apply for this funding, they should describe the project under Activity XL (g) “Other Activity” of the ELC template and clearly indicate the funding and associated justification for these projects in the F.3 budget template. Applicants may refer to the supplemental projects by number from this FAQ in the “Describe Other Activity” Field in the template (e.g. “Supplemental Projects #, #, and #). General Projects 1. Whole Genome Sequencing Training for Non-Laboratorians: • Funds available: ~$75,000 total for one lead and other participating CoEs • Description: CoEs may provide support, deliver training, develop materials, etc. on whole genome sequencing for epidemiologists and other staff who will interpret WGS results for cluster detection and investigation. 2. Hurricane Response in Puerto Rico and U.S. Virgin Islands: • Funds available: ~$250,000 total for one lead and other participating CoEs • Description: CoEs may use funding to support response efforts in Puerto Rico and the U.S. Virgin Islands including hosting reverse site visits by USVI/PR staff (and travel of those staff), delivering trainings, travel to PR and USVI, translation services, etc. 3. CoE Products Website: • Funds available: ~$50,000-$100,000 for one lead CoE • Description: One CoE will host a website that catalogs all CoE products in a searchable format (https://www.coefoodsafetytools.org/AllCoEProducts.aspx). 4. One Health Collaborations to Combat Antimicrobial Resistant (AMR) Infections • Funds available: Up to $100,000 across three projects (each project not to exceed $50,000) • Description: Funding is available for up to three projects to better respond to and prevent antimicrobial resistant (AMR) enteric outbreaks and understand and improve antimicrobial stewardship in animal health. In the application, please describe the resources available (partners, relationships, etc.) that will allow the project goals to be achieved. Project Categories: Project proposals can be submitted under the following categories (note, funding is only available for up to three projects): o Category 1. Assess understanding of AMR and antimicrobial drug usage among pet owners and explore influences on pet owner attitudes toward antibiotic prescribing in animals in order to guide development of educational interventions and materials for owners and/or veterinarians. o Category 2. Explore best ways to communicate with and provide messaging to plain sect communities (e.g. Amish and Mennonite) around prevention of enteric diseases, including outbreaks of pathogens exhibiting AMR. Educational materials developed should strive to accommodate the cultural norms of plain sect farmers. o Category 3. Explore knowledge, attitudes and practices of pet store employees and feedstore workers regarding prevention of transmission of enteric illnesses from contact with animals and develop educational interventions and materials. 12 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001679 o o Category 4. Explore and evaluate effective methods to provide education on antimicrobial stewardship in animal health. Category 5. Explore the development and use of One Health antibiograms in guiding treatment decisions and detecting and monitoring trends in AMR. Surveillance-related projects Depending on the availability of funding, there may be up to $50,000 per approved project. 5. Understanding the biases in outbreak reporting • Description: CoEs could help CDC and IFSAC (Interagency Food Safety Analytics Collaboration) better understand the biases present in outbreak reporting (e.g., variation in reporting rates, distribution of the age of cases), which form a core basis for performing food source attribution. Particular features of interest include differences in the data available for multistate vs. single-state outbreaks, by funding tier (FoodNet/FoodCORE/FDA Rapid Response Teams, OutbreakNet Enhanced, OutbreakNet), and by characteristic of state (e.g., income tax per capita). 6. Improving data available for attribution models • Description: CoEs could help CDC and IFSAC improve the breadth of sources available for models that partition cases using subtyping methods into a set of known sources, such as the Hald model and its variants, by expanding the paired epidemiological metadata available for human and non-human isolates (e.g., food, environmental). In particular, we are interested in better attributing Salmonella Enteritidis to its sources. CoEs could also assist with improving our ability to attribute to food sources by helping us find ways to help health departments provide greater detail about outbreak food vehicles (e.g., processing and preparation methods, detailed food categorization, location of preparation [particularly restaurants]). 7. Assessing interest in a mobile/web application to obtain case exposure data • Description: We would like to assess the interest of public health departments and patients in a mobile application or mobile friendly website that would allow patients to take a secure survey on their exposures. We could link their response to their isolate though a unique, but otherwise non-personal identifier (e.g., a unique number provided by the application to be given to the public health department or physician). This would potentially reduce the interview burden on local and state health departments and potentially provide information on patients who are traditionally not interviewed. This might be a particularly good project for CoEs that could collaborate with their academic partner if the project later evolves to a development stage. 8. Estimating oyster harvest areas implicated in vibriosis • Description: Currently, oyster harvest area closures depend on detecting a certain number of infected persons who are unequivocally linked to a single harvest area. However, it is common to consume oysters from multiple harvest areas in one meal, and these patients are excluded from case counts. A probabilistic model to account for single- and multiple-source exposures would improve the ability to link vibriosis outbreaks back to oyster harvest areas, leading to harvest area closures and preventing illness. 13 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001680 9. Enhancing routine public health response for Salmonella Javiana to better understand environmental contributors to infections in children • Description: In the United States, Salmonella serotype Javiana is the fourth most common Salmonella serotype isolated from ill people. It causes 6% of reported Salmonella infections, and the incidence has been increasing. The epidemiologic profile of cases suggests that local environmental conditions may be much more important contributors to infection than food. To better understand the specific sources and mechanisms by which people become infected, we would propose targeted enhancement of routine public health surveillance and response activities in select local or district health offices with consistently high incidence of Salmonella Javiana infections during peak months, e.g., collecting structured and open-ended interviews, environmental sampling, and geocoding of cases. 14 ELC NOFO FAQ: Section F (ver. 04/10/2019) TX-DSHS-19-1309-A-001681 HAI/AR Program 2019 ELC Application Q&A April 10, 2019 Updates will be posted throughout the application period New questions (since April 5th version) marked NEW Last updated: April 10, 2019 Page 1 of 18 TX-DSHS-19-1309-A-001682 Table of Contents HAI/AR General Questions ........................................................................................................................................3 Component G1 General Questions............................................................................................................................7 G1 Strategy I ........................................................................................................................................................ 10 G1 Strategy II ....................................................................................................................................................... 10 G1 Strategy III...................................................................................................................................................... 11 G1 Strategy IV ..................................................................................................................................................... 11 G1 Strategy V ...................................................................................................................................................... 11 G1 Strategy VI ..................................................................................................................................................... 12 G1 Strategy VII .................................................................................................................................................... 13 G1 Strategy VIII ................................................................................................................................................... 14 G1 Strategy IX...................................................................................................................................................... 14 G1 Strategy X....................................................................................................................................................... 14 G1 Strategy XI...................................................................................................................................................... 14 Component G2 General Questions......................................................................................................................... 16 Last updated: April 10, 2019 Page 2 of 18 TX-DSHS-19-1309-A-001683 HAI/AR General Questions NEW: Q: If a staff member performs both laboratory and epidemiologic work, is it ok to apply to both G1 and G2 for different portions of their salary? A: Yes, health departments may derive portion of staff salary from both G1 and G2 as long as the funding requests have sufficient detail regarding which G1 and G2 strategies/activities staff would support. Strong applications will connect staff funding requests with the core G1 functional roles and activities as well as those of G2. Q: How do we express multi-year goals in the application? In the background section, implementation plan, and/or milestones? A: The Application should focus on the current budget year. However, multi-year goals can provide helpful context. Applicants can describe multi-year goals in the problem statement (Approach tab) and activity-specific multi-year goals in the implementation plan (Work Plan tab). Milestones should have a completion date consistent with the coming budget period. Q: When referencing NOFO strategies and activities in our application, what labeling convention should we use? A: Each strategy is labeled by a capitalized roman numeral (I, II, III, etc.). Each activity is labeled by a lowercase letter (a, b, c, etc.). And each sub-activity is labeled by a lowercase roman numeral (i, ii, iii, etc.). For clarity, it’s best to describe an activity by both its strategy number and its assigned letter. E.g., “Strategy II, Activity a” and “Activity II.a” are both helpful ways to indicate the same activity. E.g., “Strategy II, Activity a, sub-activity iii” and “sub-activity II.a.iii” refer to the same sub-activity. Note that the descriptions for each HAI/AR strategy also include references back to the ELC logic model (page 7 of the NOFO). For example, the description for G1 Strategy II begins, “Strategy 1b: Support rapid response.” The highlighted portion in this example refers to the ELC logic model, and should not be used in workplan applications to refer to portions of the NOFO. - Q: What is the purpose of the “Work Plan Overflow Section” on the Approach tab in the application templates for Program G? How is this different from the BP Implementation Plan text boxes on the BP1 Work Plan tab? Why is there an overflow for only certain activities? A: At stages in the development of the Application Template, the Implementation Plan character limits were intended to be strictly enforced, and the HAI/AR program requested additional overflow space for complex activities (i.e., those with many sub-activities). However, the final decision was that the Implementation Plan character limits would not be strictly enforced, making the overflow sections less important. There is a limitation to the number of characters Microsoft Excel will display at one time, but all text entered into the Implementation Plans will still be accessible by the HAI/AR program during review. Q: Can you provide a link for the SharePoint site where supplemental guides and other documents are stored? Last updated: April 10, 2019 Page 3 of 18 TX-DSHS-19-1309-A-001684 A: HAI/AR supplemental guides and other documents in support of the 2019 application are available on our ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, or via email by request (haiar@cdc.gov). Applications will be stronger for considering and/or referencing these supplemental guides. Q: Since progress reports will not be collected in the 2019 ELC application, how can we incorporate our program’s progress in our goals/activities to strengthen our application? What about sharing important charts and figures? A: The ELC office will collect a close-out report in October 2019 that will cover progress for the current budget period 5 (2018-2019). In terms of using prior successes for the 2019 application, applicants are encouraged to be strategic how and when to include that information. For Tiers 2 and 3, it is important for the applicant to demonstrate capacity to perform the respective activities. In addition to the text fields in the application templates, applicants can upload supporting documents (appendices, charts, etc.) via REDCap. Important supporting documents should be cited in the text of the application template. Q: If we don’t apply for Tier 2 or Tier 3 activities in budget period 1, can we apply in a later year? Or will Tier 2 and Tier 3 funding in subsequent years only be for previously funded recipients? A: Typically in a continuation year, if a recipient has already demonstrated capacity to perform optional activities, then that recipient will have an advantage when applying for those activities. That does not preclude NEW applicants from being awarded for those activities. Note that for G1 epidemiology activities, Tier 2 is very competitive for all items and is expected to be so for the duration of the cycle. Note that for G2 laboratory activities, all applicants are encouraged to apply for Tier 2, though funding specifically for WGS within Tier 2 is very competitive. Q: Will there be one reviewer for G1 and G2, or will there be separate reviewers? A: The G1 and G2 applications will be reviewed separately, but reviewers will meet and share information to coordinate across components. Q: What is the relationship between the HAI/AR program and similar cross-cutting activities in ELC? A: Cross-cutting activities are managed by the ELC main office. HAI/AR program applicants should work with their principal investigator (PI) and ELC project officer when coordinating HAI/AR activities with cross-cutting activities. Applicants might consider applying, in part, for cross-cutting funds to support staff engaged in surveillance or outbreak response activities for more than one program or project, equipment that will be used for more than one program or project, or IT reporting infrastructure. Q: For those activities that do not have performance measures provided by CDC in the supplemental guidance, do we as the applicant need to create our own performance measures? If so, where will this information be included? Last updated: April 10, 2019 Page 4 of 18 TX-DSHS-19-1309-A-001685 A: The HAI/AR program will collect those performance measures described in the NOFO guidance during the 2019/2020 budget period. While there is no need to create additional performance measures, the milestones offer an opportunity for applicants to describe accomplishment and results associated with each activity. For Tier 2 activities, strong applications will include reduction goals and methods for baseline, process, progress, and outcome measurements, where appropriate. Q: What is the HAI/AR program guidance for milestones? A: The HAI/AR program does not have specific guidance for milestones. Applicants might consider reviewing the Cross-Cutting Epidemiology and Laboratory Capacity Program for guidance on developing milestones. Additionally, applicants can review the “G1 (Epi) Performance Measure Details Supplemental Guidance” and the “G2 (Lab) Performance Measure Details Supplemental Guidance” found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request (haiar@cdc.gov). It is beneficial for applicants to review the performance measures documents and align their milestones accordingly, where applicable. It is also recommended that applicants include a defined timeline or “achieved by date” and not always default to the funding period. In cases where one milestone may relate to multiple activities, applicants should enter that milestone for each corresponding activity. Q: Is there a minimum number of milestones for the application? A: No, there is no minimum number of milestones, as there are some instances where it’s appropriate not to enter any (e.g., when an activity is not applicable to or within the authority of the jurisdiction). Milestones are a key part of the application review, indicating the applicant’s plans to manage resources throughout the budget period. Additionally, milestones will serve as a baseline for technical assistance and technical monitoring across the budget period. Strong applications will take this into account. Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: Yes, in general, the AR/AS Expert in G1 is conceived as one position, with the individual focused on epidemiology, infection prevention, and data for action in antimicrobial resistance and stewardship (G1 Strategy VIII). By comparison, the AR Lab Expert is someone identified as having the appropriate laboratory expertise to guide G2 activities and implementation (G2 Strategy II). Note that for smaller programs, these roles might not be full time. Conversely it is possible that more than one individual might fulfill each function in larger programs. Q: On the budget template, how will the HAI/AR program use the NEW column H (Program/Project Component)? A: Column H is an open text field that ELC added to the budget template this year. It allows CDC programs and projects to specify line-level information that can aid the review process. For Component G1, applicants must enter the number “1”, the number “2”, or the word “BOTH” for each budget line item. This will indicate to reviewers that the line item will support Tier 1 activities, Tier 2 activities, or both. Blank entries will be considered both. For Component G2, applicants must enter the number “1”, the number “2”, or the number “3” to indicate the corresponding tier for each line item. Please do not use “BOTH” for Component G2. Also for G2, if Last updated: April 10, 2019 Page 5 of 18 TX-DSHS-19-1309-A-001686 applying for funding for more than one Tier, we suggest having a line item for each Tier. This way, if you do not receive funding for a higher Tier, your budget needs for the lower Tier are stated clearly. If you do consolidate line items for multiple tiers, but are not funded for all tiers, the line item budget will be reduced accordingly. Q: What is the HAI/AR program looking for in the NEW “Public Health Allocation” columns (I and J) on the budget template? A: These columns are managed by the ELC main office, and are intended to give ELC an understanding of how funding awarded at state level is being applied to local and regional (within the jurisdiction) levels. Applicants should review guidance from the ELC office for more details. Q: Should we include travel to the HAI/AR Annual Meeting in our budget request for the 2019 ELC application? A: Yes! The next HAI/AR Annual Meeting is scheduled for November 12–13, 2019. Applications should include travel funding requests for core HAI/AR program staff, such as the HAI Coordinator, the AR/AS Expert, and the AR Laboratory Expert. Note that travel funding to cover attendance at AR Lab Network Regional Meetings is covered by APHL and should not be included. Q: How is the HAI/AR program utilizing Direct Assistance (DA) positions for the coming budget period? A: The HAI/AR program does not plan to fund any NEW DA positions this year. Q. Is it possible to cross-walk other CDC funding or national partner activities, as it relates to this application? We want to align efforts with our HPP program and stakeholders like AHA, QIN/QIO. If CDC/DHQP is partnering in those efforts – I'd like to have an idea of what unique role we should be partaking in and what supporting role we can take with our partners. A. We do not have a cross-walk of other CDC funding or national partner activities at this time but will consider this for a future project. Please consider reaching out to your partners at the jurisdiction level, especially for PHEP/HPP. Q: We understand there is an average amount of award. Is there a maximum amount or ceiling that states cannot get above? A. The HAI/AR Program does not have a maximum amount or ceiling. Q: Just confirming that the background and justification can be applied across the board for Healthcare Associated Infections (G). The template looks to only allow one entry. A: G1 and G2 have separate application templates. Each application template has an approach tab, where applicants can provide the problem statement, justification, applicant capacity, and evaluation plan. Please complete both application templates. Last updated: April 10, 2019 Page 6 of 18 TX-DSHS-19-1309-A-001687 Component G1 General Questions NEW: Q: For Component G1, is it appropriate to apply to more than one Tier 2 activity? A: G1 applicants can apply for multiple Tier 2 activities. When doing so, they should include detailed descriptions of the separate Tier 2 activities in their budget requests. NEW: Q: If applicants propose new Tier 2 projects, are they competing with applicants who have already established projects? A: Yes, all applicants for a given Tier 2 application are competing for the same funding, whether they are proposing new projects or the continuation of established projects. NEW: Q: For staff members who might work on both Tier 1 and Tier 2 activities, can we split their funding requests into two budget line items? A: Yes, applicants can separate the funding request for one position into two budget lines as appropriate. NEW: Q: When the Ebola Supplement ended, some positions that were funded under Ebola/ICAR were transitioned to core ELC funding. Should these positions be marked as “continuing” on the budget request template, even if they’ve only been funded under core ELC for a few months? A: Applicants should review the guidance provided by the ELC main office when determining the priority (continuing, new, etc.) of these types of positions as would be done for all other Personnel budget line items. We strongly encourage applicants to use the “budget justification” field to describe how positions fulfill key HAI/AR roles. NEW: Q: If all our staff positions are listed as Tier 1 in the G1 budget request, does that affect our application for Tier 2 activities? A: The plan for implementation of Tier 2 activities will vary by jurisdiction. We expect the budget request to correspond to the jurisdiction’s proposed Tier 2 work plan and to detail how prospective funds will be used to execute the activity, including any staffing needs. NEW: Q: Is there an opportunity to receive funding to support IT infrastructure related to support for AUR module adoption? If so, where does it fit in the NOFO? A: HAI/AR program applicants interested in improving IT infrastructure to enhance electronic data exchange projects (e.g., to support AUR module use) could consider working with their principal investigator (PI) to outline their needs and proposed activities within Health Information Systems Capacity project (Project C). These activities can be cross-referenced within the appropriate section of the G1 work plan (e.g., G1 Strategy V). Last updated: April 10, 2019 Page 7 of 18 TX-DSHS-19-1309-A-001688 Q: Sub-Activity I.a.i addresses establishing tiers of organisms based on local epidemiology and detailing how we detect MDROs and criteria we use to respond. The plan for Activity IV.a seems intended to cover exchange of information between ARLN, PHLs and Epi, and to describe the flow of specimens and result communication. So can the plan for Activity IV.a be part of the comprehensive plan from Sub-Activity I.a.i? A: The written Containment Plan and the Coordinated Epi-Lab Work Plan are related documents that should complement one another. The documents can be organized in whatever way that best serves the health department's needs as long as the elements provided by CDC are addressed (see "G1 Containment Supplemental Guidance" and "G1-G2 Lab-Epi Coordination Supplemental Guidance"). The scope of the Lab-Epi Work Plan should be broader than just Containment-related activities. Q: On page 132, the NOFO states “Priority for funding optional activities in this year will be given to Recipients who showed progress during the prior ELC funding cycle as presented in the application (background and current capacity).” However, on the “Approach” tab of the application template, in the “Workplan” spreadsheet, there is an “Application Capacity” section but no section titled “Background.” Does “Background” in the NOFO refer to the “Problem Statement” and “Justification” sections in the “Approach” tab? A: Please use the Problem Statement and Justification sections in the approach tab to describe progress during the prior ELC Funding Cycle. You can further expand upon the progress and capacity in relevant sections of the workplan. Applicants are encouraged to be strategic how and when to include prior successes information. For G1 Tier 2, it is very important for the applicant to demonstrate capacity to perform the respective activities. Q: G1 Strategies I and II both refer to “interconnected” facilities. Does this mean facilities that share patients? A: Yes, this refers to facilities that share patients, including for example, transfer from an acute care hospital to a post-acute care facility. Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: Strategy I is focused on containment, so the epi-lab coordination for that strategy should relate solely to containment activities (see “G1 Containment Supplemental Guidance” found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request at haiar@cdc.gov). Strategy II is focused on response activities, and likewise the epi-lab coordination for that strategy should relate to response activities that are not already described in Strategy I. Finally, Strategy IV describes epi-lab coordination not already described in Strategies I or II and calls for the development of a shared epi-lab coordination plan (see “G1-G2 Lab-Epi Coordination Supplemental Guidance” also found on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and available via email by request at haiar@cdc.gov). Q: The Safe Injection Practices Coalition (SIPC) and the One and Only Campaign no longer appear in this year’s guidance. Will the SIPC continue to be supported? A: While injection safety activities are not singled out in the 2019 NOFO guidance for the HAI/AR program, they can be included as part of other listed activities. E.g.: Strategy II rapid response activities; Strategy IX education Last updated: April 10, 2019 Page 8 of 18 TX-DSHS-19-1309-A-001689 and training activities; and for Tier 2 optional work, the “other” prevention projects under Strategy VI, Activity C. Note that Tier 2 activities are highly competitive, and the priority for Strategy VI, Activity C, will be to fund a few large projects. Generally, those jurisdictions wishing to include injection safety activities should try to include them in Tier 1. CDC intends to continue providing technical and programmatic support for the Safe Injection Practices Coalition to raise awareness about safe injection practices in healthcare facilities (e.g., via regular calls and other communications and activities). Q: When contracting to perform HAI/AR activities, does that include contracting with local health departments? A: The proposed contractor is at the recipient’s discretion. If it’s important to contract with local health departments to complete the work for a given activity, please describe that decision-making in the application. Q: For onsite infection control assessments, will the HAI/AR program provide assessment tools similar to those provided under the Ebola Supplement? A: The response-driven assessments under Strategy III should be conducted as follow-up to outbreaks and/or the identification of a targeted threat. In these cases the recipient can use an existing assessment tool or a customized assessment tool, as the response dictates. The prevention-focused assessments under Strategy VI, targeting long-length-of-stay settings, highacuity settings, dialysis settings, outpatient settings, etc., have more similarity to those conducted under the Ebola Assessment. Here again recipients can use the existing tools and/or modify tools as needed, for which CDC DHQP is available for consultation. Q: The HAI/AR webinar conducted on March 15th included an estimated award of $33 million to $35 million for Component G1. What is the estimated average award for G1? A: The HAI/AR program expects to provide 57 awards for G1 Tier 1, which is the priority for that component. Individual award amounts for G1 will vary based on several factors, including the strength of the application, population size, and the available funding for proposed activities (Tier 1 and Tier 2). Q: Targeted Assessment for Prevention (TAP) has been a required activity in the past for the HAI/AR program, and now it’s listed as optional. How should TAP capacities that have been developed to date be continued? A: TAP is specifically identified in two Tier 2 optional activities (VI.b and VI.c) in the NOFO guidance for the HAI/AR program. But there are other areas in Tier 1 where TAP can be included with broader work: the Tier 1 portions of Strategy V and the prevention activities in Strategy VI. The expectation is that recipients will integrate the TAP capacities developed in prior years into ongoing core HAI/AR work. Q: Are G1 Tier 2 activities expected to continue for the entire 5 years of the upcoming ELC cycle? A: No, G1 Tier 2 optional activities are not necessarily 5-year activities. As described in the G1 NOFO guidance, optional activities in Tier 2 might be included in only the first two or three years of the ELC cycle, so work plans Last updated: April 10, 2019 Page 9 of 18 TX-DSHS-19-1309-A-001690 should reflect the potential for time-limited funding. As such, Tier 2 applications that include concrete timelines are stronger than those that don’t. Q: During the webinar, you estimated $2 million for 3–4 Device- and Procedure-Associated Prevention Projects. Will smaller Tier 2 projects be considered? A: A limited number of large Tier 2 projects with clear, measurable goals will be prioritized. However, applications for strong small projects will be considered if funding is available. G1 Strategy I Q: The description for Strategy I, Activity a states that “organisms included in each containment tier or targeted for regional intervention may vary by region depending on the local epidemiology.” Does “regional” in this case mean our HHS region, or does it mean our jurisdiction? A: Applicants have the latitude to define region in a way that is most appropriate for their health department's context. They are not bound by any previously defined regions (e.g., HHS or AR Lab Network regions). For some health departments, "region" might be part of a state, a full state, or multiple states. The goal is to think about the strategies and interventions for the most relevant geographic area. Q: Strategy I, Activity A has instructions to develop and regularly update written plans that ensure timely detection and response to targeted resistant threats. Is CDC going to provide a template for this plan? A: No, the HAI/AR program will not provide a template. Recipients should develop plans as appropriate to their capacities and usage, taking into account the criteria listed in the guide “G1 Containment Supplemental Guidance” (available on the ELC HAI/AR Resources & Submission Portal, AR Lab Network ShareFile Site, and via email by request at haiar@cdc.gov). Q: What organisms fall under this strategy? A: We encourage applicants to review the revised CDC containment strategy guideline to help guide plans for containment responses (which would be included in Strategy I) versus other responses (which would be included in Strategy II). We recognize that organisms included in each containment tier may vary by region depending on the local epidemiology. [See related answer under G1 Strategy II] Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: [See answer under Component G1 General Questions] G1 Strategy II Q: What organisms fall under this strategy? Can we include Invasive Group A Streptococcal infections (iGAS) investigations based on previous ICAR and outbreak findings? Last updated: April 10, 2019 Page 10 of 18 TX-DSHS-19-1309-A-001691 A: Strategy II includes all HAI/AR response activities that are not covered by Strategy I (please see related question under G1 Strategy I for more detail). The types of organisms and response activities covered by Strategy II are heterogeneous; the common denominator is that they are affecting healthcare patients. For anticipated response activities involving organisms that are already covered by another ELC-funded program/project, consider describing how the HAI/AR request differs from or compliments other ELC-funded program/project requests. For cross-cutting response activities, applicants can also consider outlining their needs and proposed activities in the CrossCutting Epidemiology and Laboratory Capacity Program section. Q: How does epi-lab coordination differ in Strategy I, Strategy II, and Strategy IV? A: [See answer under Component G1 General Questions] G1 Strategy III Q: When providing milestones for the response-driven onsite assessments, should we provide a number of assessments that we intend to complete? Or can we instead reference the number completed last year in the implementation plan? A: The number of response-driven onsite infection control assessments you perform under Strategy III will depend on the number of facilities where targeted organisms or resistance mechanisms have been identified and the number of facilities where outbreaks have occurred. If your health department is able to enumerate an expected number of on-site assessments for the budget year (e.g., based on prior years), this would be helpful to include in the implementation plan. Q: For onsite infection control assessments, will CDC provide assessment tools similar to those provided under the Ebola Supplement? A: [See answer under Component G1 General Questions] G1 Strategy IV Q. The supplemental guidance does a good job of detailing the components of a strong work plan. It is not clear what is expected for this application. Is it enough for us to say that we have these elements already documented, will work over the grant year to develop the additional elements and comprehensive work plan, and have the plan finished by July 2020? Or do you want details on each element now? A: Applicants should include sufficient detail to help reviewers understand how the work plan will be developed, what elements it will include, and when the plan will be completed. G1 Strategy V Last updated: April 10, 2019 Page 11 of 18 TX-DSHS-19-1309-A-001692 Q: In G1 Strategy V, Activity e the text in sub-activities v and vi is almost identical. Are these two versions of the same sub-activity? If not, can you please clarify how they are different? A: A recipient of Activity V.e is required to complete only one HAI validation report and assessment of the NHSN validation guidance. Sub-activities v and vi describe what should follow. Under sub-activity v, validators are expected to provide feedback to facilities, educational training if needed, and to correct the data in NHSN. Subactivity vi suggests providing recommendations to modifications in guidance and providing quantitative estimates of errors classified by error type to NHSN. Q: Can you further explain what you are looking for in Strategy V Activity b (identify and implement mechanisms to detect MDROs within the jurisdiction)? A: Applicants should describe how they use or plan to use various sources of data (e.g., NHSN, EIP, AR Lab Network, state/local data) for detecting emerging MDROs and to define the local and regional epidemiology. G1 Strategy VI Q: Strategy VI, Activity b, sub-activity i (Tier 2) states that for TAP, “For most jurisdictions the minimum expectation is 10 facilities.” Does this refer to the total number of facilities targeted over the funding cycle, or does it refer to the target over a funding year? A: Applicants should target at least 10 facilities in the first funding year, then expand to include other facilities in subsequent funding years as appropriate. Although we do not anticipate completed outcome measures until at least 18 months after initiation, interim measures will be expected after the first year of funding, even if there are not yet measurable improvements. As a Tier 2 optional activity, we expect funding for 2-3 years, but not necessarily for the entire 5-year funding period, so applicants should make proposals in consideration of this timeline. Q: In Strategy VI, Activity a, there is language explaining how this activity should be distinct from Area A, Strategy III. Within that language is a reference to Area B, Strategy I. There is no Strategy I under Area B. Is this a typo? A: Yes, this is a typo in the NOFO. “Area B, Strategy I” should read “Area B, Strategy VI.” Note that this was corrected in the application template for Activity VI.a. Q: For onsite infection control assessments, will CDC provide assessment tools similar to those provided under the Ebola Supplement? A: [See answer under Component G1 General Questions] Q: Under Strategy VI, Activity a, what is a reasonable number of onsite assessments? Is there a guide or standard for the targeted number of facilities? Last updated: April 10, 2019 Page 12 of 18 TX-DSHS-19-1309-A-001693 A: The appropriate target for number of assessments varies widely by setting and jurisdiction, and this variation makes a standard approach impractical. Our expectation is that each recipient will tailor and scale their approach to align with their local epidemiology and respective needs. Q: Under Strategy VI, Activity c, does Sub-Activity ii allow for prevention projects that cover work other than device- or procedure-associated infections? A: Device- or procedure-associated infection prevention projects will be prioritized for Strategy VI, Activity c, Sub-Activity ii. Other prevention project proposals can be included in this activity and will be considered if funding is available. G1 Strategy VII Q: Can you clarify what’s expected for the sub-activity VII.a.v, “Monitor state-level outpatient antibiotic use and use of selected antibiotic classes (e.g., fluoroquinolones) in order to inform dissemination strategies and collaborative activities. Data can be obtained from CDC's Antibiotic Resistance Patient Safety Atlas at https://gis.cdc.gov/grasp/PSA/indexAU.html?” A: Strong applications will describe how the health department plans to use data from the jurisdiction when developing dissemination strategies. Using the Patient Safety Atlas data to identify targets for stewardship strategies may help states with antibiotic prescribing above the national average. Other options for using data to target dissemination strategies include using Medicaid data, collaborating with the QIN-QIO to use Medicare data, leveraging the QIN-QIO’s use of Medicare data, or collaborating with local health systems and/or insurers to find and target dissemination to high prescribers. Q: With respect to Strategy VII, is the required section (Activity a) limited only to the activities listed, or can we include other additional activities? Or should we place any other additional activities under the optional section (Activity b)? A: To the extent possible, please align activities with the NOFO. If you want to include additional activities under Strategy VII, we recommend including them where they seem to align best. If they are discrete data-driven, intervention projects, then Tier 2 Activity b would be best. If the activities are more focused on building antibiotic stewardship capacity and working with facilities, then Tier 1 Activity a would be more appropriate. If you decide to include additional activities, please include a description of how the impact of each activity would be assessed, since it may not be reflected in the current performance measures. Q: Can you clarify the intent of Strategy VII, Activity b (Tier 2)? It seems to indicate applications for largescale, well-defined, time-limited special projects funded above and beyond routine stewardship activities. Do you have specific projects in mind for VII.b? What could this funding be put toward? E.g., could this funding go toward supporting partner involvement, supporting facilities, supporting outside resources to disseminate clinical decision support tools, collecting data, in addition to supporting state health department staff time? A: For Activity b (Tier 2), we are looking for projects that are intervention-based with a quantitative component, specifically data-driven interventions that are supported by evidence or have been shown to be successful. It is up to the jurisdiction to determine whether that involves academic or other partners, but the specifics of the Last updated: April 10, 2019 Page 13 of 18 TX-DSHS-19-1309-A-001694 intervention and how impact will be assessed must be clearly described. Tier 1 activities are more conducive to supporting staff time. Q: Under G1, Strategy VII, Activity b, “Implement targeted project to improve antibiotic use,” do applicants have to choose only one of the listed sub-activities? Is there a possibility of getting more than one funded? A: Applicants can include one, two, or three of the sub-activities in the application for G1 Activity VII.b. If the applicant includes more than one sub-activity, these may need to be prioritized by the HAI/AR program in the review process. Note that this a Tier 2 activity and thus very competitive. G1 Strategy VIII Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: [See answer under HAI/AR General Questions] G1 Strategy IX Q: Strategy IX, Activity d says to "Improve onsite assessment capacity by developing expertise in facility assessment.” Examples include “training staff in conducting assessments.” Does this refer to training facility staff or staff within the health department’s HAI program? A: Activity d refers to staff within the health department’s HAI program, with the goal of ensuring the program has sufficient expertise to conduct assessments. G1 Strategy X Q: For Strategy X, Activity b, should we apply if we’re not an EIP site? A: Activity X.b is intended for EIP sites. However, this is a required Tier 1 activity, so please don’t leave it blank on the application template. If the applicant is not an EIP site, the text for X.b can simply indicate that. G1 Strategy XI Q: As a local jurisdiction, are we expected to create an HAI plan? Or is that just for states? A: In this cycle, all ELC-funded HAI/AR programs are expected to create and update an HAI plan regularly. Local health departments should work with the state health department to ensure that plans are coordinated based on collaborative discussions and planning. Q: Will CDC provide a template for the jurisdictional HAI plans? Last updated: April 10, 2019 Page 14 of 18 TX-DSHS-19-1309-A-001695 A: CDC does not currently have a revised template for jurisdictional HAI plans. We anticipate that jurisdictions will have latitude to update their current plan’s existing structure/outline (if it still serves their needs) or to consider a NEW/revised/expanded format. The goal is to reflect current activities, data-driven needs and goals (e.g., future directions and priorities), with input from your HAI/AR advisory committee and health department leadership. Examples of plans can be found at: https://www.cdc.gov/hai/state-based/index.html. Last updated: April 10, 2019 Page 15 of 18 TX-DSHS-19-1309-A-001696 Component G2 General Questions NEW: Q: What items should we include in applications for the Tier 2 WGS funding in G2? A: Given the anticipated amount of funding available and the highly competitive nature of this portion of the G2 award, we suggest you think of Tier 2 WGS funding as an opportunity to support sequencing reagents, supplies, and/or small equipment, ideally in laboratories with some existing infrastructure. DHQP can provide resources and bioinformatics support for analysis of WGS data. If you are seeing opportunities within your laboratory to support bioinformatics training and staff, think of Project I Section I (Cross-cutting EID Capacity, Systems, and Leadership) for AMD workforce development. NEW: Q: Is the G2 Tier 2 WGS funding to support just sequencing for our state or will we also be responsible for sequencing for other states in our region? A: Tier 2 WGS funding is to support activities in your state alone. Regional labs will provide WGS support for the jurisdictions in their region. NEW: Q: Is there flexibility in how states funded for G2 Tier 2 WGS testing choose how to prioritize their sequencing? A: Yes, states can choose how best to set their sequencing priorities, within the list of CDC priorities, as they will be dependent on local epidemiology and needs. NEW: Q: Do Tiers 1 and 2 of G2 include funding opportunities to support PFGE or environmental sampling? A: We are not providing funding to specifically support PFGE or environmental sampling. CDC may be able to provide assistance for these activities. Please contact HAIAR@cdc.gov for more information. NEW: Q: Does G2 Tier 2 WGS funding support long-read sequencing? A: The funding levels and priorities of Tier 2 WGS opportunities are focused on short-read sequencing. Further genomic characterization may be beneficial but long-read sequencing would be at the discretion of and with funding support by the sequencing lab. DHQP is available for consult in deciding which isolates should be considered for long-read. NEW: Q: Is there some flexibility in G2 Tier 2 WGS funding for a state to pool their resources and knowledge with another state to do WGS? A: We will be funding individual jurisdictions for WGS pathogens within their jurisdictions only. It would be difficult in terms of funding to disseminate funds to multiple jurisdictions to accomplish one goal. NEW: Q: Can we use the DNA flex kit for WGS? Last updated: April 10, 2019 Page 16 of 18 TX-DSHS-19-1309-A-001697 A: We are currently evaluating the use of this kit with our protocols but do not anticipate any issues with labs wanting to use this kit. NEW: Q: Can non-regional labs apply for funding to support CPO colonization screening? A: At this time we are not currently funding non-regional labs for CPO screening since the regional labs are already funded for this activity. Although there are some non-regional labs that are performing colonization screening, they are not being funded through ELC. If you feel this is an activity you would like to perform in your lab, we encourage you to include this in your grant application with a detailed justification. NEW: Q: G2 WGS priorities list “all CRAB”. Are we expected to perform PCR for the primary targets first or skip straight to WGS? A: Perform PCR first to facilitate rapid detection of primary carbapenemase gene targets. NEW: Q: Pan-resistant isolates are not included in your WGS priorities for G2. Should they be? A: G2 WGS priorities will not include suspected pan-resistant isolates. Suspected pan-resistant isolates will be sent to CDC for comprehensive AST and long-read WGS. NEW: Q: Can you please specify/point out where I can find the DHQP recommendations for testing a proportion of CRPA isolates, as referenced in the following activities: Strategy I Activity a, Strategy I Activity b, Strategy III Activity a? A: You’ll find some guidance in the CRE/CRPA State Testing Guidance document on ShareFile. In that document, titled “Guidance for Testing CRE & CRPA in State and Local Public Health Labs” we recommend each public health lab “tests at least 10 CRPA isolates each month. Labs may choose a sampling scheme (e.g., the first 10 isolates received, the last 10 isolates received) and focuses testing in regions or facilities with high prevalence.” Q: In the G2 guidance, under Strategy I, Activity b (Tier 1), you are asking for mechanism testing by PCR on E. coli, Enterobacter, Klebsiella, and Citrobacter, as well as a portion of CRPA isolates. However in Tier 2 Citrobacter is mentioned as an expanded organism along with Serratia, Providencia, and Proteus. Is the mention of Citrobacter in Tier 1 in error? A: Yes, Citrobacter was included in Tier 1 in error. The correct language for Strategy I, Activity b should say “(at least E. coli, Enterobacter, and Klebsiella) and a proportion of CRPA.” Q: Given the expectation of $44k per award for G2 Tier 1, is the expectation to request lab staff in G1? A: No, the applicant should apply for what is needed for lab activities under G2, applying for expanded testing in Tier 2 as appropriate. Depending on capacity and burden in the jurisdiction, if an applicant doesn’t need one full time person, the HAI/AR staff encourages the applicant to request a part-time position. Last updated: April 10, 2019 Page 17 of 18 TX-DSHS-19-1309-A-001698 Q: Is there any place to include environmental surveillance for antibiotic resistance? A: This year’s G2 application does not include environmental surveillance. Q: Regarding whole genome sequencing (WGS) for isolates, given the capacity limitations in state labs, will it be acceptable to collaborate with another program that can accomplish the work and upload the sequences? A: If an applicant’s best means for conducting whole genome sequencing is with a partner, it is appropriate to propose that. Please be as detailed as possible; whatever party does perform the sequencing should do so according to established guidelines. Note that this specific Tier 2 activity is very competitive. Q: Since there is a preferred platform for sequencing (MiSeq), can this be funded as part of G2? A: Yes, applicants can request funding under “Equipment.” Q: Can you clarify if the AR/AS Expert in G1 and the Lab AR/AS Expert in G2 are separate funded positions? A: [See answer under HAI/AR General Questions] Q: Should budget requests include travel funding for AR Lab Network Regional Meetings? A: Funding to cover attendance at AR Lab Network Regional Meetings is covered by APHL and should not be included in the ELC budget request. [See related answer under HAI/AR General Questions] Q: Is the Strategy in Tier III, Number VI, Activity e, “Expand and sustain AR lab testing and reporting for surveillance,” a required strategy or is it optional? A: If applying to be a regional lab, then all Tier III strategies (except XI and XII) are required. If not applying to be a regional lab, then you should not be applying for work under Tier III. Q: If applying for regional lab funding, should we also apply for all activities under Tier II, understanding that WGS and Candida identification is included under both Tiers? A: If you want to be funded for WGS and Candida identification and are also applying to be a regional lab under Tier III, it may make sense to apply for funding for these activities under both Tiers, in case you are not selected to be a regional lab. Please note that you will not receive funding for activities under BOTH Tiers. Last updated: April 10, 2019 Page 18 of 18 TX-DSHS-19-1309-A-001699 03/01/2019 G1 and G2 Supplemental Guidance: Coordinated Epidemiology and Laboratory (Epi-Lab) Work Plan Tier 1 G1, Area A, Activity IV.a: Using elements and guidance provided by CDC, collaborate with public health labs (local, state, and regional) to develop coordinated work plans to improve coordination and information flow. Tier Associated Strategy G2, Area A, Activity III.b: Using elements and guidance provided by CDC, collaborate with ELC-funded HAI/AR programs to develop and regularly update coordinated work plans to improve communication and information flow that ensure timely detection and response to targeted resistance threats. How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. The Epidemiology and Laboratory Capacity for Infectious Diseases Guidance for the 2019–2023 cycle includes two interrelated components that address healthcare-associated infections (HAIs) and antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Recipients are expected to promote improved epidemiologylaboratory (epi-lab) collaboration, including development of coordinated work plans. Coordinated work plans should be based upon collaborative discussions and planning across the HAI/AR Program (G1 and G2), clarify roles and responsibilities, and include internally consistent content. Strong applications will include the minimum elements described below. Minimum elements to be included in work plans:   For G1 (epidemiology): o Describe how data provided by the AR Lab Network will be used to define local epidemiology, identify priorities for response and prevention, and facilitate coordinated containment and other response elements, including sharing of results for timely action and providing recommendations for testing. o Describe the HAI coordinator’s role in assuring epi-lab coordination, either directly or through assignment of this task. o Describe steps taken to work with public health laboratory partners to develop coordinated work plans. o Describe response to laboratory results (including alert values), establishment of timeframes, roles, and the responsible party for each associated action. For G2 (laboratory): o Describe how laboratory results will be reported to the health department and timeframes for reporting. Page 1 of 2 TX-DSHS-19-1309-A-001700 03/01/2019 o o o o o Describe how coordination with and technical support will be provided to clinical and other public health laboratories. Describe how the AR lab expert will assure epi-lab coordination, either directly or through assignment of this task. Describe steps taken to work with the health department to develop coordinated work plans. Describe the flow of information to report laboratory results (including alert values), including timeframes, roles and responsibilities of each party, and the responsible party for each associated action. [For G2 Tier 3 Applicants Only] For regional labs, describe the role of the regional epidemiologist, including how that individual will work with state and local labs and epis in the region to facilitate testing (including screening), results reporting, and public health response as appropriate. Page 2 of 2 TX-DSHS-19-1309-A-001701 03/01/2019 G1 Supplemental Guidance: Epi Performance Measure Details At-A-Glance There are 12 performance measures in support the G1 component of the HAI/AR Program: nine align with Tier 1 activities and are required of all Recipients, and three align with Tier 2 activities and are only required if a Recipient receives additional funds to implement the related activity. Measures are Tier 1 unless otherwise noted. Below is a summary of the measures. Detailed guidance is found on subsequent pages. These are draft measures, which will be refined further based on input from health departments and will be finalized prior to August 1, 2019. ELC Core Areas Area A. Surveillance, Detection, and Response Associated Measures PM1. Number of clinical laboratories engaged to improve testing PM2. Proportion of index patients or clusters with targeted novel or highconcern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Area B. Prevention and Intervention Strategies PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Area C. Communications, Coordination, and Partnerships Optional Prevention and Intervention Strategies (Area B, Tier 2) PM5A. Of the facilities engaged by the Recipient or a designee to facilitate implementation of antibiotic stewardship core elements (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type PM6. Status of state’s HAI plan PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction PM8. Number of facilities implementing TAP Strategy, by facility type (Tier 2) PM9. Implementation of HAI prevention Collaboratives (Tier 2) PM10. Implementation of targeted project to improve antibiotic use (Tier 2) 1 TX-DSHS-19-1309-A-001702 03/01/2019 A. Surveillance, Detection and Response HAI/AR performance measures for ELC Core Area A - Surveillance, Detection and Response - are intended to assess progress made towards 1) the rapid identification and containment of novel or high-concern resistance or 2) timely and effective response to HAI/AR outbreaks. The measures in this section are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM1. Number of clinical laboratories engaged to improve testing Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Enhance other aspects of epi-lab coordination Rationale Data Elements Clinical laboratories are the frontlines for detecting novel or high-concern resistance. It is critical that clinical laboratories use appropriate testing methods (e.g., use the correct breakpoints) to improve detection of targeted organisms, case reporting, and response, and that they submit relevant isolates to AR Lab Network laboratories for testing. The HAI/AR program plays an important role in supporting AR Lab Network laboratories by helping to connect them with clinical laboratories who may need additional support on testing methodologies or isolate submission. 1. Number of clinical laboratories the Recipient engaged to improve testing Clinical laboratories include any laboratories in the jurisdiction that are not AR Lab Network /public health laboratories. Additional Guidance Performance Target Recipient engagement of clinical laboratories includes the provision of technical support and/or consultation that facilitates the connection of the clinical laboratories to public health laboratories for additional support. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 2 TX-DSHS-19-1309-A-001703 03/01/2019 Performance Measure Number & Name PM2. Proportion of index patients or clusters with targeted novel or high-concern antibiotic-resistant organisms or mechanisms for which the Recipient or a designee implemented the containment strategy Associated Outcome(s) Novel or high-concern resistance rapidly identified and contained Associated Strategy(ies) Support containment of novel or high-concern antibiotic-resistant organisms Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale Rapid and intensive response is critical to the successful containment of targeted novel or high-concern antibiotic resistant organisms in healthcare settings. Understanding how Recipients implement the containment strategy to address resistant organisms helps to track the Recipient’s role in these efforts and provides CDC information on how to best provide guidance in implementing the containment strategy. In order for CDC to calculate proportions by key features (e.g., organism, facility type, mechanism), please provide a list of Containment Strategy responses to novel or high concern MDROs (e.g., Tier 1, Tier 2, or Tier 3 organisms or mechanisms). Include responses contained to a single index patient and those involving suspected or confirmed transmission of targeted MDROs. For each Containment Strategy response, please include: a. b. c. d. Data Elements e. f. g. Organism(s) Mechanism(s) Pan-resistant By Facility type(s), indicate the following for each facility type involved in the investigation a. Did your health department (or designee) perform colonization screenings? b. Did your health department (or designee) provide onsite assistance? c. How many onsite infection control assessments did your health department (or designee) conduct? Was this event contained to a single index patient or was there suspected or confirmed transmission of targeted MDROs? Which public health program(s) provided assistance during this response? (Staff from your HAI/AR program, other state public health program, other local public program, and/or CDC) Laboratory linking identifier (e.g., index patient state isolate ID) The following will be calculated by CDC program using AR Laboratory Network data for each response: 3 TX-DSHS-19-1309-A-001704 03/01/2019 a. b. Additional Guidance Performance Target What was the interval between index patient specimen collection date and alert date (in days)? Did colonization screenings result in at least one positive result for the targeted organism(s) or mechanism(s)? Refer to CDC’s Interim Guidance for a Health Response to Contain Novel or Targeted MDROs (https://www.cdc.gov/hai/containment/guidelines.html) for guidance on how to assign organisms and resistance mechanisms to response tiers based on jurisdiction’s epidemiology. Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 4 TX-DSHS-19-1309-A-001705 03/01/2019 Performance Measure Number & Name PM3. Number of responses in the jurisdiction conducted by the Recipient or a designee, by pathogen or issue and facility type (exclusive of responses reported in Measure PM2) Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Support rapid response Conduct response-driven onsite infection control assessments and evaluations and provide recommendations for containment and other responses Rationale The Recipient plays a critical role in responding to possible outbreaks or other HAI/AR issues. Understanding the types of responses implemented, by pathogen or issue identified and facility type, allows CDC and the Recipient to track issues and settings requiring the greatest public health support. In order for CDC to calculate counts by key features (e.g., organism, facility type, issue), please provide a list of each HAI/AR outbreak or investigation within your jurisdiction.1 For each response not reported in measure PM2, please include: a. b. c. d. e. f. Data Elements g. h. Event type(s), E.g., Was this a response to a single index patient, cluster/outbreak of infections, drug diversion, product contamination, and/or infection control breach Primary organism(s) Primary facility or unit type(s) Primary infection type(s) Did your health department (or designee) provide onsite assistance? How many onsite infection control assessments did your health department (or designee) conduct? Which public health programs provided assistance during this response? (e.g., HAI/AR program, other state public health program, other local public program, and/or CDC) Was a patient notification initiated? 1 Health departments with a high volume of responses to certain events (e.g., influenza-like illness or GI illness in long-term care facilities) can work with the CDC program on modified reporting for these types of responses. For reporting purposes, a response refers to efforts to control newly identified HAIs and AR risks not described in performance measure PM2 and includes but is not limited to investigation of possible outbreaks or serious infection control breaches. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. 5 TX-DSHS-19-1309-A-001706 03/01/2019 Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 6 TX-DSHS-19-1309-A-001707 03/01/2019 B. Prevention and Intervention Strategies HAI/AR performance measures for the ELC Core Area B: Prevention and Intervention Strategies are intended to track progress towards 1) reductions in healthcare associated infections in all healthcare settings, 2) improved infection control capacity and practices in all healthcare settings, or 3) improved antibiotic use, including implementation of antibiotic stewardship core elements in healthcare settings. The measures are useful for understanding the quality of program implementation, and can help both CDC and Recipients to identify both opportunities to strengthen program delivery and to highlight successes. Performance Measure Number & Name PM4. Number of proactive onsite infection control assessments conducted by the Recipient or designee in long length-of-stay, high-acuity facilities (e.g., vSNF, LTACHs) or others (e.g., dialysis facilities, outpatient facilities) in the jurisdiction, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Onsite infection control assessments are a key prevention strategy when conducted proactively to mitigate issues in long length-of-stay high-acuity or other high-risk settings. Understanding the extent to which Recipients have conducted proactive infection control assessments in different settings, and why, gives a sense of which facilities are a priority in the jurisdiction. Beyond the onsite infection control assessment, Recipients should also follow up after the assessment to support facilities in implementing recommendations. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities]): Data Elements 1. Number of proactive onsite infection control assessments conducted by the Recipient or designee 2. Number of unique facilities for which assessments were conducted 3. Data, rationale, or identified need that led to assessments Additional Guidance Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Proactive infection control assessments are those that focus on facilities at high risk for AR threats or HAI outbreaks, with the goal of improving infection control practices to reduce transmission of selected MDROs or reduce HAIs. This type of infection control assessment is distinct from response-driven infection control assessments 7 TX-DSHS-19-1309-A-001708 03/01/2019 that are focused on facilities where targeted AR threats or outbreaks have been identified. Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 8 TX-DSHS-19-1309-A-001709 03/01/2019 Performance Measure Number & Name PM4A. Of the facilities where proactive onsite infection control assessments were conducted (see Measure PM4): Average number and range of visits made per facility to mitigate identified infection control gaps, and description of gaps and steps taken to address them, by facility type Associated Outcome(s) Improved infection control capacity and practices in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale Understanding the effort required to address infection control gaps in various settings and the steps taken to do so provides information on burden as well as common areas that need to be addressed and potentially effective means to do so. For each facility type (long length-of-stay, high-acuity facilities [e.g., vSNF, LTACHs] or others [e.g., dialysis facilities, outpatient facilities] for which proactive infection control assessments were conducted from Measure PM4: Data Elements 1. Average number and range of visits made per facility to mitigate identified gaps in infection control 2. Describe the most common infection control gaps identified, by infection control gap domain, and the steps taken by the Recipient to successfully mitigate those gaps Additional Guidance Performance Target Provision of onsite assistance to assess infection control issues may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided. Infection control domains should be those defined in the ELC Infection Control Assessment and Response (ICAR) program. An assessment tool using these domains can be found at https://www.cdc.gov/hai/prevent/infection-control-assessmenttools.html. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 9 TX-DSHS-19-1309-A-001710 03/01/2019 Performance Measure Number & Name PM5. Number of facilities the Recipient or a designee engaged to facilitate implementation of antibiotic stewardship core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship efforts are implemented at the jurisdiction-level. Rationale This information will be used to help CDC understand:  which settings are priorities in each jurisdiction,  which settings are priorities across the nation, and  the types of contributions Recipients are making to antibiotic stewardship. 1. Number of facilities that the Recipient or a designee directly engaged to facilitate core element implementation, by facility type (i.e., acute care hospitals, longterm care facilities, specific categories of outpatient facilities) 2. Description of the Recipient or designee’s activities to facilitate core element implementation, by facility type Data Elements 3. Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), academic centers, EIP, local health departments, or regulatory/licensing entities) engaged, by facility type, and a brief summary of their role. 4. Provide Supporting data that demonstrates why those facilities were targeted (e.g., antibiotic prescribing data by county or provider, NHSN data on the proportion of hospitals within the jurisdiction that have stewardship programs meeting all of the CDC’s Core Elements for antibiotic stewardship). Engagement with facilities may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, consultant, or other entity (designee) for which the Recipient can assure the quality of services provided; the Recipient must play a substantial role in the effort. Additional Guidance Examples of Recipient activities may include analysis of data and provision to partners (e.g., quality improvement programs, hospital associations); supporting tracking, reporting, or facility feedback; conducting gap analyses; providing educational sessions; providing tele-stewardship or mentoring; or other types of technical support. Include the following types of facilities:  Acute care hospitals 10 TX-DSHS-19-1309-A-001711 03/01/2019   Performance Target Long-term care facilities Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 11 TX-DSHS-19-1309-A-001712 03/01/2019 Performance Measure Number & Name PM5A. Of the facilities engaged by the Recipient or designee to facilitate implementation of antibiotic stewardship core elements, (see Measure PM5): Proportion of facilities with stewardship programs meeting all CDC core elements, by facility type Associated Outcome(s) Antibiotic stewardship core elements implemented in healthcare settings Associated Strategy(ies) Implement antibiotic stewardship efforts This measure will help us understand the extent to which antibiotic stewardship core elements are being implemented in healthcare settings targeted by the Recipient. CDC will use this information to track progress over time toward the eventual goal of all facilities implementing effective stewardship programs. Data will be used by CDC and Recipients to identify opportunities for further engagement of facilities or facility types to improve antibiotic stewardship programs and track successful implementation of the core elements. Rationale For each facility type addressed in measure PM5, by facility type: 1. Proportion of facilities engaged by the Recipient or a designee with stewardship programs meeting all CDC core elements Numerator: Number of facilities meeting all CDC core elements Denominator: Number of facilities engaged by the Recipient or a designee to facilitate core element implementation (from Measure PM5) Data Elements Additional Guidance Performance Target Include the following types of facilities: 1. Acute care hospitals 2. Long-term care facilities 3. Outpatient facilities (i.e., primary care clinics, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics) N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001713 03/01/2019 Communications, Coordination and Partnerships HAI/AR performance measures for ELC Core Area C: Communications, Coordination, and Partnerships are intended to track progress towards 1) improved information sharing and data-driven prevention or 2) enhanced coordination of prevention efforts in all healthcare settings. Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) PM6. Status of state’s HAI plan Improved information sharing and data-driven prevention Convene HAI Advisory Committee Rationale Annual updates to the state’s HAI plan are important to ensure that the plan remains relevant to newly identified or prioritized issues for the state, based on ongoing analysis of data, response efforts, and prevention needs. Data Elements 1. Status of updates to the state’s HAI plan (Updates complete/ Updates underway/ Updates not yet begun) a. Briefly describe updates made and any challenges encountered in updating the state’s HAI plan. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001714 03/01/2019 Performance Measure Number & Name PM7. Confirmation of update to inventory of healthcare settings in the jurisdiction Associated Outcome(s) Improved information sharing and data-driven prevention Associated Strategy(ies) Engage public health and healthcare providers Rationale Building upon work previously funded through the Ebola supplement, the Recipient is expected to maintain and update as needed an inventory of all healthcare settings in the jurisdiction. This inventory should be used to guide outreach for containment, response, and prevention activities. It is also important for CDC to have access to this updated inventory, to provide context for the Recipient’s activities and measures, providing a denominator for engagement of select facilities for various activities. Data Elements 1. Confirmation that the Recipient updated the facility inventory in the most recent budget period (Yes – update completed/Yes – update in progress/No) 1. If “No,” please explain why the facility inventory update has not been completed. Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001715 03/01/2019 Optional Prevention and Intervention Strategies (Area B, Tier 2) Three measures align with Tier 2 activities and are only required of Recipients who receive additional funds to perform the related activity. Performance Measure Number & Name PM8. Number of facilities implementing TAP Strategy*, by facility type (Tier 2) Associated Outcome(s) Reduction in healthcare associated infections in all healthcare settings Associated Strategy(ies) Implement data-driven prevention strategies Rationale This measure will tell us about the extent and nature of the TAP Strategy implementation, and resulting changes to infection control practices and infection rates. When reporting, please specify if the TAP Strategy was implemented for CDI, CLABSI, CAUTI, and/or MRSA. Report separately for each selected HAI and by targeted facility type. 1. Number of facilities identified as high need based on TAP reports. a. Describe criteria used to identify facilities in need of targeting (e.g., CAD greater than 10, top XX% of CADs) Data Elements 2. Number of facilities for which TAP Facility Assessments were conducted a. Number of these facilities identified as high need in data element #1 b. Number of facilities for which the Recipient provided a completed Feedback Report summarizing results from the Assessment c. Number of facilities for which evidence-based infection prevention methods were implemented to address gaps identified in the Facility Assessment d. Number of facilities that demonstrated a reduction in infection rates following the intervention(s). i. Reduction in infection rates following the intervention(s). e. Describe the most common infection control gaps identified, and the steps taken to successfully mitigate those gaps 3. Identify the partner(s) (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in these efforts and a brief summary of their role and responsibilities 15 TX-DSHS-19-1309-A-001716 03/01/2019 Full implementation of the TAP Strategy includes running TAP reports to target facilities, assessing gaps in infection control using the TAP Facility Assessments, implementing prevention measures, and tracking improvements. Additional Guidance Provision of onsite assistance may be done directly by the Recipient or through the support of a local health department, academic partner, contractor, or other entity for which the Recipient can assure the quality of services provided. * For settings where the formal TAP Strategy is unavailable (e.g., dialysis) - the same steps should be taken and reported on, even if conducted using different assessment or reporting forms. Performance Target N/A TAP reports and SIR data are available via NHSN. Recommended Data Source Reporting Frequency and Timeline Data demonstrating completion of various elements of the TAP strategy should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Twice per year 16 TX-DSHS-19-1309-A-001717 03/01/2019 Performance Measure Number & Name Associated Outcome(s) Associated Strategy(ies) Rationale PM9. Implementation of HAI prevention Collaboratives (Tier 2) Reduction in healthcare-associated infections in all healthcare settings Enhanced coordination of prevention efforts in all healthcare settings Implement data-driven prevention strategies This measure will help CDC understand the movement of the HAI prevention Collaborative(s) in the jurisdiction toward achieving their stated goal(s). For each HAI prevention Collaborative being supported by the Recipient, please provide the following: a. For each HAI reduction goal of the Collaborative: Provide data on each shared measurement as of reporting timeframe (provide most current data even if Collaborative is still underway). Data Elements b. Number of facilities, by facility type, enrolled in the Collaborative. c. Identify each partner (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in implementing the Collaborative and a brief summary of their role and responsibilities. Additional Guidance Performance Target The focus of the Collaborative and the reduction goal(s) should be HAI-specific, such as an intended reduction in rates of C. difficile. This measure is not intended to capture Collaboratives focused on activities such as antibiotic stewardship unless those activities are implemented as part of a broader Collaborative explicitly aimed at reductions in HAI rates. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 17 TX-DSHS-19-1309-A-001718 03/01/2019 Performance Measure Number & Name PM10. Implementation of targeted project to improve antibiotic use (Tier 2) Associated Outcome(s) Antibiotic use improved Associated Strategy(ies) Implement antibiotic stewardship efforts For projects intended to improve antibiotic use, this measure will help us understand how the targeted antibiotic use project is being implemented and the extent to which those projects have achieved the desired outcomes. Rationale CDC will use this information to identify successful approaches to improving antibiotic use in different settings as well as opportunities to support Recipients with their efforts as needed. For each targeted project, please: 1. Describe the outcomes of the project as they relate to the specific, measurable objectives, as of the reporting timeframe. Where possible, supplement the description with quantitative data. Data Elements 2. Describe the Recipient’s specific roles and responsibilities in implementing the project. 3. Additional Guidance Performance Target Indicate the partners (e.g., health systems, hospital associations, quality improvement programs (e.g., QIN/QIOs, HIINs), Epicenters, EIP, local health departments, or regulatory/licensing entities) engaged in the project and a brief summary of their role(s). If you are analyzing state-specific or local antibiotic prescribing data (e.g., Medicaid data, all payers all claims data or other claims data, proprietary data, electronic health record data from local healthcare systems, other) to inform targeted stewardship interventions, please specify how you have used the data to inform targeted stewardship interventions. N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored any format that is available to the Recipient. CDC HAI/AR program staff will provide a reporting template. Reporting Frequency and Timeline Twice per year 18 TX-DSHS-19-1309-A-001719 03/01/2019 G1 Supplemental Guidance: Containment of novel or high-concern multidrug-resistant organisms (MDROs) Tier 1 Area A, Sub-Activity I.a.i: Using guidance and elements provided by CDC, collaborate with the public health laboratories to develop and regularly update written plans that Associated ensure timely detection and response to targeted resistant threats. The plan should Strategy include the list of antibiotic-resistant organisms or mechanisms by response tiers, based on epidemiology of the jurisdiction. Tier How to use this document Please describe how you will address the elements below in the appropriate Work Plan section of your ELC Application Template. As part of year 1 of the 2019 ELC cycle, Recipients will be required to develop a written plan for the detection and response to targeted resistant threats (organisms or mechanisms) within their jurisdiction (see Area A, Sub-Activity I.a.i). Developing the plan should give Recipients the opportunity to review and solidify their strategy. Plans should take into account the local epidemiology of targeted organisms and the resources available for timely detection and response. The plan will also allow CDC to better understand and address gaps that might exist and to better support jurisdictions in these efforts. The following elements should be included in the plan: 1. Description of the standard operating procedure for responding to alerts from the AR Laboratory Network about targeted multidrug-resistant organisms (MDROs), including: a. how facilities will be contacted b. how basic epidemiology will be collected to inform the response c. how decisions about the need for colonization testing of contacts will be made d. how colonization testing will be collected (if indicated) e. how results will be communicated to healthcare facilities and providers 2. Criteria/thresholds for on-site infection control assessments, including description of triggers for ongoing follow-up visits 3. Description of roles (e.g., AR expert, AR lab expert, “lab-epi” liaisons) and responsibilities among public health partners for response activities a. State health department Recipients should specify how they will work local health departments b. State health department Recipients with labs that are part of AR Lab Network should specify how they will work with regional labs c. Local health department Recipients should specify how they will work with state health departments 4. Description of plans for data collection and management TX-DSHS-19-1309-A-001720 03/01/2019 5. A list of organisms that will be targeted for detection and response and their associated categories (i.e., organism Tiers 1–3 as specified in CDC guidance, https://www.cdc.gov/hai/containment/guidelines.html) TX-DSHS-19-1309-A-001721 03/01/2019 G1 Supplemental Guidance: Patient Safety Information Exchange (previously termed MDRO patient registry) Tier 2 (Optional) Area A, Activity V.d: Implement, continue, or enhance an MDRO patient registry to facilitate inter-facility communication, target interventions, and improve surveillance. The registry should tie to public health actions, enable tracking of the regional spread of MDROs, and fit into the overall surveillance and response strategy. MDRO registries Associated will only be considered for funding if the work plan addresses these requirements and Strategy articulates how the registry is related to other surveillance, laboratory, and response activities, including state HAI and AR surveillance, NHSN, and the AR Lab Network. Guidance for MDRO registries is forthcoming from CDC; CDC will share this guidance with applicants when it is available. Tier How to use this document Please address each of the elements described below in the appropriate Work Plan section of your ELC Application Template. This is only required for health departments applying for this Tier 2 activity. Health departments requesting funding for a Patient Safety Information Exchange (previously termed multidrug-resistant organism or MDRO patient registry) should include the following on their request: 1. 2. 3. 4. A brief description of the current stage of registry development and/or implementation Whether the system is designed to use manual and/or automated data entry Whether the system is designed to provide manual and/or automated alerts to facilities Any current or planned interoperability with other systems in the jurisdiction or in neighboring jurisdictions 5. The basic data elements collected 6. The organisms targeted by the system 7. Intended uses (e.g., facilitate inter-facility communication, track regional spread of targeted organisms), including how the system fits into the overall surveillance and response strategy TX-DSHS-19-1309-A-001722 03/01/2019 G2 Supplemental Guidance: Lab Performance Measures Antibiotic Resistance Laboratory Network (AR Lab Network) At-A-Glance There are 15 performance measures in support of G2 activities for the AR Lab Network. These performance measures are intended to track progress towards core Surveillance, Detection and Response capacities, namely: 1) the rapid identification and containment of novel or high concern resistance or 2) timely and effective response to HAI/AR outbreaks. In the columns for Tiers, checkmarks are assigned to each measure for which recipients in that the Tier are expected to report data. Measures marked as optional are only required of those recipients who were funded for the related activity. Below is a summary of the measures. Detailed guidance is found on subsequent pages. Measure PM1. Characterization of the clinical laboratory network in jurisdiction Tier 1  Tier 2  Tier 3  PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory    PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction    PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory    PM5. Proportion of isolates tested, and number of isolates tested by genera    PM6. Number of isolates transported upon request to CDC    PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program      PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance PM10. Proportion of isolates tested for expanded drug susceptibility with results returned to submitter, in accordance with timeline per CDC guidance PM11. For laboratories performing C. difficile testing: Proportion of specimens cultured and proportion of isolates sequenced    1 TX-DSHS-19-1309-A-001723 03/01/2019 PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of non-viable and contaminated specimens received from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission.  PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe    Specific guidance for each measure, including specific data to be reported, is provided on the following pages. 2 TX-DSHS-19-1309-A-001724 03/01/2019 Performance Measure Number & Name PM1. Characterization of the clinical laboratory network in jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Associated Strategy(ies) Rationale Improve laboratory and epidemiology coordination and outreach This measure will provide information to CDC and the Recipient on the breadth of the jurisdiction’s clinical laboratory network and the resulting ability to obtain appropriate isolates for testing. 1. Proportion of clinical laboratories in the jurisdiction agreeing to submit isolates for testing Numerator: Number of clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of clinical laboratories serving facilities in the jurisdiction Data Elements 2. Proportion of clinical laboratories submitting isolates, in total and by type of isolate Numerator: Total number of clinical laboratories submitting isolates for testing By type of isolate: a. Number of clinical laboratories submitting CRE isolates for testing b. Number of clinical laboratories submitting CRPA isolates for testing c. Number of clinical laboratories submitting Candida spp. isolates for testing d. Number of clinical laboratories submitting CRAB isolates for targeted surveillance (see guidance, Tier 1, Strategy III,d) for testing e. Number of clinical laboratories submitting ESBL isolates for targeted surveillance (see guidance, Tier 1, Strategy III.d) for testing Denominator: Number of clinical laboratories that have agreed to submit isolates for testing Facility types served by participating clinical laboratories: 3 TX-DSHS-19-1309-A-001725 03/01/2019 3. Proportion of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates, by facility type a. For short-stay acute care hospitals and long-term acute care hospitals, by facility type: Numerator: Number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Total number of that type of facility in the jurisdiction, if available b. For outpatient facilities and post-acute care facilities other than longterm acute care: Numerator: Estimated number of facilities in the jurisdiction served by clinical laboratories that have agreed to submit isolates for testing Denominator: Estimated total number of that type of facilities in the jurisdiction, if available (**number ranges will be provided for both the numerator and denominator and need to be determined) Regional laboratories should report in their state laboratory capacity. Performance Target For Data Element #3b of this measure, please include the following types of facilities:  Short-stay acute care hospitals include critical access hospitals.  Post-acute care facilities include skilled nursing facilities, inpatient rehabilitation facilities; do not include long-term acute care hospitals in this category  Outpatient facilities include primary care clinics, ambulatory surgical centers, outpatient specialty and subspecialty clinics, emergency departments, retail health clinics, urgent care clinics, dental clinics N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Once per year (end of year) Additional Guidance 4 TX-DSHS-19-1309-A-001726 03/01/2019 Performance Measure Number & Name PM2. Median and range (in days) from receipt of CRE/CRPA and Candida (if applicable) isolates to communication of final mechanism testing and antibiotic susceptibility testing (AST) results to submitting laboratory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillance Timely communication and reporting of laboratory results to the submitting laboratory is critical to ensuring timely and effective response or containment efforts. 1. Median and range (in days) from date of specimen receipt at public health laboratory to date of communication of final mechanism and AST testing results to submitting laboratory. 2. Describe any challenges you’ve faced with reporting results back to the submitting laboratories within 2 days of testing. Submitting laboratories could be a clinical laboratory or public health laboratory. Additional Guidance For Candida isolates, only AST is applicable; mechanism testing is not applicable for Candida isolates. Performance Target Goal is for results to be communicated to submitting laboratory within 2 days of testing. Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 5 TX-DSHS-19-1309-A-001727 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM3. For results identified as a defined “alert” by CDC (e.g., novel or highconcern resistance): Median and range (in days) to communicate test results with alert values to CDC and the HAI/AR program of originating jurisdiction Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and reporting Expand and sustain AR lab testing and reporting for surveillanceExpand and sustain AR lab testing for response Timely communication and reporting of laboratory results with alert values to the appropriate entities (e.g., health department, CDC) is 1) critical to ensuring timely and effective response or containment efforts, 2) an indicator of the quality of coordination between laboratory and epidemiology partners, and 3) a key component of laboratory testing for ongoing surveillance and reporting purposes. 1. Median and range (in days), from date of specimen receipt at public health laboratory to date of communication of final test results with alert values to: a. CDC b. HAI/AR program of the originating jurisdiction 2. Describe any challenges you’ve faced with reporting test results with alert values to CDC or the originating jurisdiction’s HAI/AR program within 1 day of testing. Additional Guidance N/A Performance Target Goal is for results to be communicated to relevant entities within 1 day of availability of results Recommended Data Source LIMS and emails/REDCap Reporting Frequency and Timeline Once per year (end of year) 6 TX-DSHS-19-1309-A-001728 03/01/2019 Performance Measure Number & Name PM4. Number of laboratory personnel trained to proficiency in performing all tests in their AR Lab Network test directory Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Sustain AR capacity to implement AR Lab Network Activities Sustain workforce capacity to implement AR Lab Network regional lab activities Increasing or maintaining the number of laboratory personnel who are proficient in performing all tests in a laboratory’s test directory is a critical component of sustaining laboratory capacity and ensuring timely detection of resistance. 1. Number of laboratory personnel trained to proficiency in performing all phenotypic testing available in your AR Lab Network test directory. Please include both: a. Total number proficient in performing AST available in your AR Lab Network test directory b. Total number proficient in performing carbapenemase production testing available in your AR Lab Network test directory 2. Number of laboratory personnel trained to proficiency in performing mechanism (PCR-based) testing available in your AR Lab Network test directory. Additional Guidance The measure focuses on proficiency in, and training in, testing available in your jurisdiction’s AR Lab Network test directory, not all testing possible in CDC’s AR Lab Network test directory. Each data element should focus solely on testing available in your AR Lab Network test directory. Performance Target N/A Recommended Data Source Administrative data Reporting Frequency and Timeline Once per year (end of year) 7 TX-DSHS-19-1309-A-001729 03/01/2019 Performance Measure Number & Name PM5. Proportion of isolates tested, and number of isolates tested by genera Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Increased state, local, and regional public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Enhance and sustain laboratory testing for surveillance and reporting Associated Strategy(ies) Expand and sustain AR Lab testing and reporting Expand and sustain AR lab testing and reporting for surveillance Rationale Isolate testing is a key activity to ensure robust surveillance and response efforts, so it is important to understand the level of isolate testing in funded laboratories. 1. Proportion of isolates tested: Numerator: Total number of isolates tested Denominator: Total number of isolates received Data Elements 2. Number of isolates tested by genera (for regional laboratories, please also include the state of origin): a. Tier 1: include CRE (at least E. coli, Enterbacter, and Klebsiella) and CRPA isolates, as recommended and updated annually by CDC b. Tier 2: include Candida spp. (if applicable) and expanded breadth of CRE testing to include at least Citrobacter, Providencia, Proteus, and Serratia, in addition to target genera described under Tier 1 c. Tier 3: include carbapenem-resistant Acinetobacter baumannii (CRAB), ESBL, and S. pneumoniae, in addition to target genera described under Tiers 1 and 2 3. For regional laboratories only: include number of isolates forwarded by state/local AR Lab Network laboratories to regional laboratory for testing Additional Guidance Mtb, C. difficile and GC are not included in this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 8 TX-DSHS-19-1309-A-001730 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM6. Number of isolates transported upon request to CDC Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Enhance and sustain laboratory testing for surveillance and response Expand and sustain AR lab testing and reporting for surveillance Isolate transport to Regional AR Lab Network laboratories and/or CDC is necessary for appropriate laboratory coordination which allows for expanded testing. 1. Number of isolates transported upon request to CDC 2. For each isolate transported to CDC, please indicate the isolate ID Additional Guidance N/A Performance Target N/A Recommended Data Source Administrative tracking Reporting Frequency and Timeline Once per year (end of year) 9 TX-DSHS-19-1309-A-001731 03/01/2019 Performance Measure Number & Name PM7. Frequency and content of laboratory testing report or summaries shared with the HAI/AR program Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved coordination and information sharing with epidemiology, laboratory and prevention partners to support outbreak response and prevention efforts Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Improve laboratory and epidemiology coordination and outreach Regular reporting of laboratory results to the HAI/AR program supports response and containment efforts, and promotes strong coordination between HAI/AR laboratory and epidemiology functions. The frequency and nature of this reporting is an indication of the extent of this coordination between laboratory and epidemiology entities in the jurisdiction. 1. Frequency of laboratory testing reports or summaries shared by the public health laboratory with the HAI/AR program (i.e., weekly, monthly, quarterly, semi-annually, annually, other) 2. Description of the content (i.e., types of data or information shared) and level of detail included (aggregate or line list) of the laboratory testing reports or summaries shared with the HAI/AR program Additional Guidance N/A Performance Target N/A Recommended Data Source Data should be compiled by the Recipient while conducting the activity. Data can be stored in Word, Excel, or any format that is available to the Recipient. Reporting Frequency and Timeline Twice per year 10 TX-DSHS-19-1309-A-001732 03/01/2019 Performance Measure Number & Name PM8. For laboratories performing whole genome sequencing (WGS) (optional for Tier 2): Proportion of healthcare associated organism isolates tested by WGS that passed quality control in accordance with CDC testing protocols Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing and reporting Expand and sustain AR lab testing for response Laboratories funded to perform whole genome sequencing must be able to demonstrate sequencing capacity, following guidance and training recommendations put forth by CDC. Tracking the proportion of isolates tested with WGS that pass quality control (QC) will help CDC understand laboratory capacities for WGS and how CDC can target support. 1. Proportion of isolates (CRE, CRPA, or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing of submission that passed QC in accordance with CDC protocol. Numerator: Number of isolates tested by WGS that passed QC Denominator: Total number of isolates tested by whole genome sequencing 2. Number and type of organisms (i.e., CRE, CRPA, C. difficile (if applicable), or other healthcare associated organisms coordinated by CDC) tested by whole genome sequencing 3. Additional Guidance Median and range (in days) from date of receipt at public health laboratory to final report of WGS results to the HAI/AR program Tier II: only laboratories funded specifically for WGS should report on this measure. Tier III: all regional laboratories should report on this measure. Performance Target N/A Recommended Data Source LIMS Reporting Frequency and Timeline Once per year (end of year) 11 TX-DSHS-19-1309-A-001733 03/01/2019 Performance Measure Number & Name PM9. Proportion of colonization swabs (for CPOs and C. auris) tested with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Associated Strategy(ies) Rationale Data Elements Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of colonization swabs tested with results returned to submitter in accordance with timeline specific in CDC guidance. a) For carbapenemase-producing organisms (CPOs) (within 2 days of swab receipt at the public health laboratory) Numerator: Number of swabs tested with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of swabs tested b) For C. auris (in accordance with current CDC guidelines) Numerator: Number of swabs tested with results reported back to submitter within recommended timeframe Denominator: Total number of swabs tested 2. Describe any challenges with reporting colonization testing results back to submitter within required timeframe Reported by regional lab (Tier 3) only. Additional Guidance The submitter may be a facility or the health department, depending upon the jurisdiction’s processes. Performance Target N/A Recommended Data Source LIMS/ETOR Reporting Frequency and Timeline Once per year (end of year) 12 TX-DSHS-19-1309-A-001734 03/01/2019 Performance Measure Number & Name PM10. Proportion of isolates tested for expanded drug susceptibility (ExAST) with results returned to submitter, in accordance with timeline per CDC guidance Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Expand and sustain AR lab testing for response Timely communication and reporting of laboratory results to the appropriate entities (e.g., health department, CDC) is critical to ensuring timely and effective response or containment efforts. 1. Proportion of isolates tested with results returned to submitter in accordance with timeline specific in CDC guidance. c) For highly resistant isolates requiring testing against new drugs (within 3 days of isolate receipt at the public health laboratory) Numerator: Number of isolates tested for ExAST with results reported back to submitter within 2 days of receipt of swab Denominator: Total number of isolates tested for ExAST 2. Describe any challenges with reporting ExAST testing results back to submitter within required timeframe Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 13 TX-DSHS-19-1309-A-001735 03/01/2019 Performance Measure Number & Name PM11. For laboratories conducting C. difficile testing: Proportion of specimens cultured and the proportion of isolates sequenced Associated Outcome(s) Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Rationale Data Elements Implement or maintain additional laboratory capacity Building culture capacity is necessary to assess emerging and changing epidemiology of C. difficile and advanced molecular detection is important in improving C. difficile typing and assessing transmission dynamics. 1. Proportion of available specimens cultured for C. difficile Numerator: Number of specimens cultured for C. difficile Denominator: Total number of specimens available for culture 2. Proportion of available C. difficile isolates sequenced Numerator: Number of C. difficile isolates sequenced Denominator: Total number of isolates available for sequencing Additional Guidance Reported by regional laboratories (Tier 3) only. Performance Target N/A Recommended Data Source LIMS/Project specific data Reporting Frequency and Timeline Once per year (end of year) 14 TX-DSHS-19-1309-A-001736 03/01/2019 Performance Measure Number & Name PM12. For laboratories conducting N. gonorrhoeae testing: The number and percent of GC samples received including non-viable and contaminated specimens from i) each submitting SURRG laboratory and ii) from all assigned sentinel sites Novel or high-concern resistance rapidly identified contained Associated Outcome(s) Associated Strategy(ies) Rationale Increased public health laboratory capacity to detect and confirm antibiotic resistance using CDC recommended methods Implement or maintain additional laboratory capacity (some regional AR labs) Tracking viability and contamination issues from submitters can be used to identify persistent submitter issues that need to be addressed 1) Number of isolates forwarded by state/local labs to AR Lab Network regional lab for testing. 2) Proportion of non-viable specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter Data Elements 3) Proportion of contaminated specimens submitted by each SURRG submitter (DEL, GCL, SLD, MAL, MCL, NYL, SFL, UWA): Numerator: Number of non-viable specimens submitted by specific SURRG submitter Denominator: Number of specimens submitted by specific SURRG submitter 4) Proportion of isolates transported upon request to CDC Numerator: Number of isolates transported to CDC Denominator: Total number of isolates requested Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 15 TX-DSHS-19-1309-A-001737 03/01/2019 Performance Measure Number & Name PM13. For laboratories conducting N. gonorrhoeae testing: Number and percent of AST results reported to submitters within 3 weeks of submission. Timely and effective response to HAI/AR outbreaks Associated Outcome(s) Associated Strategy(ies) Rationale Data Elements Improved test results and data reporting to partners including public health epidemiologists, laboratorians, healthcare partners, and CDC to inform surveillance efforts and outbreak response Implement or maintain additional laboratory capacity (some regional AR labs) Timely communication and reporting of laboratory results to the appropriate entities (e.g., clinical laboratory, health department, CDC) is 1) an indicator of the quality of coordination between laboratory and epidemiology partners and is a key component of lab testing for surveillance and reporting purposes and 2) critical to ensuring timely and effective response or containment efforts. 1) Proportion of AST results reported to sentinel sites within 3 weeks of submission: Numerator: Number of AST results reported to sentinel sites within 3 weeks of submission. Denominator: Number of GC isolates received at AR Lab Network 2) Proportion of AST results reported to SURRG submitters within 3 weeks of submission: Numerator: Number of SURRG results reported to SURRG submitters within 3 weeks of submission. Denominator: Number of SURRG specimens submitted to AR Lab Network 3) Describe any challenges you’ve faced with conducting AST and/or reporting results back to submitting laboratories within 3 weeks of submission. Additional Guidance Performance Target Include all specimens submitted in measure, including non-viable and contaminated specimens. Results for non-viable and contaminated specimens must be sent to submitters even if no culture or AST was performed. Goal is for results of “alert” samples to be communicated to relevant entities within 24 hours of having result. Goal is for results of non-alert samples to be communicated within 30 days of sample receipt at the public health laboratory Recommended Data Source Reporting Frequency and Timeline N/A Once per year (end of year) 16 TX-DSHS-19-1309-A-001738 03/01/2019 Performance Measure Number & Name Associated Outcome(s) PM14. For laboratories conducting N. gonorrhoeae testing: Whole genome sequencing (WGS) testing, number and percentage of isolates selected for sequencing and number of isolates sequenced successfully. Novel or high-concern resistance rapidly identified contained Timely and effective response to HAI/AR outbreaks Associated Strategy(ies) Implement or maintain additional laboratory capacity (some regional AR labs) Rationale Advanced molecular detection is important in improving typing and assessing transmission dynamics. 1. Monthly proportion of GC isolates selected for WGS Numerator: number of GC isolates selected for sequencing based on selection criteria described in protocol. Denominator: Total number of GC isolates received by GC AR Lab Network (per month). 2. Monthly proportion of GC isolates selected for WGS and had to be resequenced due to not meeting minimum GC WGS QC standards. Numerator: Number of isolates re-sequenced Denominator: Number of isolates selected for WGS Data Elements 3. Monthly proportion of viable isolates for which WGS was performed successfully within 1 month of antibiotic susceptibility testing. Numerator: Number of genomes successfully sequenced within one month of AST completion. Denominator: Total number of GC isolates with AST data selected for WGS for the month. 4. Monthly proportion of WGS sequences transmitted from AR network laboratory to CDC per month. Numerator: number of genome sequences transmitted to CDC. Denominator: number of genomes sequenced and passed QC standards. Additional Guidance N/A Performance Target 100-125 isolates sequenced per month. Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 17 TX-DSHS-19-1309-A-001739 03/01/2019 Performance Measure Number & Name PM15. For laboratories conducting molecular Mtb testing: Number of isolates successfully tested by 24-loci MIRU-VNTR or whole genome sequencing within the appropriate timeframe Enhanced molecular surveillance of antibiotic resistance of Mtb Associated Outcome(s) Enhanced capacity for detection of outbreaks and transmission of Mtb Associated Strategy(ies) Rationale Data Elements Expand and sustain molecular testing of Mtb isolates Establishing and sustaining laboratory capacity for molecular Mtb testing (24-loci MIRU-VNTR and whole genome sequencing [WGS]) is a core strategy for the surveillance of resistance determinants and transmission. 1. Number and percentage of isolates successfully tested by 24-loci MIRU-VNTR within two weeks of submission. 2. Number and percentage of isolates successfully tested by WGS within three weeks of submission. Additional Guidance N/A Performance Target N/A Recommended Data Source N/A Reporting Frequency and Timeline Once per year (end of year) 18 TX-DSHS-19-1309-A-001740 Supplemental Guidance: Targeting facilities and clinical laboratories for AR Lab Network testing of CRE and CRPA The Epidemiology and Laboratory Capacity (ELC) for Infectious Diseases Guidance for the 2019–2023 cycle includes two programs that encourage coordinating connections with clinical laboratories serving the state or jurisdiction to solicit isolates of carbapenem-resistant Enterobacteriaceae (CRE) and Pseudomonas aeruginosa (CRPA) from healthcare facilities (including acute and poste-acute care facilities) to test for novel and emerging antibiotic resistance (AR) — G1. Healthcare-associated Infections, Antibiotic Resistance, and Antibiotic Stewardship and G2. Antibiotic Resistance Laboratory Network (AR Lab Network). Early detection of targeted resistant organisms in a jurisdiction is critical for controlling their spread. Health Departments should strive to develop laboratory networks that are representative and that support regional control strategies. This document has 2 aims (1) to assist G1 and G2 recipients without an established network to identify high-risk settings and develop connections between healthcare facilities and clinical laboratories as the basis for a regional network; (2) to assist G1 and G2 recipients, who have already developed a regional network, to troubleshoot and expand connections to other high-risk healthcare facilities and clinical laboratories. CDC is available to provide additional consultation to assist health departments and public health laboratories. For more information, please contact HAIAR@cdc.gov. Goals of Network The goals of the network should include: 1. Identifying isolates with novel resistance phenotypes quickly (i.e., as close as possible to importation into a region). 2. Capturing isolates from a representative set of facilities. 3. Supporting the jurisdiction’s current strategy to slow the spread of targeted resistance. This might include: o Identifying initial instances of importation of targeted organisms in areas where these organisms are uncommon, OR o Informing control interventions in areas where these organisms are more common. Considerations • Health departments should aim for 100% enrollment of clinical laboratories serving facilities in the jurisdiction if capacity is available to test all CRE and CRPA. • If capacity is not available to test all CRE and CRPA, health departments should strategically target laboratories according to local epidemiology, priorities for detection and prevention, and the characteristics of the healthcare facilities and populations served. • Prioritize recruitment of laboratories that serve short stay acute care hospitals and high-acuity post-acute care facilities in healthcare regions not currently represented or underrepresented in the current clinical laboratory catchment TX-DSHS-19-1309-A-001741 Designing a Network – General principles and Strategies 1. Identify healthcare regions: Divide the jurisdiction into healthcare regions that best represent where patients receive care in order to provide a broad overview of the jurisdiction. Different approaches can be used to define these healthcare regions. One approach is to identify the major population centers with each region. Alternatively, jurisdictions can assign healthcare regions according to known healthcare referral/transfer networks; data on healthcare referral regions is available through the Dartmouth Atlas for Healthcare. 2. Identify healthcare facilities and affiliated clinical laboratories in each healthcare region: Within each healthcare region, prioritize acute care, long term acute care and skilled nursing facilities that frequently refer patients to these facilities; map each facility to the affiliated clinical laboratory. Determine which clinical laboratories within a healthcare region are not submitting isolates to the AR Laboratory Network. 3. Expand clinical laboratory catchment strategically*: • • Consider targeting healthcare facilities that will collaborate effectively with public health authorities to implement local infection control recommendations. For example, if a patient is identified as having a rare CRE, the facility will implement appropriate transmission-based precautions and perform surveillance screening if necessary. Recruit laboratories based on local epidemiology (e.g., stage of emerging mechanism emergence). Examples of recruitment approaches for different stages of emergence follow. Many jurisdictions have targeted MDROs in different stages of emergence, and may use a combination of the strategies below to prioritize laboratory recruitment. o To promptly detect resistance mechanisms that are novel to the region, target laboratories that serve high risk populations. This primarily includes laboratories that serve high-acuity post-acute care facilities LTACH and skilled nursing facilities with ventilator units) but could also include clinical laboratories that serve academic and tertiary care short-stay acute care hospitals. Consider prioritizing short-stay acute care hospitals where international patients or patients from outside the region receive care. o To prevent spread of targeted resistance mechanisms from areas of higher prevalence to areas of lower prevalence, prioritize enrolling laboratories serving ‘bridge facilities’. Bridge facilities are tightly connected to other healthcare facilities in the region and might serve as a conduit for spread to other healthcare facilities or regions. An example of a bridge facility might be an LTACH in a suburb of a major city; the LTACH may accept patients from hospitals within the city but the prevalence of multidrug-resistance may be lower than other healthcare facilities within the city. Patients in the LTACH may be referred to other nursing homes or short stay acute care hospitals in other parts of the region. o If some targeted organisms are considered endemic (multiple facilities are repeatedly identifying cases without clear epidemiologic links) in part of the region, recruit laboratories to facilitate detection and response to emerging threats in the TX-DSHS-19-1309-A-001742 endemic region and prevent spread to other regions. For example, a jurisdiction with endemic KPC-CRE in a metropolitan area may recruit laboratories in that city serving high risk facilities to detect emerging resistance mechanisms (e.g., NDM-CRE), while also recruiting laboratories serving bridge facilities to prevent spread outside the metro area. CDC Support Available CDC is available for additional consultation to help public health departments and laboratories develop their network and/or generate lists of target facilities. For more information or assistance, please contact us at HAIAR@cdc.gov. TX-DSHS-19-1309-A-001743 Interim Guidance for Whole Genome Sequencing of HAI/AR Pathogens Supplemental guidance includes: 1. Priorities: Selection of isolates for sequencing 2. Platforms: Illumina MiSeq (paired-end) for all sequencing; other Illumina platforms that can produce paired-end reads are acceptable 3. Protocols: Please refer to protocols used for PulseNet. Job aids and best practices for additional technical assistance (i.e., Gram positives, Pseudomonas, etc.) will be available 4. Sequence Data Quality Metrics and Processing: QuAISAR-H pipeline provide an easy, all-in-one tool for initial processing and analyses of raw sequence data 5. Data Sharing Methods: Multiple avenues to accommodate different systems and capacities 6. Posting to NCBI: DHQP-hosted umbrella “CDC HAI-Seq”; include SRA number in LIMS as link to WGS data 7. Metadata Guidelines: Non-identifiable isolate information will accompany sequence data TX-DSHS-19-1309-A-001744 Priorities for Sequencing at State/Local/Regional Labs   Untenable to sequence every HAI or MDRO pathogen Priorities for sequencing are as follows: 1. Sequencing that supports outbreak investigations (CRE, CRPA CRAB) 2. All CRAB isolates 3. CRE and CRPA that may carry novel carbapenemase genes • Carbapenemase-producing (e.g., mCIM- or CarbaNP-positive) but PCR negative for KPC, NDM, OXA-48-like, VIM, and IMP • Note: Exclude isolates with resistance profiles that explain carbapenemase production – Enterobacter that are cefotaxime, ceftriaxone, and ceftazidime resistant but cefepime susceptible (indicates high levels of AmpC beta-lactamase) – Serratia that are resistant to carbapenems and susceptible to 3rd generation cephalosporins (indicates presence of SME gene) 4. Non-KPC isolates • Resistance to any beta-lactam above meropenem (e.g., aztreonam-avibactam; ceftazadime-avibactam; meropenem-vabrobactam) unless AST and RT-PCR suggest KPC TX-DSHS-19-1309-A-001745 Platforms  State and local public health labs should use the Illumina MiSeq (pairedend) for all sequencing.  Other Illumina platforms that can produce paired-end reads are acceptable. TX-DSHS-19-1309-A-001746 Protocols   Please refer to protocols used for PulseNet (with adjustments recommended – see below) (https://www.cdc.gov/pulsenet/pdf/PNL32-MiSeq-Nextera-XT.pdf) – DHQP will investigate the impact of any changes to current PulsetNet protocols on the sequencing of HAI pathogens Recommended adjustments to current PulseNet protocols – HAI pathogen WGS runs may be of higher diversity than those typically seen for PulseNet activities • Consider a slightly higher phiX spike-in for runs of higher diversity (~2-5% is generally appropriate) – To plan sequencing runs with maximum efficiency and data quality, please use our pooling job-aid calculator tool (forthcoming) – If sites need further technical assistance, (for example, for gram positives) – DHQP is working to provide job aids/best practices • Pseudomonas aeruginosa are difficult to sequence and should be sequestered to their own Pseudomonas-only runs as much as possible. Alternatively, a small number (<5) of Pseudomonas can be included in non-Pseudomonad sequencing runs. • DHQP working on a QMS version of a calculator tool for planning sequencing runs of diverse organisms and other job aids TX-DSHS-19-1309-A-001747 Sequence Quality Metrics and Processing: QuAISAR-H Pipeline  Pipeline for Quality control, Assembly, species Identification, Sequence typing, Annotation, and Resistance mechanisms for Healthcare-associated pathogens  Automates routine evaluation and provides an easy, all-in-one tool for initial processing and analyses of raw sequence data  Available for sites that want to run it locally – Command line available on GitHub soon (link forthcoming) • Complex, not originally intended for broad distribution • Requires many pointers and dependencies be set up locally • DHQP cannot support all states as they set this up – GUI-like application on CDC AMD Portal currently in beta-testing • Available to external partners via SAMS Level 1 credentialing TX-DSHS-19-1309-A-001748 QuAISAR-H Pipeline       QuAISAR-H iX, Quality control steps trim reads, remove PhiX, check for contaminants using two bioinformatics tools, Kraken and Gotcha Genomes are assembled by SPAdes Classified using publically available MLST schemes Annotated using Prokka Species verified with Average Nucleotide Identity Antimicrobial resistance genes are identifiedd using c-SSTAR to apply non-redundant ResFinder and ARG-ANNOT databases ( C Trimmomatic Assesment Kraken ( SRST2 ) Gottcha ) SPAdes plasmidSPAdes ( Kraken ) Trim contigs Trim contigs ( C-SSTAR ) )-----1 ( plasmid Finder, ___ 16s1D) ___. ~ QUality control Assembly Identification plasmid Finder ( BUSCO) Resistance mechanisms Healthcare TX-DSHS-19-1309-A-001749 Sequence Quality Metrics    Quality Metrics – Aim for 60X coverage • No lower than 40X (quality concerns) • No higher than 100X (cost, more than quality concerns) – Species ID should match expected ID from traditional laboratory methods, using QuAISAR-H pipeline – 200 contigs or less, using QuAISAR-H pipeline – Assembled genome ratio should be between 0.6-1.4, using QuAISAR-H pipeline To ensure quality metrics are met, sites should send their first sequencing run to DHQP for confirmation before proceeding with further sequencing Note: Data must pass quality checks prior to uploading to NCBI TX-DSHS-19-1309-A-001750 Data Sharing  All WGS data will be shared by states with DHQP for centralized analyses  Options for sharing data directly with DHQP – BaseSpace – Secure CDC Sharefile (similar to Box) – MMB secure FTP – Additional options under consideration  Working toward developing capacity for direct NCBI upload is important TX-DSHS-19-1309-A-001751 Posting to NCBI    DHQP will host an NCBI umbrella, “CDC HAI-Seq” – For bioprojects and sequence data generated by CDC and other public health laboratories related to healthcare-associated infections – Can include any data format, including raw reads and/or assemblies – Broad BioProjects for NTM, Staph, Cdiff, Gram negatives, etc. For outbreaks: – Delays between the completion of sequencing and submission to CDC/DHQP should be minimized. – Internal analyses by state health departments should not be prioritized if it will compromise the speed with which data are shared with DHQP so that data can be evaluated from across the outbreak. – DHQP will post a representative sample(s) to NCBI as a reference and to support data sharing and improved public health response. Ideally, states communicates NCBI ID (SRA number) to DHQP via LIMS, HL7 messaging, or other mechanism; not spreadsheet/emails TX-DSHS-19-1309-A-001752 Plan for Metadata on NCBI  Setting conservative limits to the metadata included across all HAI/AR activities – Time: Specimen collection year – Type: Specimen type (human, animal, environmental, other) – Location: Specimen collection location (United States) – Source: Specimen source (blood, urine, device, surface, etc.) – Organism: Genus, species – ID: Isolate identifier (unique ID assigned to isolate by organization who sequenced it; cannot be linked readily to original ID without master) • Isolate ID must be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically • Follow CDC guidance for assigning WGS IDs TX-DSHS-19-1309-A-001753 Plan for Metadata on NCBI  Suggested WGS ID (under development) – YYYYLC-00000, where • YYYY=year sequenced • LC = Location code for where sequencing was performed (code assigned by and key retained at DHQP) • 00000=Consecutive numbers assigned by the sequencing lab  Again: Isolate ID should be assigned before sequencing; otherwise, original ID will be linked permanently to the sequence data posted publically TX-DSHS-19-1309-A-001754 Questions? Metagenomics and Molecular Biology, Division of Healthcare Quality Promotion HAIseq@cdc.gov For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-001755 2019 Epidemiology and Laboratory Capacity (ELC) Program H: Vector-borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Frequently Asked Questions Personnel 1. Can jurisdictions ask for more than one FTE or FTE equivalent in Tier 1 if that is what is needed to accomplish Tier 1 activities in our jurisdiction? Yes, you CAN request more than 1.0 FTE to support Tier 1 activities; however, the accompanying narrative must justify that this personnel time is required. To the extent that the same personnel support Tier 2 and/or Tier 3 activities, please indicate this in your narrative and budget request. 2. How do I ask for funding for staff that works on both Tier 1 and Tier 2 activities? If we split their time between tier 1 and tier 2, what happens if I do not get the funding for tier 2? Staff funding is tied to the activities the staff person supports. Under the proposed scenario, if Tier 2 activities are funded, funding for staff supporting those activities could be supported. In contrast, if Tier 2 activities are not funded, funding for staff supporting those activities may not be supported. Please see the answer in #1 of this section as well. 3. I rely on contractors to complete activities. Are they considered the same as FTEs, as noted in your webinar and Q&A document, if they are performing the same activities? Contractors would be considered the same as FTE staff. 4. Several positions have been historically funded by ELC to complete ELC activities. Can I still ask for funding for this position in the new competitive cycle? What about historical positions that are currently vacant? Yes, applying for funding to support these positions is appropriate under the new competitive cycle. Budget 1. Is there additional funding attached to tier 2 beyond the $150,000-260,000 range mentioned? The NOFO language is: “In year 1, CDC intends to support several (<8) jurisdictions to develop and maintain Tier 2 and Tier 3 activities with award levels up to $1,000,000, depending on proposed activities.” Please clarify this NOFO language. The Vector-Borne Diseases Program would like to clarify that the highest levels of funding noted in the NOFO language is meant to support jurisdictions proposing Tier 3 activities, not Tiers 2 and 3 as written. For FY19 specifically, we anticipate funding 5-7 jurisdictions at $500,000-750,000 (total award) to support work plans that include considerable Tier 3 activities. The Program intends to support remaining jurisdictions for Tier 1 and Tier 2 activities, depending on the needs of the jurisdiction. Although we anticipate the majority of awards requests to fall within the estimated award range of $150,000-$260,000 (based on TX-DSHS-19-1309-A-001756 historical ELC vector-borne disease funding levels), jurisdictions may receive funding awards above or below the estimated range. Larger awards will be linked to well-conceived work plans associated with activities that adequately justify higher funding levels. 2. In regards to preparing two different budgets, one for Tier 1 and one for Tiers 2 and 3, how should we submit this when our capacity is already much higher than just Tier 1? We acknowledge that many jurisdictions may already have vector-borne disease capacity that goes beyond Tier 1. Regardless, please prepare the two budget tabs to differentiate between “core” and “enhanced” VBD capacity and associated funding needs. The Tier 1 tab in the budget should include your needs to be successful in all required Tier 1 activities as applicable to your jurisdiction. Budget needs for additional (optional) enhanced activities beyond Tier 1 should be included in the second budget tab, covering Tiers 2 and 3. 3. Could we submit an application for Tier 2 or Tier 3 activities in future budget period years? Will we be able to apply for it later if we do not ask for it now? Yes, you will have the opportunity in future years to request funding for Tier 2 and 3 activities even if you do not apply for them this year. 4. The Webinar mentioned preparing a budget for one year. In our narrative, are we writing for 1-year, or laying out plans for the 5-year period? Your work plans should reflect your plans for the year one budget period only. 5. My jurisdiction has staff positions funded from the Zika supplemental. We would like to keep these positions for this next competitive ELC cycle since they are essential to our vectorborne disease program. How do we do this? Applying for funding to support these positions is appropriate under the new competitive cycle. As the positions described in this scenario were funded using supplemental funding in previous years, we cannot guarantee these positions will be supported under this new competitive cycle for ELC. Work Plan 1. Are the tier 2 and 3 activities likely to be maintained past one year, i.e. should we submit budgets for these activities for one year or multi-year? Yes – these are likely to be maintained past year 1. Please only propose one year of funding for the first budget period. Epidemiology 1. Can you explain activity “identify and report non-nationally notifiable VBD cases to CDC”? If non-nationally notifiable diseases are captured in the state, how are these reported to ArboNET? Is it the same mechanism? Non-notifiable arboviruses are reported to ArboNET using the same mechanism for notifiable diseases. Please see the Table 1 at the end of the FAQ for a list of notifiable and non-notifiable TX-DSHS-19-1309-A-001757 arboviral disease conditions. For non-arboviral conditions, please contact the respective point of contract listed in the Program H guidance. Laboratory 1. How much detail would you like on the supply line? For example, if we are asking for PPE or PCR Reagents – how specific should we be? Please associate supplies with a specific test or activity where possible, e.g. “PCR reagents for arboviral testing” or “PPE for tick surveillance activities.” 2. My jurisdiction is interested in becoming a regional reference lab for testing. Are we allowed to do outreach to other states to see if they have a need? Are we allowed to share our letters of support to DVBD during this application period? In this scenario, it is up to the jurisdiction to determine if and how they would do outreach to other states to gain support. Unfortunately, we have no mechanism to accept letters of support for this application. Jurisdictions could note established collaborations or memorandums of understanding with other jurisdictions in the narratives sections. 3. How should collaborations with universities be handled to make sure that they are not crossing the line of “research.” If ELC is strictly non-research, what activities with universities are expected and encouraged? As you likely know, CDC cannot fund research activities under the ELC cooperative agreement. However, CDCs Vector-Borne Program does support a domestic research program through other funding opportunities, including under the Emerging Infections Program and the VectorBorne Disease Centers of Excellence cooperative agreements. In certain situations, jurisdiction staff can participate in CDC or other funded research activities if their time is not fully funded by ELC. For example, if laboratory staff are funded 50% by ELC and 50% by other sources, they may be able to support collaborative research under the 50% time covered by other support. Additionally, ELC-funded staff could collaborate with partners to help determine and prioritize research needs, participate in trainings, or host fellowship or graduate students. 4. Can we request support for maintenance agreements for laboratory equipment? Yes, requesting support maintenance agreements for laboratory equipment is appropriate if the equipment supports testing for vector-borne diseases. Cost-sharing measures should be used if the maintenance agreement supports testing for other programs as well. Ecology 1. Can you please clarify the difference between ArboNET and MosquitoNET reporting CDC collects mosquito data in two systems, ArboNET and MosquitoNET. These systems collect different information (reporting to MosquitoNET does not replace reporting to ArboNET). • ArboNET: Reports of mosquito pools testing positive for arboviruses by county and date of collection (also called numerator data). Can also report county level data for numbers of mosquitoes collected and tested weekly by species (also called denominator data). TX-DSHS-19-1309-A-001758 • MosquitoNET: Detailed mosquito abundance data by specific geographic coordinates. MosquitoNET now covers all mosquito species. We are primarily interested in jurisdictions submitting surveillance data for all medically important mosquitoes. Reporting of nuisance mosquitoes is optional. The system is also used to report insecticide resistance testing results. 2. If we request funding for some ecological surveillance activities, can we then subcontract local vector control districts or a university group to do them? Yes, subcontracting to local vector-control districts or universities is acceptable. 3. Can you clarify the difference between “passive” (Tier 1) and “active” (Tier 2) surveillance for vectors? We make the following definitions regarding passive Tier 1 surveillance and active Tier 2 vector surveillance. • Passive: entomological surveillance activities already occurring in your jurisdiction, but not performed or coordinated by you. Examples could include, universities, or other state agencies, e.g. agriculture or veterinary agencies • Active: entomological surveillance activities performed or coordinated by you. This could include collaborations with universities or local health departments/vector control agencies, or subcontracted to an outside group. 4. Will CDC support funding for tick surveillance of Dermacentor or other non-Ixodes tick species? Tick surveillance requests that relate to Ixodes species and align with the new surveillance guidance will be prioritized over other non-Ixodes tick surveillance funding requests. 5. If a jurisdiction passively receives vectors from partners, but actively conducts pathogen testing at their public health laboratory, where would this jurisdiction submit their activity request – in Tier 1 or Tier 2? Under this scenario, this activity would be consider Tier 2 if receiving mosquitoes for testing at the jurisdiction laboratory and Tier 3 if performing pathogen testing in ticks. 6. My jurisdiction currently sends collected ticks to CDC for pathogen testing. Which activity would this best align? We consider sending ticks to CDC for pathogen testing a Tier 2 activity. It best aligns with NOFO Strategy 1c, c) Actively conduct or coordinate ecologic/vector surveillance and pathogen testing, and report to the appropriate CDC systems (e.g. ArboNET, MosquitoNET). TX-DSHS-19-1309-A-001759 Table 1: Arboviral Condition Codes Condition Code Condition Name Nationally Notifiable 10058 Cache Valley virus disease, neuroinvasive No 10066 Cache Valley virus disease, non-neuroinvasive No 11718 California encephalitis virus disease Yes 10054 California serogroup virus diseases, neuroinvasive Yes 10061 California serogroup virus diseases, non-neuroinvasive Yes 10073 Chikungunya virus diseases Yes 10093 Colorado tick fever virus disease No 10680 Dengue Yes 11705 Dengue, severe Yes 11704 Dengue-like illness Yes 10053 Eastern equine encephalitis virus disease, neuroinvasive Yes 10062 Eastern equine encephalitis virus disease, non-neuroinvasive Yes 50237 Flavivirus disease, not otherwise specified No 10078 Jamestown Canyon virus disease, neuroinvasive Yes 10079 Jamestown Canyon virus disease, non-neuroinvasive Yes 10059 Japanese encephalitis virus disease, neuroinvasive No 10068 Japanese encephalitis virus disease, non-neuroinvasive No 11712 Keystone virus disease Yes 10081 La Crosse virus disease, neuroinvasive Yes 10082 La Crosse virus disease, non-neuroinvasive Yes 10072 Other arboviral disease, not otherwise specified (Alkhurma virus, Barmah Forest virus, Bourbon virus, Heartland virus, Highlands J virus, Kyasanur Forest virus, Mayaro virus, Murray Valley encephalitis virus, O'nyong-nyong virus, Oropouche virus, Rift Valley Fever virus, Rocio virus, Ross River virus, Sindbis virus, Tahyna virus, Toscana virus, Usutu virus, Other Arbovirus) No 10057 Powassan virus disease, neuroinvasive Yes 10063 Powassan virus disease, non-neuroinvasive Yes 11734 Snowshoe hare virus disease Yes 10051 St. Louis encephalitis virus disease, neuroinvasive Yes 10064 St. Louis encephalitis virus disease, non-neuroinvasive Yes 10074 Tick-borne encephalitis viruses No 11724 Trivittatus virus disease Yes 10055 Venezuelan equine encephalitis virus neuroinvasive disease No 10067 Venezuelan equine encephalitis virus non-neuroinvasive disease No 10056 West Nile virus disease, neuroinvasive Yes 10049 West Nile virus disease, non-neuroinvasive Yes 10052 Western equine encephalitis virus disease, neuroinvasive Yes 10065 Western equine encephalitis virus disease, non-neuroinvasive Yes 10660 Yellow fever Yes 50224 Zika virus disease, congenital Yes 50223 Zika virus disease, non-congenital Yes TX-DSHS-19-1309-A-001760 50222 Zika virus infection, congenital Yes 50221 Zika virus infection, non-congenital Yes TX-DSHS-19-1309-A-001761 2019 Epidemiology and Laboratory Capacity (ELC) Notice of Funding Opportunity (NOFO) CDC-RFA-CK19-1904 Project W: “Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” Questions & Answers 1. Are there any specifications regarding the congenital exposure and infections for which this project in the ELC cooperative agreement is targeted (such as those that are associated with birth defects and/or developmental delay)? We are open to applications about mother/baby linked surveillance for any congenital infections that have current significant gaps in information – and hopefully gaps that could be addressed by having enhanced public health surveillance. 2. Is Zika required as one of the congenital exposures and infections included in the application? No 3. Is there any guidance regarding how to structure the application if a jurisdiction includes more than one infection for this Project? No specific guidance, but we are open to jurisdictions separately requesting support for Zika follow up AND a different congenital infection – both under this project. Applicants should not propose the establishment of a new surveillance system or registry, but leveraging an existing system such as the US Zika Pregnancy and Infant Registry is highly encouraged. 4. What catchment area is encouraged for the jurisdictions, entire state or certain counties? A specific catchment area is the jurisdiction’s decision. 5. Will travel and training be covered? Yes. Funding could be used for travel and training, but a strong application would include funding for personnel and contractual support – specifically a jurisdictional – level coordinator for mother/baby linked surveillance activities. 6. What perinatal infections are other jurisdictions facing? Some jurisdictions have mentioned conducting mother/baby linked surveillance for Zika, perinatal Hepatitis C, and congenital Syphilis. 7. Do all jurisdictions have to monitor the same infections? No. 8. What are some deciding factors for an acceptable application? Funding decisions will be based on 1) quality of application; 2) number of births per year in the proposed area of surveillance; and 3) estimates of exposure to infectious diseases among pregnant women in the jurisdiction. 9. What is the maximum award amount? The funding range is $200,000 - $425,000 with an estimated total number of awards of 4-9 jurisdictions. The estimated average award amount is $320,000. 10. May I apply for work that relates to Neonatal abstinence syndrome in this cooperative agreement? No. TX-DSHS-19-1309-A-001762 11. There are multiple surveillance systems currently supported by CDC’s NCBDDD—how are they intended to relate/not duplicate one another? There are two complementary surveillance systems used to monitor the impact of Zika in the U.S. states and territories. The surveillance systems have different approaches: • Mother-infant-child linked surveillance based on a maternal exposure o Example: The US Zika Pregnancy and Infant Registry collects information on pregnant women with lab evidence of possible Zika infection and their children over time to assess the impact of maternal infection on childhood outcomes. • Infant outcome-based surveillance o Example: Zika Birth Defects Surveillance collects information on infants born with specific birth defects potentially related to Zika, regardless of congenital exposure, and helps refer the families of these children with birth defects to services in their communities. This system may capture infants whose mothers were not tested during pregnancy. The intention of this project is to expand and enhance maternal-infant-child linked surveillance of Zika and/or other infections during pregnancy and monitor maternal, infant and childhood outcomes. As a reminder, this NOFO is non-research. Enhanced surveillance is appropriate, while longitudinal research studies are not allowable. 12. Can a new birth defects surveillance systems be funded under this project? No. Applications from jurisdictions that already have a foundational surveillance system that can be adapted to address emerging threats to mothers and babies will be stronger. The US Zika Pregnancy and Infant Registry database, if not already available in a jurisdiction, can be provided to jurisdictions upon request. 13. Are maintenance fees for existing birth defects surveillance systems eligible for coverage? Yes. This is an allowable cost as long as it is deemed reasonable by the program. 14. Could the surveillance system be active or passive? Yes, the surveillance system could be active or passive. 15. What types of other health threats are included? This project is focused on congenital infections defined as infections that are identified during pregnancy. The purpose of this project is to conduct mother-infant-child surveillance based on an infectious exposure during pregnancy. Infant outcomes of interest may include, but are not limited to birth defects. 16. XI. Strategy X: Work with cross-cutting health information systems team within your health department to develop core surveillance capacity within health departments to monitor and protect pregnant women, infants, and children” does not have an activity listed, and it is not listed on the BP1 Work Plan tab. How should applicants respond? Please disregard Strategy X provided in the guidance, and respond comprehensively to Strategy 1g and Strategy 1h in the work plan. Strategy X was inadvertently omitted from the work plan template. Strategy 1g: Strengthen connections across the health departments to establish strong coordination and collaboration between infectious disease experts, maternal/child health experts, and birth defects experts Strategy 1h: Advance innovative IT strategies to monitoring linked mother-child health information while minimizing burden TX-DSHS-19-1309-A-001763 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Tuesday, April 16, 2019 1:35 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Reminder: ELC Annual Meeting Survey Closes Friday, April 19, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, Thank you for attending the 2019 ELC Annual Meeting. In order to continue to provide a beneficial meeting to you each year, we are asking you to complete the following survey https://is.gd/elcannualmeeting2019. Please complete this survey by 4pm on Friday, April 19, 2019. Again, thank you for attending the 2019 ELC Annual Meeting and your feedback is greatly appreciated. Thank you, The ELC Team TX-DSHS-19-1309-A-001764 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, May 02, 2019 5:15 PM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Attachment(s): "ELC_Budget_NonPersonnel_Report_Formatting_Tool.xlsm" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings. It has come to the ELC’s attention that when generating the Non-Personnel report, either for senior leadership review or for printing as a PDF for upload into Grants.gov, that a formatting issue renders the report to be challenging to read in terms of line item justifications. Attached is a tool that can be used to fix the Non-Personnel report formatting issue. Steps 1. 2. 3. 4. Open the ‘ELC Budget Non-Personnel Report Formatting Tool’; Select the ‘Update Template’ button; Select the ELC Budget Template that needs fixing when prompted by the tool; & Save the ELC Budget Template once the tool has applied the fix. Please note: Any time the Non-Personnel Report is refreshed, using the ‘Generate/Refresh’ button on the Menu tab of the budget, the fix applied by the attached tool reverts back to the original formatting. Therefore, should a need arise to refresh the Non-Personnel report, please apply the formatting tool afterward to have the fix re-applied. The final version of the uploaded Non-Personnel report should have the tool applied so that the corrected formatting is present during the review conducted by the Office of Grants Services (OGS). There will not be any penalty if a jurisdiction cannot complete the Non-Personnel report fix. If you have already submitted your application, including budget, into Grants.gov, please let your Project Officer know and the fix will be conducted on your behalf on the ELC side. Sincerely, The ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, April 12, 2019 4:28:17 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Good afternoon, Please find the FINAL updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 3) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, March 29, 2019 3:53:18 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: Re: ELC Supplementary Information for 2019 Good afternoon, Please find the updated Supplementary Information for Applying to 2019 ELC NOFO (VERSION 2) document attached, and also located in the REDCap file repository. Sections that include updates and new information are highlighted in yellow. Thanks and we look forward to seeing many of you next week! ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Thursday, March 21, 2019 6:04:53 PM To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Subject: ELC Supplementary Information for 2019 TX-DSHS-19-1309-A-001765 Good afternoon, Please find the Supplementary Information for Applying to 2019 ELC NOFO document attached here, and also located in REDCap in the file repository. As mentioned in previous communications, this document is intended to provide information that may help applicants more effectively draft applications in response to the FY 2019 ELC NOFO. This document will: • • • • describe the new ELC structure and contrast it with previous project periods, offer tips for developing effective work plans, milestones, and budgets, provide additional information about the submission process and tools that may aid applicants, illustrate materials from the ELC and partner program webinars, including a compilation of frequently asked questions for applicants to reference, and instructions on how to download the recorded ELC webinars. PLEASE NOTE: ELC encourages alignment with the activities in the published NOFO guidance, but understands that some jurisdictions may have unique activities that do not quite fit in the established activities. As such, ELC has published a second version (v2) of application templates for Cross-cutting Epi and Lab Capacity (Program A) and ELC Leadership Management and Administration (Project B), which replaced the previous version on REDCap as of 1:45pm ET on 3/21/19. The updated versions provide the structure for applicants to include up to three “other” activity options under each strategy in the template. If you require this option, and have already started with version 1, please send your template to the ELC@cdc.gov mailbox, and we can assist with the transfer of information into version 2. Either template version will be accepted. Thank you, ELC Team TX-DSHS-19-1309-A-001766 1 2 -3 4 -5 6 -7 8 9 ELC Budget Non-Personnel Report Formatting Tool A Once you click the button below, you will be asked to select your ELC budget template file. This tool will modify the non-personnel report by adding lines to help better distinguish where justifications begin and end. Please ensure that the budget template file is closed before running this tool. - TX-DSHS-19-1309-A-001767 Sheet1 From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) Sent: Thursday, May 02, 2019 6:33 PM EDT To: Komatsu, Kenneth (CDC azdhs.gov) ; Brady, Shane (CDC azdhs.gov) ; Santibanez, Margarita@CDPH ; Esmeralda IniquezStevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov) ; Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us) ; DOH ; Shuford,Jennifer (DSHS) ; Banicki,Allison (DSHS) ; Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD) ; Mcconnell, Michelle (HHS/OS/OGA) ; Waterman, Steve (CDC/DDID/NCEZID/DVBD) ; Escotto, Dianne A. (CDC/DDID/NCEZID/DGMQ) ; Villarino, Elsa (CDC/DDID/NCEZID/DGMQ) ; FonsecaFord, Maureen (CDC/DDID/NCEZID/DGMQ) ; Contreras, Sonia (CDC/DDID/NCEZID/DGMQ) ; Montiel, Sonia (CDC/DDID/NCEZID/DGMQ) (CTR) ; Arrouzet, Cory (CDC/DDID/NCEZID/DGMQ) ; Clements, Crystal (CDC/DDID/NCEZID/DGMQ) ; Goryoka, Grace (CDC/DDID/NCEZID/OD) ; Angelo, Kristina (CDC/DDID/NCEZID/DGMQ) ; Borntrager, Denise (CDC/DDID/NCEZID/DGMQ) ; Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR) ; Tyler,Carla (DSHS) ; Sidwa,Tom (DSHS) ; Frieda Adams (Freida.Adams@state.nm.us) ; Olivia.Arizmendi@cdph.ca.gov ; Torres,David (DSHS) ; Delossantos,Rosy (DSHS) ; April Fernandez (april.fernandez@cdph.ca.gov) ; Kozo, Justine ; Paula Kriner ; Maria Fierro ; Robert Guerrero (robert.guerrero@azdhs.gov) ; Mariana Casal (mariana.casal@azdhs.gov) ; Corona Luevanos,Adriana (DSHS) ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Eugene Livar ; McConnell, Michelle S (Mexico City) ; Pezzi, Clelia (CDC/DDID/NCEZID/DGMQ) ; Ledezma,Elvia (DSHS) ; Travis.Leyva@state.nm.us ; Cass, Anne (CDC cdph.ca.gov) ; Lee,Yihua (DSHS) ; Martinez,Angelica (DSHS Contractor) ; Foy,Elizabeth (DSHS) ; Vaaler,Margaret (DSHS) ; Rodriguez,MariaG (DSHS) ; Ruiz,Mauro (DSHS) ; Prot,Emilie (DSHS) ; Wendorf, Kristen (CDPH-CIDDCDC-TCB) ; Shah, Neha (CDC cdph.ca.gov) ; Perez,Alberto (DSHS) ; Rosenbluth,Lauren (DSHS) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Phippard, Alba (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) ; Paddock, Christopher (CDC/DDID/NCEZID/DVBD) ; Peterson, Amy (CDC/DDID/NCEZID/DVBD) ; Armstrong, Paige A (CDC/DDID/NCEZID/DVBD) ; Barrera, Roberto (CDC/DDID/NCEZID/DVBD) ; Hemme, Ryan Russell (CDC/DDID/NCEZID/DVBD) ; Adams, Laura E. (CDC/DDID/NCEZID/DVBD) ; Reyes, Monica (OS/OGA) ; Baker, Nicole (OS/OGA) ; Venkat, Heather (CDC azdhs.gov) ; Limon, Melissa, DOH ; hayley.yaglom@azdhs.gov ; Kjemtrup, Anne@CDPH ; Padgett, Kerry@CDPH ; Rubio, Bianka (CDC/DDID/NCEZID/DGMQ) (CTR) ; Edie.r.lederman@ice.dhs.gov ; Qualls,Whitney (DSHS) ; Kramer, Vicki (CDPH-CID-DCDC) (Vicki.Kramer@cdph.ca.gov) ; Nikos.Gurfield@sdcounty.ca.gov CC: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) ; Phippard, Alba (CDC/DDID/NCEZID/DGMQ) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Subject: Prioritizing the Proposed Next Steps for the Infectious Disease Prioritization at the U.S. Southern Border Region Attachment(s): "Prioritize__Next_Steps_for_Disease_Priorization_5.1.2019.docx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Thank you for participating in the USMU’s Infectious Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Border Region. In order to finalize the general recommendations and proposed next steps and begin the implementation phase of this process we are asking everyone to do the following: By Friday May 17, please review the attached document (Prioritize_Next_Steps_for_Disease_Priorization_5.1.2019) and: § Assign each proposed next step a priority level; and § Indicate if you would like to participate in the efforts (conference calls, workgroups) to accomplish each proposed next step and if you would are interested in leading/co-leading that effort. § Propose any suggested changes on the wording of either the general recommendations or the proposed next steps. Using track changes would be preferred but not necessary. § Please return the completed document to Alba Phippard (ign7@cdc.gov) and Tom Gray (mze3@cdc.gov) by Friday May 17. For those of you interested in the recommendation to create a dashboard for visualization of border region infectious disease morbidity data, please let us know right away if you would like to discuss this further. The US-Mexico Border Health Commission is leading a somewhat related project, and it would be beneficial to further define the needs of our working group so efforts might be harmonized. As you may remember, we still need to flesh-out the proposed next steps for Health Education, Promotion & Capacity Building. For TX-DSHS-19-1309-A-001768 that we are proposing that we gather together a smaller group of individuals who have expertise in those areas to develop and prioritize those next steps for review by the larger group by early June. Bianka Rubio, USMU’s health communication specialist, will be leading that effort. Please be on the lookout tomorrow for an email further describing that effort and how to get involved. Much of the content (general recommendations, proposed next steps) will be incorporated into the final report for the larger disease prioritization effort. We will be reaching out to each state, through the original voting members, to discuss approval process for that final report shortly. Thank you and if you have any questions or comments please do not hesitate to reach out Tom Gray Alba Phippard Public Health Specialist Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention BIDS Program Manager US - Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 3851 Rosecrans St., Ste 715 San Diego, CA 92110 Office: (619) 692-8479 Mobile: (619) 206-0461 Telwork (Fri): (619) 206-0461 Email: APhippard@cdc.gov 619.692.5625 office To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html Confidentiality Notice: This message and the accompanying documents may contain information that is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this e-mail is not the intended recipient, you are hereby notified that you are strictly prohibited from reading, disseminating, distributing, or copying this communication. If you have received this e-mail in error, please notify the sender immediately and destroy the original transmission. Thank you. TX-DSHS-19-1309-A-001769 Infectious Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Border Region General Recommendations and Proposed Next Steps for Prioritized Diseases Name: State/Affiliation: Instructions: § By Friday May 17, please review the General Recommendations and Proposed Next Steps for the Infections Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Land Border. § Assign each next a priority level (1 – 3). § Indicate whether or not you would like to participate in efforts (conference calls, workgroups) to accomplish each next step and if you would be interested in leading or co-leading that effort. § Return the completed document to Alba Phippard (ign7@cdc.gov) and Tom Gray (mze3@cdc.gov). TX-DSHS-19-1309-A-001770 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Coordination General Recommendations Enhance existing mechanisms for coordinating initiatives between the U.S. federal, state, and local agencies involved in border health activities in the U.S.-Mexico border region to address the priority diseases. Existing mechanisms include: § CDC’s Binational Border Infectious Disease Surveillance (BIDS) Program; § Binational Technical Work Group (BTWG); § U.S.-Mexico Border Health Commission (BHC); and § Border sister-city/state/region binational meetings and committees. Coordi nation General Recommendations Conduct gap analysis1 for priority diseases in the border region to inform development of comprehensive approaches. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Explore opportunities to integrate existing mechanisms (BHC, BIDS, BTWG) to enhance coordination, leverage best practices, and reduce duplication of efforts. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with the BTWG on broadening partner participation on monthly teleconferences by including, based on the meeting topic and goal, different federal, state, and local partners and relevant subject matter experts and decision makers in programs such as STD/HIV, TB, and healthcare-associated infections. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with BTWG to address topic areas specific to Aedes-borne arboviruses and Rickettsioses and regularly exchange surveillance information on insecticide resistance. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Identify and leverage resources for annual face-to-face meetings of local, state and federal partners involved in border/binational health. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Next Steps Priority Involvement TB Next Steps § Convene a workgroup of the states/partners to discuss scope of gap analysis and level of priority. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001771 Page 2 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations 1Gap Coordination analysis: process to determine the difference (the gap) between current program practices/capabilities and the needs of the community and current evidence based best practices. Priority Involvement Aedes and Rickettsioses Next Steps § None recommended. Enteric Next Steps § Unclear if needed at this time. Share state models for exchanging public health Next Steps (General, Aedes, Enteric, data electronically with Mexican health jurisdiction Rickettsioses and TB) partners. § Share information and materials for existing models in the border region (e.g. ADHS MEDSIS). § Identify cross-border data sharing programs in other countries and research the Pulse Net data sharing agreement between the U.S. and Canada. General Recommendations Surveillance Next Steps Prioritize identification of binational outbreaks/clusters of priority diseases. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Priority Involvement Aedes and Rickettsioses Next Steps § Continue to strengthen bilateral communication with Mexico, for example, via binational forums focused on Aedes-born diseases and Rickettsioses such as BTWG meetings and broader conferences. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Establish a system to monitor Spanish ProMed for reports of outbreaks in Mexico. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric Next Steps § Review border state/county clusters and drug resistant cases that may require collaboration. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001772 Page 3 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Surveillance General Recommendations Engage community healthcare providers, including correctional health, to ensure surveillance and reporting mechanisms are in place for monitoring infectious diseases among mobile populations. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement TB Next Steps § Review border state/county clusters and pediatric case investigations that may require collaboration. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead General Next Steps § Explore how USMU and Border Health Commission can assist the states to engage Department of Homeland Security (DHS) partners for improved communication, reporting and coordination. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Convene workgroup to discuss strategies for engaging community health care providers on disease reporting (e.g. provider education on diagnosis and reporting, assessments of current reporting activities and quality improvement). ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Aedes Next Steps § Develop approaches, including potential thresholds, to alert border region community health centers serving mobile populations about increases in Aedes mosquito populations, cases or outbreaks of Zika, dengue, or chikungunya to stimulate and increase testing of patients with acute febrile illness. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001773 Page 4 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Rickettsioses Next Steps § Develop additional approaches to better integrate veterinary and public health surveillance and systematize crossreporting between sectors. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Implement strategies to educate providers on the diagnostic tests and testing requirements for rickettsioses, as well as appropriate treatment. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with DHS partners such as Immigration and Customs Enforcement and U.S. Customs and Border Protection to improve understanding of these agencies public health surveillance and reporting systems, and identify opportunities to enhance surveillance among both employees and immigrant populations. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric and TB Next Steps § Leverage existing cross-border projects to establish best practice for cross-border contact tracing infrastructure. Prioritizing Proposed Next Steps for Disease Prioritization TX-DSHS-19-1309-A-001774 Page 5 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Surveillance General Recommendations Create a web-based dashboard for selected notifiable diseases with county level and aggregated border region data for increased understanding of case counts, rates and trends in the border region. Dashboard features could include mapping and interactive features based on resources and feasibility. Next Steps Priority Involvement Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Establish a workgroup to discuss: o Feasibility, resources and required partners. o Inclusion of data from non-border counties to show true scope and pattern of disease burden. o Variables for inclusion. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Surveillance § Explore how similar programs have shared data through web-based applications: o CDCs NCHHSTP ATLASPlus Mapping and Visualization Tool for HIV, Hepatitis, STD and TB and CDC Wonder o Arizona Disease Data & Statistics Tables o Arizona Flu Disease Tables o PulseNet – enteric data displays. General Recommendations Next Steps Strengthen surveillance for prioritized vectorborne diseases and vector presence in the border region through active surveillance approaches. Aedes and Rickettsiosis Next Steps: § Discuss feasibility of implementing syndromic sentinel surveillance for acute febrile illness with confirmatory testing at key sites in the border region. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Convene key border agency partners to explore and further operationalize participatory surveillance for vector-borne diseases and vector presence for the border region. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Prioritizing Proposed Next Steps for Disease Prioritization Priority Involvement TX-DSHS-19-1309-A-001775 Page 6 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Laboratory Not applicable for enteric or TB. Review and implement approaches to strengthen surveillance and laboratory practices for antimicrobial resistance in the border region. Ensure that culture-independent diagnostic testing does not reduce high quality public health surveillance in the border region. Prioritizing Proposed Next Steps for Disease Prioritization Enteric and TB Next Steps § Identify venues (BTWG, face to face meetings) that can be used to discuss whole genome sequencing (WGS) and its potential impact on surveillance in the border region. Topics for discussion include: o How state health departments are managing ability/inability to conduct WGS for enteric specimens and the prioritization of specimens for testing. o Time delays inherent with WGS. o Possibility that gaps in enteric surveillance will widen with WGS and fewer outbreaks will be identified. o How best to use WGS to investigate highest priority clusters o How to engage with Mexican partners to identify cross-border clusters. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric Next Steps § Assess diagnostic methods used for enteric disease surveillance to ensure identification of outbreaks and drug resistance. § Identify current and best practice state regulations for culture and susceptibility testing of priority diseases where use of CIDT can limit identification of resistant strains. § Improve timeliness of enteric disease confirmatory testing. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001776 Page 7 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Outbreak Response & Preparedness Next Steps for Aedes and Rickettsioses were not identified. Continue to use the BTWG and opportunities for face-to-face meetings, to work with partners, including Mexican counterparts, to address preparedness, foster awareness of emerging public health issues and encourage collaboration. General Recommendations Prioritizing Proposed Next Steps for Disease Prioritization Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Use existing forums (e.g. BHC, BTWG, local meetings) as platforms to discuss: o Solutions to ongoing challenges with crossing specimens for public health purposes (both routine crossings and during an outbreak). o Preparedness and response capacity building, through tabletop exercises, and sharing best practices (including sharing regional plans). o Data sources (e.g. U.S. federal detention data and Mexico’s national surveillance system) that are important for outbreak response and preparedness activities. o Mechanisms to coordinate and leverage prevention messaging between partners to strengthen outbreak response. o Outbreak investigations. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Evaluate the use of the Operational Protocol for Binational Communication and Coordination on Disease Notifications and Outbreaks and regional sub-plans to inform revision and strengthening. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Next Steps Priority Involvement TX-DSHS-19-1309-A-001777 Page 8 Outbreak Response & Preparedness Outbreak Response & Preparedness Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Expand, standardize and maintain mosquito surveillance to improve description of the geographic distribution of Aedes mosquitoes and where transmission is more likely to occur. Aedes Next Steps § Make recommendation, when feasible, for regional VBD Centers of Excellence to cover New Mexico in their surveillance activities. § Share known resources related to riskmodeling and forecasting challenges. § Better disseminate information about Mexico’s surveillance and data. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TB Next Steps § Optimize existing efforts for disease notification and follow-up (e.g. TB contact projects in California and Texas, CureTB, and the meet and greets coordinated by ADHS staff). ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Improve educational approaches for persons who leave the U.S. from custody settings after exposure to TB, and potentially other priority diseases. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Not applicable for enteric diseases, rickettsioses or TB. Enhance follow-up of patients or contacts that cross the border or who are deported after diagnosis or exposure for improved infectious disease control efforts. Identify best practices and continuing challenges in follow-up of binational patients with select notifiable diseases in the border region. This acknowledges that surveillance systems may be sufficient for some diseases, but there are limited resources and mechanisms for comprehensive follow-up (i.e. case-holding, monitoring, and Prioritizing Proposed Next Steps for Disease Prioritization TX-DSHS-19-1309-A-001778 Page 9 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations contact tracing). Next Steps Priority Involvement Aedes and Rickettsioses Next Steps § No recommendations. Enteric Next Steps § Unclear if needed at this time. Outbreak Response & Preparedness General Recommendations Next Steps Priority Involvement Develop and implement evidence-based methods General Next Steps to evaluate population mobility and healthcare § Convene workgroup(s) to discuss strategies use patterns among U.S.-Mexico border crossers. for capturing healthcare access/patterns of seeking care of mobile populations. Prioritizing Proposed Next Steps for Disease Prioritization ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001779 Page 10 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Health Education, Promotion & Capacity Building General Recommendations Improve education and outreach for populations with limited English proficiency. Ensure education materials for specific populations are tested for accuracy and understandable messaging. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement General Next Steps § Create opportunities and a platform for regular sharing of validated educational and prevention materials in border communities. § Leverage the Mexican Consulate’s Ventanilla de Salud network to reach their unique population (e.g. to provide health education or test educational materials). Due to time constraints next steps have not been discussed as a group. TX-DSHS-19-1309-A-001780 Page 11 From: Marquez,Cynthia S (DSHS) Sent: Friday, May 17, 2019 10:38 AM EDT To: Aldridge,Tiffany (DSHS) ; Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: RE: Zika Activities Good Morning, Imelda is available in the morning … 8:30-12:00 CST. Thank you, Cynthia S. Marquez Executive Assistant to Imelda Garcia Division Office for Laboratory and Infectious Disease Services (LIDS) Texas Department of State Health Services P. O. Box 149347, MC 1927, G-401 Austin, Texas 78714-9347 (512) 776-2174 (512) 776-7229 (fax) TEXAS f!e~lth~nd Hunlall Se-rvices T~xa~ Departme:ntof State HealthServ im From: Aldridge,Tiffany (DSHS) Sent: Friday, May 17, 2019 9:37 AM To: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Marquez,Cynthia S (DSHS) Subject: RE: Zika Activities Good Morning, I am unavailable at 11 a.m. CST on Monday but the rest of my day is open. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Garcia,Imelda M (DSHS) Sent: Friday, May 17, 2019 9:32 AM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Aldridge,Tiffany (DSHS) ; Marquez,Cynthia S (DSHS) Subject: Re: Zika Activities Of course. Do you want to talk later this morning? Or Monday? Imelda M. Garcia, MPH Associate Commissioner Laboratory & Infectious Disease Services Division Texas Dept. of State Health Services iPhone: 512-461-4476 Office: 512-776-7679 CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. Sent from my iPhone TX-DSHS-19-1309-A-001781 On May 17, 2019, at 9:29 AM, Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) wrote: WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning, Do you have time for a quick call (15 minutes or so) to discuss your current Zika activities and spending forecast for the remainder of the budget period? We are currently reviewing applications but I have some time on Monday, June 20th, my morning is wide open. Please let me know what time works best for you and I will send you an invite. Thanks De’Lisa De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-001782 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, May 17, 2019 10:48 AM EDT To: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) CC: Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Byrd, Shirley K. (CDC/OCOO/OFR/OGS) Subject: For Immediate action: Final FFRs for Ebola Accounts WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, In an effort to minimize the return of funds to the U.S. Treasury and maximize the ability for our recipients to benefit from these dollars, we are respectfully requesting that final FFRs be submitted as soon as possible for all of your Ebola accounts that have not been extended through 7/31/19. Ebola funds were awarded on subaccounts ending in: • • • CK15 EB16 EBLA17 Please email your final FFRs to both the Office of Grant Services (OGS) (Shirley Byrd: yuo6@cdc.gov) and the ELC mailbox (ELC@cdc.gov). Thanks, ELC Team TX-DSHS-19-1309-A-001783 From: Gray, Thomas (CDC/DDID/NCEZID/DGMQ) (CTR) Sent: Monday, May 20, 2019 3:25 PM EDT To: Komatsu, Kenneth (CDC azdhs.gov) ; Brady, Shane (CDC azdhs.gov) ; Santibanez, Margarita@CDPH ; Esmeralda IniquezStevens (Esmeralda.Iniguez-Stevens@cdph.ca.gov) ; Sandra. Melman@state. nm. us (Sandra.Melman@state.nm.us) ; DOH ; Shuford,Jennifer (DSHS) ; Banicki,Allison (DSHS) ; Groseclose, Samuel L. (CDC/DDPHSIS/CPR/OD) ; Mcconnell, Michelle (HHS/OS/OGA) ; Waterman, Steve (CDC/DDID/NCEZID/DVBD) ; Escotto, Dianne A. (CDC/DDID/NCEZID/DGMQ) ; Villarino, Elsa (CDC/DDID/NCEZID/DGMQ) ; FonsecaFord, Maureen (CDC/DDID/NCEZID/DGMQ) ; Contreras, Sonia (CDC/DDID/NCEZID/DGMQ) ; Montiel, Sonia (CDC/DDID/NCEZID/DGMQ) (CTR) ; Arrouzet, Cory (CDC/DDID/NCEZID/DGMQ) ; Clements, Crystal (CDC/DDID/NCEZID/DGMQ) ; Goryoka, Grace (CDC/DDID/NCEZID/OD) ; Angelo, Kristina (CDC/DDID/NCEZID/DGMQ) ; Borntrager, Denise (CDC/DDID/NCEZID/DGMQ) ; Coffee, Elizabeth (CDC/DDID/NCIRD/DVD) (CTR) ; Tyler,Carla (DSHS) ; Sidwa,Tom (DSHS) ; Frieda Adams (Freida.Adams@state.nm.us) ; Olivia.Arizmendi@cdph.ca.gov ; Torres,David (DSHS) ; Delossantos,Rosy (DSHS) ; April Fernandez (april.fernandez@cdph.ca.gov) ; Kozo, Justine ; Paula Kriner ; Maria Fierro ; Robert Guerrero (robert.guerrero@azdhs.gov) ; Mariana Casal (mariana.casal@azdhs.gov) ; Corona Luevanos,Adriana (DSHS) ; Aldridge,Tiffany (DSHS) ; Gamez,Monica (DSHS) ; Eugene Livar ; McConnell, Michelle S (Mexico City) ; Pezzi, Clelia (CDC/DDID/NCEZID/DGMQ) ; Ledezma,Elvia (DSHS) ; Travis.Leyva@state.nm.us ; Cass, Anne (CDC cdph.ca.gov) ; Lee,Yihua (DSHS) ; Martinez,Angelica (DSHS Contractor) ; Foy,Elizabeth (DSHS) ; Vaaler,Margaret (DSHS) ; Rodriguez,MariaG (DSHS) ; Ruiz,Mauro (DSHS) ; Prot,Emilie (DSHS) ; Wendorf, Kristen (CDPH-CIDDCDC-TCB) ; Shah, Neha (CDC cdph.ca.gov) ; Perez,Alberto (DSHS) ; Rosenbluth,Lauren (DSHS) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Phippard, Alba (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) ; Paddock, Christopher (CDC/DDID/NCEZID/DVBD) ; Peterson, Amy (CDC/DDID/NCEZID/DVBD) ; Armstrong, Paige A (CDC/DDID/NCEZID/DVBD) ; Barrera, Roberto (CDC/DDID/NCEZID/DVBD) ; Hemme, Ryan Russell (CDC/DDID/NCEZID/DVBD) ; Adams, Laura E. (CDC/DDID/NCEZID/DVBD) ; Reyes, Monica (OS/OGA) ; Baker, Nicole (OS/OGA) ; Venkat, Heather (CDC azdhs.gov) ; Limon, Melissa, DOH ; hayley.yaglom@azdhs.gov ; Kjemtrup, Anne@CDPH ; Padgett, Kerry@CDPH ; Rubio, Bianka (CDC/DDID/NCEZID/DGMQ) (CTR) ; Edie.r.lederman@ice.dhs.gov ; Qualls,Whitney (DSHS) ; Kramer, Vicki (CDPH-CID-DCDC) (Vicki.Kramer@cdph.ca.gov) ; Nikos.Gurfield@sdcounty.ca.gov CC: Phippard, Alba (CDC/DDID/NCEZID/DGMQ) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Subject: RE: Prioritizing the Proposed Next Steps for the Infectious Disease Prioritization at the U.S. Southern Border Region Attachment(s): "Prioritize__Next_Steps_for_Disease_Priorization_5.1.2019.docx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, first I would like to thank everyone who sent in their prioritized lists prior to the deadline (folks in Arizona and Texas). We have extended the deadline until this Thursday May 23. Please fill the attached document out and return it to us by COB Thursday May 23. Thank you! Tom Gray Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 619.692.5625 office Good afternoon, Thank you for participating in the USMU’s Infectious Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Border Region. In order to finalize the general recommendations and proposed next steps and begin the implementation phase of this process we are asking everyone to do the following: TX-DSHS-19-1309-A-001784 By Friday May 17, please review the attached document (Prioritize_Next_Steps_for_Disease_Priorization_5.1.2019) and: § Assign each proposed next step a priority level; and § Indicate if you would like to participate in the efforts (conference calls, workgroups) to accomplish each proposed next step and if you would are interested in leading/co-leading that effort. § Propose any suggested changes on the wording of either the general recommendations or the proposed next steps. Using track changes would be preferred but not necessary. § Please return the completed document to Alba Phippard (ign7@cdc.gov) and Tom Gray (mze3@cdc.gov) by Friday May 17. For those of you interested in the recommendation to create a dashboard for visualization of border region infectious disease morbidity data, please let us know right away if you would like to discuss this further. The US-Mexico Border Health Commission is leading a somewhat related project, and it would be beneficial to further define the needs of our working group so efforts might be harmonized. As you may remember, we still need to flesh-out the proposed next steps for Health Education, Promotion & Capacity Building. For that we are proposing that we gather together a smaller group of individuals who have expertise in those areas to develop and prioritize those next steps for review by the larger group by early June. Bianka Rubio, USMU’s health communication specialist, will be leading that effort. Please be on the lookout tomorrow for an email further describing that effort and how to get involved. Much of the content (general recommendations, proposed next steps) will be incorporated into the final report for the larger disease prioritization effort. We will be reaching out to each state, through the original voting members, to discuss approval process for that final report shortly. Thank you and if you have any questions or comments please do not hesitate to reach out Tom Gray Alba Phippard Public Health Specialist Eagle Medical Services San Diego Quarantine Station, US-Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention BIDS Program Manager US - Mexico Unit Division of Global Migration and Quarantine Centers for Disease Control and Prevention 3851 Rosecrans St., Ste 715 San Diego, CA 92110 Office: (619) 692-8479 Mobile: (619) 206-0461 Telwork (Fri): (619) 206-0461 Email: APhippard@cdc.gov 619.692.5625 office To learn more about CDC's role in US-Mexico Health, visit: http://www.cdc.gov/USMexicoHealth/index.html Confidentiality Notice: This message and the accompanying documents may contain information that is privileged, confidential, or exempt from disclosure under applicable law. If the reader of this e-mail is not the intended recipient, you are hereby notified that you are strictly prohibited from reading, disseminating, distributing, or copying this communication. If you have received this e-mail in error, please notify the sender immediately and destroy the original transmission. Thank you. TX-DSHS-19-1309-A-001785 Infectious Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Border Region General Recommendations and Proposed Next Steps for Prioritized Diseases Name: State/Affiliation: Instructions: § By Friday May 17, please review the General Recommendations and Proposed Next Steps for the Infections Disease Prioritization for Multijurisdictional Engagement at the U.S. Southern Land Border. § Assign each next a priority level (1 – 3). § Indicate whether or not you would like to participate in efforts (conference calls, workgroups) to accomplish each next step and if you would be interested in leading or co-leading that effort. § Return the completed document to Alba Phippard (ign7@cdc.gov) and Tom Gray (mze3@cdc.gov). TX-DSHS-19-1309-A-001786 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Coordination General Recommendations Enhance existing mechanisms for coordinating initiatives between the U.S. federal, state, and local agencies involved in border health activities in the U.S.-Mexico border region to address the priority diseases. Existing mechanisms include: § CDC’s Binational Border Infectious Disease Surveillance (BIDS) Program; § Binational Technical Work Group (BTWG); § U.S.-Mexico Border Health Commission (BHC); and § Border sister-city/state/region binational meetings and committees. Coordi nation General Recommendations Conduct gap analysis1 for priority diseases in the border region to inform development of comprehensive approaches. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Explore opportunities to integrate existing mechanisms (BHC, BIDS, BTWG) to enhance coordination, leverage best practices, and reduce duplication of efforts. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with the BTWG on broadening partner participation on monthly teleconferences by including, based on the meeting topic and goal, different federal, state, and local partners and relevant subject matter experts and decision makers in programs such as STD/HIV, TB, and healthcare-associated infections. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with BTWG to address topic areas specific to Aedes-borne arboviruses and Rickettsioses and regularly exchange surveillance information on insecticide resistance. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Identify and leverage resources for annual face-to-face meetings of local, state and federal partners involved in border/binational health. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Next Steps Priority Involvement TB Next Steps § Convene a workgroup of the states/partners to discuss scope of gap analysis and level of priority. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001787 Page 2 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations 1Gap Coordination analysis: process to determine the difference (the gap) between current program practices/capabilities and the needs of the community and current evidence based best practices. Priority Involvement Aedes and Rickettsioses Next Steps § None recommended. Enteric Next Steps § Unclear if needed at this time. Share state models for exchanging public health Next Steps (General, Aedes, Enteric, data electronically with Mexican health jurisdiction Rickettsioses and TB) partners. § Share information and materials for existing models in the border region (e.g. ADHS MEDSIS). § Identify cross-border data sharing programs in other countries and research the Pulse Net data sharing agreement between the U.S. and Canada. General Recommendations Surveillance Next Steps Prioritize identification of binational outbreaks/clusters of priority diseases. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Priority Involvement Aedes and Rickettsioses Next Steps § Continue to strengthen bilateral communication with Mexico, for example, via binational forums focused on Aedes-born diseases and Rickettsioses such as BTWG meetings and broader conferences. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Establish a system to monitor Spanish ProMed for reports of outbreaks in Mexico. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric Next Steps § Review border state/county clusters and drug resistant cases that may require collaboration. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001788 Page 3 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Surveillance General Recommendations Engage community healthcare providers, including correctional health, to ensure surveillance and reporting mechanisms are in place for monitoring infectious diseases among mobile populations. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement TB Next Steps § Review border state/county clusters and pediatric case investigations that may require collaboration. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead General Next Steps § Explore how USMU and Border Health Commission can assist the states to engage Department of Homeland Security (DHS) partners for improved communication, reporting and coordination. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Convene workgroup to discuss strategies for engaging community health care providers on disease reporting (e.g. provider education on diagnosis and reporting, assessments of current reporting activities and quality improvement). ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Aedes Next Steps § Develop approaches, including potential thresholds, to alert border region community health centers serving mobile populations about increases in Aedes mosquito populations, cases or outbreaks of Zika, dengue, or chikungunya to stimulate and increase testing of patients with acute febrile illness. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001789 Page 4 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Rickettsioses Next Steps § Develop additional approaches to better integrate veterinary and public health surveillance and systematize crossreporting between sectors. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Implement strategies to educate providers on the diagnostic tests and testing requirements for rickettsioses, as well as appropriate treatment. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Work with DHS partners such as Immigration and Customs Enforcement and U.S. Customs and Border Protection to improve understanding of these agencies public health surveillance and reporting systems, and identify opportunities to enhance surveillance among both employees and immigrant populations. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric and TB Next Steps § Leverage existing cross-border projects to establish best practice for cross-border contact tracing infrastructure. Prioritizing Proposed Next Steps for Disease Prioritization TX-DSHS-19-1309-A-001790 Page 5 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Surveillance General Recommendations Create a web-based dashboard for selected notifiable diseases with county level and aggregated border region data for increased understanding of case counts, rates and trends in the border region. Dashboard features could include mapping and interactive features based on resources and feasibility. Next Steps Priority Involvement Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Establish a workgroup to discuss: o Feasibility, resources and required partners. o Inclusion of data from non-border counties to show true scope and pattern of disease burden. o Variables for inclusion. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Surveillance § Explore how similar programs have shared data through web-based applications: o CDCs NCHHSTP ATLASPlus Mapping and Visualization Tool for HIV, Hepatitis, STD and TB and CDC Wonder o Arizona Disease Data & Statistics Tables o Arizona Flu Disease Tables o PulseNet – enteric data displays. General Recommendations Next Steps Strengthen surveillance for prioritized vectorborne diseases and vector presence in the border region through active surveillance approaches. Aedes and Rickettsiosis Next Steps: § Discuss feasibility of implementing syndromic sentinel surveillance for acute febrile illness with confirmatory testing at key sites in the border region. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Convene key border agency partners to explore and further operationalize participatory surveillance for vector-borne diseases and vector presence for the border region. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Prioritizing Proposed Next Steps for Disease Prioritization Priority Involvement TX-DSHS-19-1309-A-001791 Page 6 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Laboratory Not applicable for enteric or TB. Review and implement approaches to strengthen surveillance and laboratory practices for antimicrobial resistance in the border region. Ensure that culture-independent diagnostic testing does not reduce high quality public health surveillance in the border region. Prioritizing Proposed Next Steps for Disease Prioritization Enteric and TB Next Steps § Identify venues (BTWG, face to face meetings) that can be used to discuss whole genome sequencing (WGS) and its potential impact on surveillance in the border region. Topics for discussion include: o How state health departments are managing ability/inability to conduct WGS for enteric specimens and the prioritization of specimens for testing. o Time delays inherent with WGS. o Possibility that gaps in enteric surveillance will widen with WGS and fewer outbreaks will be identified. o How best to use WGS to investigate highest priority clusters o How to engage with Mexican partners to identify cross-border clusters. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Enteric Next Steps § Assess diagnostic methods used for enteric disease surveillance to ensure identification of outbreaks and drug resistance. § Identify current and best practice state regulations for culture and susceptibility testing of priority diseases where use of CIDT can limit identification of resistant strains. § Improve timeliness of enteric disease confirmatory testing. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001792 Page 7 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Outbreak Response & Preparedness Next Steps for Aedes and Rickettsioses were not identified. Continue to use the BTWG and opportunities for face-to-face meetings, to work with partners, including Mexican counterparts, to address preparedness, foster awareness of emerging public health issues and encourage collaboration. General Recommendations Prioritizing Proposed Next Steps for Disease Prioritization Next Steps (General, Aedes, Enteric, Rickettsioses and TB) § Use existing forums (e.g. BHC, BTWG, local meetings) as platforms to discuss: o Solutions to ongoing challenges with crossing specimens for public health purposes (both routine crossings and during an outbreak). o Preparedness and response capacity building, through tabletop exercises, and sharing best practices (including sharing regional plans). o Data sources (e.g. U.S. federal detention data and Mexico’s national surveillance system) that are important for outbreak response and preparedness activities. o Mechanisms to coordinate and leverage prevention messaging between partners to strengthen outbreak response. o Outbreak investigations. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Evaluate the use of the Operational Protocol for Binational Communication and Coordination on Disease Notifications and Outbreaks and regional sub-plans to inform revision and strengthening. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Next Steps Priority Involvement TX-DSHS-19-1309-A-001793 Page 8 Outbreak Response & Preparedness Outbreak Response & Preparedness Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations Next Steps Priority Involvement Expand, standardize and maintain mosquito surveillance to improve description of the geographic distribution of Aedes mosquitoes and where transmission is more likely to occur. Aedes Next Steps § Make recommendation, when feasible, for regional VBD Centers of Excellence to cover New Mexico in their surveillance activities. § Share known resources related to riskmodeling and forecasting challenges. § Better disseminate information about Mexico’s surveillance and data. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TB Next Steps § Optimize existing efforts for disease notification and follow-up (e.g. TB contact projects in California and Texas, CureTB, and the meet and greets coordinated by ADHS staff). ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead § Improve educational approaches for persons who leave the U.S. from custody settings after exposure to TB, and potentially other priority diseases. ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead Not applicable for enteric diseases, rickettsioses or TB. Enhance follow-up of patients or contacts that cross the border or who are deported after diagnosis or exposure for improved infectious disease control efforts. Identify best practices and continuing challenges in follow-up of binational patients with select notifiable diseases in the border region. This acknowledges that surveillance systems may be sufficient for some diseases, but there are limited resources and mechanisms for comprehensive follow-up (i.e. case-holding, monitoring, and Prioritizing Proposed Next Steps for Disease Prioritization TX-DSHS-19-1309-A-001794 Page 9 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 General Recommendations contact tracing). Next Steps Priority Involvement Aedes and Rickettsioses Next Steps § No recommendations. Enteric Next Steps § Unclear if needed at this time. Outbreak Response & Preparedness General Recommendations Next Steps Priority Involvement Develop and implement evidence-based methods General Next Steps to evaluate population mobility and healthcare § Convene workgroup(s) to discuss strategies use patterns among U.S.-Mexico border crossers. for capturing healthcare access/patterns of seeking care of mobile populations. Prioritizing Proposed Next Steps for Disease Prioritization ☐1 ☐2 ☐3 ☐ Yes ☐ Lead/Colead TX-DSHS-19-1309-A-001795 Page 10 Prioritizing Proposed Next Steps for Prioritized Diseases, Please Return by 5.17.2019 Health Education, Promotion & Capacity Building General Recommendations Improve education and outreach for populations with limited English proficiency. Ensure education materials for specific populations are tested for accuracy and understandable messaging. Prioritizing Proposed Next Steps for Disease Prioritization Next Steps Priority Involvement General Next Steps § Create opportunities and a platform for regular sharing of validated educational and prevention materials in border communities. § Leverage the Mexican Consulate’s Ventanilla de Salud network to reach their unique population (e.g. to provide health education or test educational materials). Due to time constraints next steps have not been discussed as a group. TX-DSHS-19-1309-A-001796 Page 11 From: Electronic Data Exchange (CDC) Sent: Tuesday, May 21, 2019 2:47 PM EDT To: Electronic Data Exchange (CDC) CC: Hoover, Michele (CDC/DDPHSS/CSELS/DHIS) Subject: DHIS to Present NNDSS and Other Surveillance-related Sessions at 2019 CSTE Annual Conference WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. DHIS to Present NNDSS and Other Surveillance-related Sessions at 2019 CSTE Annual Conference The CDC Division of Health Informatics and Surveillance (DHIS) is excited to announce several surveillance-related sessions at the 2019 Council of State and Territorial Epidemiologists (CSTE) Annual Conference, including sessions on the National Notifiable Diseases Surveillance System (NNDSS), Epi Info, NEDSS Base System (NBS), and the National Syndromic Surveillance Program (NSSP). This year’s conference is in Raleigh, North Carolina, on June 2–6. On Sunday, June 2, 8:00 am–5:00 pm, the NNDSS and NSSP teams will participate in a workshop, “Surveillance/Informatics— Surveillance: Getting from Data to Action,” that will provide learning opportunities and small group dialogue around policies and practices that support effective collection and use of public health surveillance data, particularly as it relates to effective data visualization to motivate action. The goals of this workshop are the following: • Provide information about the framework, priorities, and implementation of the CDC Public Health Data strategy. • Provide a forum for discussing new surveillance opportunities among CSTE members, CDC staff, other public health partners, and key stakeholders. • Facilitate peer-to-peer learning and discussion across organizational and disciplinary boundaries. • Identify current and evolving workforce needs to enhance public health’s ability to access relevant data and use it meaningfully. Also, on Sunday, June 2, 9:00 am–5:00 pm, the Epi Info™ team will present a full-day workshop on “Epi Info,” a public domain suite of software tools designed for the public health community and used for outbreak investigations; for development of small to mid-sized disease surveillance systems; as analysis, visualization, and reporting components of larger systems; and in the continuing education in the science of epidemiology and public health analytic methods at schools of public health around the world. The workshop has two parts: · Part I will provide an overview of Epi Info suite of products. The session will discuss the data collection need during a public health event and how various kind of data collection scenarios are handled through Epi Info™ products. Participants will learn how to quickly design data collection forms using the Epi Info™ Form Designer and explore various solutions for data collection (Web and Cloud solutions https://www.cdc.gov/epiinfo/cloud.html and Epi Info™ for Mobile (https://www.cdc.gov/epiinfo/mobile.html). Hands-on exercises will be completed during the session. · Part II of the workshop will highlight importing data into a central database repository from data collected through the suite of product offerings (Desktop, Web & Cloud, and Mobile). Participants will learn how to set up dashboards to analyze data using the Visual Dashboard, explore the various statistical analyses that can be performed using Epi Info™, and learn the limitations and appropriateness of each for a given data set. On Monday, June 3, the NNDSS team will participate in three exciting sessions: · 10:30 am–12:00 pm: “NNDSS Modernization Initiative: Final Boarding Call,” Lesliann Helmus, DHIS associate director for surveillance; and Andrew Kuehl, Message Validation, Processing, and Provisioning System; · 1:00–1:45 pm: “Defining the Future for NNDSS,” Lesliann Helmus, DHIS associate director for surveillance; Paula Yoon, DHIS director; and Jennifer Adjemian, DHIS Surveillance and Data Branch chief; and · 5:45–6:30 pm: “Implementation of ‘Country of Usual Residence’ in the 2019 Tables of National Notifiable Infectious Diseases and Conditions,” Delicia Carey and Ruth Jajosky, DHIS Surveillance Operations Team. On Tuesday, June 4, DHIS staff will present the following two sessions: · 7:30–8:15 am: “NNDSS Low Incidence and International Quarantinable Disease Verification Protocol: Suggestions for Changes and Enhancements,” Ruth Jajosky, DHIS Surveillance Operations Team, and · 10:30–11:00 am: “Bring Your Own System: Implementing IIS Integration in Public Health Surveillance Using a System-agnostic Approach for Interoperability,” Michael Wodajo, NBS team. On Wednesday, June 5, DHIS staff will present the following two sessions: · 7:30–8:15 am: “Syndromic Surveillance Policy Issues—Open Discussion,” Michael Coletta, NSSP Program Manager and session facilitator, and · 1:00–1:45 pm: “Informatics and CDC Emergency Response: Options for Standardizing Emergency Case Notification Messaging to CDC,” Loretta Foster, DHIS Message Mapping Guide Team. Find more information about DHIS and its systems, programs, and initiatives at https://www.cdc.gov/csels/dhis/. Find more information about the CSTE 2019 Annual Conference at https://www.csteconference.org/2019/. TX-DSHS-19-1309-A-001797 From: Dutton,RJ (DSHS) Sent: Tuesday, May 21, 2019 6:54 PM EDT To: Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Reyes, Monica (OS/OGA) ; Torres,David (DSHS) CC: Corona Luevanos,Adriana (DSHS) ; DeLaFuente,Edith (DSHS) ; Banicki,Allison (DSHS) Subject: RE: next BHC Friday Sadly last time they allowed TB Echo to go for 60 minutes!! Come on people manage the agenda!! David will be great – I have a legislative mandated Task Force for Border Health Officials meeting Friday, June 7—takes priority and so unlikely I can sit in… I usually always make these calls -- especially with annual Commission meeting coming June 19-20 (so, will have someone from central office to sit in in case there are other issues for us to address). Thx, RJD From: Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) [mailto:kzm5@cdc.gov] Sent: Tuesday, May 21, 2019 5:27 PM To: Reyes, Monica (OS/OGA) ; Torres,David (DSHS) Cc: Corona Luevanos,Adriana (DSHS) ; Dutton,RJ (DSHS) Subject: next BHC Friday WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. David is ready to go for TX BIDS presentation. As last time, plan for 10 min presentation and 5-10 min for project-related questions. I will be driving to a meeting in the desert…so if he can go first that would be great. Once I hit the mountains I will lose connectivity. Thanks… Kathleen Moser, MD Medical Officer, US-Mexico Unit – San Diego Office Division of Global Migration and Quarantine National Center for Emerging & Zoonotic Infectious Diseases Centers for Disease Control and Prevention Desk: 619-692-5628 Fax: 619-692-8821 Telework (Fri) 619-455-5383 TX-DSHS-19-1309-A-001798 From: Aldridge,Tiffany (DSHS) Sent: Tuesday, May 28, 2019 11:22 AM EDT To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) CC: Garcia,Imelda M (DSHS) Subject: RE: Question on ELC H1 Budget Attachment(s): "TX ELC Project H VBD Tier1 Budget - AL approved 05.02.19.xlsx","TX ELC Project H VBD Tiers 2 and 3 Budget - AL approved 05.02.19.xlsx","RE Question on ELC H1 Budget.msg" Good Morning Nga, Please see attached. We also sent it over with another request last week (see attached). There was not enough space in the itemized lines to add them so we sent them as an attachment as they were submitted last year. Please let me know if there is anything else you may need from us. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) [mailto:ypg2@cdc.gov] Sent: Tuesday, May 28, 2019 10:05 AM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: FW: Question on ELC H1 Budget WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi Tiffany – Could you help us with this request? We need the attachment with the lab supplies requested (~181k). Nga From: Lindell, Kristine (CDC/DDID/NCEZID/DVBD) Sent: Friday, May 24, 2019 11:12 AM To: Sidwa,Tom (DSHS) ; Robinson,Laura (DSHS) ; Qualls,Whitney (DSHS) Cc: Vuong, Nga (CDC/DDID/NCEZID/DVBD) ; Duggar, Christopher (CDC/DDID/NCEZID/DVBD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: Question on ELC H1 Budget Good afternoon, In reviewing Texas’s ELC Vector-borne Disease H1 Budget, we noticed reference to an attached list of supplies for $191,262. (“List of Supplies is included as an attachment to this application. The section for Supplies only allows us to enter 65 supplies but our supply list for this project included 132 items.”) However, we have had trouble locating this attachment in the supporting documents. Could you please re-send this list of supplies? Thank you very much, Kristine Kristine Lindell Public Health Advisor CDC/NCEZID/DVBD/ADB 3156 Rampart Road, MS P-02, Fort Collins, CO 80521 Cubicle Location: 3-218 Phone: 970-221-6402 E-mail: lgz7@cdc.gov TX-DSHS-19-1309-A-001799 From: Aldridge,Tiffany (DSHS) on behalf of Aldridge,Tiffany (DSHS) Sent: Friday, May 24, 2019 2:17 PM EDT To: Qualls,Whitney (DSHS) ; Thompson,Martha (DSHS) CC: Sidwa,Tom (DSHS) ; Robinson,Laura (DSHS) Subject: RE: Question on ELC H1 Budget Attachment(s): "TX ELC Project H VBD Tier1 Budget - AL approved 05.02.19.xlsx","TX ELC Project H VBD Tiers 2 and 3 Budget - AL approved 05.02.19.xlsx" The full budget was sent to CDC. There were too many items listed in Project H to add them all to the template. I’m attaching the DSHS approved budget with the list of supplies. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Qualls,Whitney (DSHS) Sent: Friday, May 24, 2019 12:59 PM To: Thompson,Martha (DSHS) Cc: Sidwa,Tom (DSHS) ; Robinson,Laura (DSHS) ; Aldridge,Tiffany (DSHS) Subject: FW: Question on ELC H1 Budget Martha, Do you have this? Whitney A. Qualls, MS, PHD Medical Entomologist Zoonosis Control Branch Texas Department of State Health Services Office: 512-776-2790 Cell: 512-774-8344 FAX: 512-776-7454 Whitney.Qualls@dshs.texas.gov Mailing Address: P.O. Box 149347, Mail Code 1956 Austin, Texas 78714-9347 Physical Address: 1100 W. 49 th Street, Mail Code 1956 Austin, Texas 78756-3199 Visit our website at: www.texaszoonosis.org CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code § 81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. From: Lindell, Kristine (CDC/DDID/NCEZID/DVBD) Sent: Friday, May 24, 2019 12:12 PM To: Sidwa,Tom (DSHS) ; Robinson,Laura (DSHS) ; TX-DSHS-19-1309-A-001800 Qualls,Whitney (DSHS) Cc: Vuong, Nga (CDC/DDID/NCEZID/DVBD) ; Duggar, Christopher (CDC/DDID/NCEZID/DVBD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: Question on ELC H1 Budget WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, In reviewing Texas’s ELC Vector-borne Disease H1 Budget, we noticed reference to an attached list of supplies for $191,262. (“List of Supplies is included as an attachment to this application. The section for Supplies only allows us to enter 65 supplies but our supply list for this project included 132 items.”) However, we have had trouble locating this attachment in the supporting documents. Could you please re-send this list of supplies? Thank you very much, Kristine Kristine Lindell Public Health Advisor CDC/NCEZID/DVBD/ADB 3156 Rampart Road, MS P-02, Fort Collins, CO 80521 Cubicle Location: 3-218 Phone: 970-221-6402 E-mail: lgz7@cdc.gov TX-DSHS-19-1309-A-001801 A 1 2 3 4 5 6 7 8 9 10 11 12 13 B Contents: Tab 1.  Tab 2.  Tab 3.  Tab 4. Tab 5.  Tab 6. C D 29 30 31 32 33 34 35 36 37 38 39 F G H Budget Template Instructions Budget Template PHS 424A DSHS Indirect Cost Calculator Sub-Contract Template Instructions Sub-Contract Template Funds Coordination and Management Branch (FCMB) staff members are available to provide assistance in completing the tool.  In addition, detailed training in either a group setting or one-onone can be provided on DSHS Grant processes. FCMB Contact list: Elaine McHard (512) 776 - 6646 Branch Manager Sharon Golden (512) 776 - 6562 Team Lead Grants Budget Analysts: Anna Layfield (512) 776-2388 David de la Rosa (512) 776-3217 Karen Cathey (512) 776-3125 Community Health Improvement 14 15 16 17 18 19 20 21 22 Environmental Epidemiology & Disease Registries Joy Counce (512) 776 - 6564 23 24 Health Promotion & Chronic Disease Prevention Joy Counce (512) 776 - 6564 25 26 Maternal & Child Health Suzanne Lucignani (512) 776 - 2591 27 28 E DSHS Grant Budget Template Funds Coordination and Management Branch Revised 01/07/2019 Sharon Golden (512) 776 - 6562 Joy Counce (512) 776 - 6564 Elaine McHard Sharon Golden Joy Counce Sharon Golden Sharon Golden Elaine McHard  All Sections All Sections All Sections, except below Maternal and Child Health Block Grant National Violent Death Reporting System Zika Health Program Grant (512) 776 - 6646 Executive Offices (512) 776 - 6562 All Sections Consumer Protection (512) 776 - 6564 All Sections Laboratory & Infectious Disease Services (512) 776 - 6562 All Sections Regional & Local Health Operations (512) 776 - 6562 All Sections, except below PPHF Preventive Health and Health (512) 776 - 6646 Services Block Grant 40 Contents TX-DSHS-19-1309-A-001802 A I B C D E F I G I H Vacant areas - Please contact Elaine McHard (512) 776 - 6646 or Sharon Golden (512) 776 - 6562 for assistance. 41 42 I 43 44 I 45 DSHS Grant Budget Tool.xlsx I I I I I IRevised 01/07/2019 Contents TX-DSHS-19-1309-A-001803 A 1 2 3 4 B C I D E F G H I J Budget Template Instructions Funds Coordination and Management Branch Revised 01/07/2019 K L M This tab contains instructions for completing the Budget Template and should not be included in the grant application package.  In some cases, DSHS policy is cited in the definition to assist the grant developer in determining proper use of funds within the categorical budget. 5 6 I 7 A. Personnel Definition: Actual salaries and wages for all staff position in the proposed project. 8 9 *Enter the following information for each position in the Personnel category: 10 Position Title  11 % of Time 12 Last, First Name of Staff 13 Budget # I 14 Position # 15 Position Description 16 Annual Salary 17 Longevity, if applicable 18 Benefit Replacement Pay (BRP), if applicable 19 20 I Merits are no longer accounted for on grant applications. 21 22 I 23 B. Fringe I I I I - -24 -25 -26 -27 -28 -29 -30 -31 32 Definition: Fringe benefits paid by the employer on behalf of its employees. This includes employer contributions for social security, retirement, health and accident insurance and workers' compensation insurance. Fringe benefits requested should represent actual benefits paid for employees. *Current Fringe benefits rate is 36.62% effective 9/1/2017 The fringe benefit breakout is: Social Security - 7.65% Retirement - 10.00% Health Insurance -18.97%  (this includes the health insurance surcharge of 1%) C. Travel Definition: The cost of transportation, lodging, meals and related expenses incurred by staff while traveling to perform duties required by the proposed project. Please utilize the DSHS Travel Office website: http://online.dshs.internal/traveloffice.aspx to ensure proper costs are charged when completing the Tab 2 Budget template. *Current In-State lodging rate for 2019 is $85/night.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. *Current In-State Per Diem for 2019 is $46/day.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001804 Page #P of 39 A -33 -34 -35 -36 -37 38 I I I I G I I I I I I B I C D E F H I J K L M Please Note: Per DSHS Travel Office (12/2018), the DSHS maximum Lodging rate without an approved exception form is $85.00 for Lodging.  From the DSHS Travel office website refer to Rate section, GSA Maximum Lodging and Mileage Rates Within Texas for the appropriate State Fiscal Year and link to the GSA website. *Current Mileage reimbursement is $.58/mile effective 01/01/2019-12/31/2019 per HHSC Connection 01/07/2019. *Current Travel Reservation Fee is $12.00 based on the National Travel System's (NTS) contract for full service arrangements or $19.50  based on the Short's Travel Management System's contract for full service arrangements at: https://www.comptroller.texas.gov/purchasing/programs/travel-management/travel-agency/.  State Contract effective September 1, 2014 through August 31, 2019. *Current state airline contract with American Airlines and JetBlue Airways, effective 10/01/2015 - 08/31/2019. This section identifies baggage charges related to state business are reimbursable.  It is assumed that the first checked bag is necessary to complete business travel. Charges for excessive baggage may be reimbursed as long as the travel is related to state business (e.g. state-owned equipment). Agencies are responsible for ensuing the reasonableness of the reimbursement and number of baggage's necessary.  For additional information and updates, please utilize the DSHS Travel website at http://online.dshs.internal/traveloffice.aspx or contact the DSHS Travel Coordinator for assistance. NOTE: The sample spreadsheet reflects the $12.00 reservation fee for NTS full-service travel arrangements and should be adjusted based on the service requested. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001805 Page #P of 39 A B C 39 40 D. Equipment D E F G H I J K L M Definition: Equipment is defined by DSHS as non-expendable personal property with a unit cost of more than $5,000 and a useful life of more than one year. 41 *Detailed description of equipment is required. 42 NOTE: Indirect Cost is not charged on equipment. 43 44 45 E. Supplies Definition: Costs for materials and supplies necessary to carry out the program. 46 *Detailed description of supplies is required. 47 48 49 F. Contractual Definition: Activities identified in the scope of work that are delegated by the applicant to a second party; the cost of providing these activities are recorded in this category as either Sub-recipient or Vendor. Travel costs incurred by a second party while performing these activities should be included in this category. Contracts for administrative services are not included in this category; they are properly classified in the Other category. *Enter the following information for each contract in the Contractual category: A. Name of Contractor B. Method of Selection C. Period of Performance D. Scope of Work E. Method of Accountability F. Budget Justification and Detail: This maybe required by the Federal Agency 50 51 52 53 54 55 56 57 NOTE: Indirect Cost is charged up to the 1st $25,000 of each sub-recipient Category 4000 contract. 58 59 60 G. Other 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Definition: All other allowable direct costs not listed in any of the above categories are to be included in this category. Some of the major costs that should be budgeted in this category are: *contracts for administrative services *space and equipment rental *utilities and telephone expenses *data processing services *printing and reproduction expenses *postage and shipping *contract clerical or other personnel services *janitorial services *exterminating services *security services *insurance and bonds *equipment repairs or service maintenance agreements *books, periodicals, pamphlets, and memberships *advertising *registration fees *patient transportation *training costs, speaker fees and stipends *The Other Budget Category requires a general description of the service and cost.  The justification should include an explanation of the purpose of the service. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001806 Page #P of 39 I A B C 75 H. Indirect Cost I 76 77 78 79 80 81 82 83 84 85 - -86 -87 88 D I E F G H I J K L M I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information services). *Current I/C rate agreement dated 09/17/2018.  Rates are as follows: I I FIXED rate 9/1/2017 - 8/31/2018 Health Programs - 18.1% Laboratory Services - 33.9% Lab percentage should only be used for funds that will be budgeted on lab program IDs. Provisional rate 9/1/2018 - 8/31/2021 Health Programs - 18.1% Lab percentage should only be used for funds Laboratory Services - 33.9% that will be budgeted on lab program IDs. NOTE: *The categorical totals, excluding the contractual category, will automatically "link" to the PHS 424A, and DSHS Indirect Cost tabs upon completion of the Budget Template tab. In the DSHS Indirect Cost tab, the contractual dollar amounts from the Budget Template tab will need to be manually entered into the contractual category rows in the "Budget Template Total" column. Placement of the contractual items are determined by identifying contracts as either "sub-contracts in excess of $25,000" or "sub-contracts up to $25,000". The contract dollar amounts will need to be manually entered into the appropriate row to populate the "Budget Template Total" field. In addition, the number of contracts will need to be included in the "# of contracts" field. The Sub-total Contractual row will ensure that the contractual categorical dollar amount and the number of contracts equal those on the Budget Template tab. **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate for the "Effective Period" of 9/1/2017 - 8/31/2018 and 9/1/2018 - 8/31/2021. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect cost rate. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001807 Page #P of 39 A B C D E F G H I J 1 Texas Department of State Health Services 2 3 4 5 ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond CK14-140105PPHF18, Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Budget Request Period: 8/1/19-7/31/20 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A. $144,153 Personnel Position % of Time Annual Salary Benefit Annual Longevity Replacement Pay (BRP) Months Total 1. Epidemiologist II 100% $51,508 $1,200 $0 12 $52,708 EPI Arshadmansab, Sepehr (H21400/Position # 85197) Position Description: Provides expertise and complex consultative support and technical assistance on zoonotic diseases with emphasis on arboviral diseases. In coordination with Zoonosis Control Branch (ZCB) epidemiologists, communicates with public health regions and local health departments, laboratories, and other disease data providers for issues involving case   reporting   and   data   management.   The   position   supports   the   ZCB   epidemiologists   in   data   management   including document intake, quality assurance, data entry, and filing that facilitate the ultimate reporting of data to CDC.  This position is currently federally-funded by ELC Zika Response funds that expire 7/31/2019. This position is vital to the day-to-day ZCB ELC activities. Currently ELC Zika Response funded 2. Program Specialist IV 100% $46,287 $0 $0 12 $46,287 EPI Owens, Kamesha (H21400/Position # 85198) Position Description:   Performs   advanced   work   related   to   epidemiology   of   and   surveillance   for   vector-borne   diseases including arboviral diseases. The position also provides advanced consultative services and technical assistance to health care   providers,   public   health   regions   and   local   health   departments   on   the   diagnosis,   treatment,   and   reporting   of   these notifiable conditions. This position is currently federally-funded by ELC Zika Response funds that expire 7/31/2019. This position is vital to the day-to-day ZCB ELC activities. Currently ELC Zika Response funded 3. Molecular Biologist III 100% $45,158 $0 $0 12 $45,158 LAB/ECO NEW (H41000/Position # TBD) Position Description:   This   will   be   a   split   position   between   the   Arbovirus   Laboratory   and   the   Viral   Isolation   Laboratory. Performs   highly   complex   (senior-level)   molecular   biology   work.   Primary   responsibilities   include   supervising,   training   and conducting   arbovirus   testing   on   mosquito   specimens   and   clinical   specimens.   Coordinates   and   performs   all   aspects   of arbovirus diagnostic work including nucleic acid extractions, real-time multiplex RT-PCR analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting   requirements.     Consults   with   medical   personnel/Epidemiologists   regarding   test   application   and   interpretation. Participates in the preparation and supervision of validation studies. Prepares SOP documents. Supervises and trains staff. 22 B. H41000 Fringe $52,789 H21400 Fringe Fringe Benefits 2. Budget Template TX-DSHS-19-1309-A-001808 #P of ]  K L M N O P Q R S T U V 1 2 3 4 5 PERSONNEL TOTAL 6 7 H41000 H21400 8 9 TOTAL SALARIES $144,153 $45,158.00 $98,995.00 Months are NOT included in the Total calculation 10 11 12 13 14 15 16 17 18 19 20 21 $16,537 22 $36,252 2. Budget Template TX-DSHS-19-1309-A-001809 #P of ]  A 23 24 I I I I I I B C D E F G Fringe benefits are applicable to direct salaries and treated as direct costs.  Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% I I I I 2. Budget Template I H I J I TX-DSHS-19-1309-A-001810 #P of ]  A 25 C. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 Travel B C D E F G H 1. In-State $7,984 a. Travel description: DSHS Medical Entomologist, PSIII (Border Entomologist), and three arbovirus laboratory staff will travel to the Texas Mosquito Control Association (TMCA) meeting.  Opportunity to gain knowledge and discuss current trends in arbovirus surveillance for Texas. Requesting attendance to develop presentation skills and to provide networking opportunities. ECO $3,210 Mileage:  1 trip x  5 persons x 350 miles r/t @ $.58/mile $1,015 Airfare: # persons @ $? r/t $0 Ground Transportation:  # persons @ $? $0 Lodging:  3 nights @ $85/night x 5 persons x 1 trip $1,275 Per Diem:  4 days @ $46/day x 5 persons x 1 trip $920 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 b. Travel description: The State Medical Entomologist and one arbovirus Laboratory staff to attend the South Texas Tropical Medicine and Vector-borne Diseases Conference (South Padre Island, Feb 2020). Opportunity to give a presentation on guidance for integrated vector management and the services provided by the DSHS Arbovirus Surveillance Program in Texas. ECO $978 Mileage:  # trips x  # persons x # miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $50 x 1 trip (2 staff traveling in state $100 vehicle. Includes gas.) Lodging:  3 nights @ $85/night x 2 persons x 1 trip $510 Per Diem:  4 days @ $46/day x 2 persons x 1 trip $368 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 c Travel description: The State Medical Entomologist and One arbovirus Laboratory staff  to attend the Western Gulf Center of Excellence for Vector-borne Diseases 4th Annual Conference (Location and Date TBD). Opportunity to discuss ongoing collaborations and training activities with local health departments and academic partners. ECO $716 Mileage:  # trips x  # persons x # miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $50 x 1 trip (2 staff traveling in state vehicle. Includes gas.) $100 Lodging:  2 nights @ $85/night x 2 persons x 1 trip $340 Per Diem:  3 days @ $46/day x 2 persons x 1 trip $276 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 2. Budget Template ECO ECO I $25,374 TOTAL J TOTAL a H41000 H21400 b H41000 H21400 ECO c H41000 H21400 TX-DSHS-19-1309-A-001811 #P of ]  K 25 H41000 26 H21400 L M N O P Q R S T U V $14,654 $10,721 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 $2,408 $803 $489 $489 43 44 45 46 47 48 49 50 51 52 $358 $358 53 54 55 56 57 58 2. Budget Template TX-DSHS-19-1309-A-001812 #P of ]  A 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 B C D E F d Travel description: Travel for four zoonosis control branch staff to attend Diseases in Nature Conference (DIN) to be held in Austin or San Antonio in the Spring of 2020. DIN is a onehealth, zoonotic disease-focused annual conference which includes vector-borne disease topics. Attendees include physicians, nurses, veterinarians, and public health professionals such as epidemiologists. Attending staff will have the opportunity to receive current, authoritative information on zoonotic diseases, including surveillance, prevention, detection and control. Attending staff may also be on the conference agenda to speak or present poster(s) based upon conference acceptance of abstracts.  EPI $3,080 Mileage:  1 trip x  2 persons x 0 miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $200 rental cars (2 staff travelling from Rio Grande Valley and Houston areas. 2 staff travelling in state vehicles.) $400 Lodging:  3 nights @ $158/night x 4 persons x 1 trip $1,896 Per Diem:  4 days @ $46/day x 4 persons x 1 trip $736 Travel Fees:  4 persons @ $12.00 x 1 trip $48 Baggage Fees-determined by carrier:# persons @ $? $0 G H EPI 2. Out-of-State I J d H21400 $17,390 a. Travel description: The   medical   entomologist,   regional   medical   entomologist,   and   two arbovirus team members will travel to the American Mosquito Control Association (AMCA) meeting in Portland, Oregon. Opportunity to discuss current trends and protocols in arbovirus surveillance nationwide. Also, meet with colleagues from other state health departments and CDC to discuss high throughput mosquito testing programs and mutual challenges we all face regarding endemic and newly emerging arboviruses. $8,048 Mileage:  # trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 4 persons @ $800 r/t  x 1 trip $3,200 Ground Transportation:  4 persons @ $75 x 1 trip $300 Lodging:  5 nights @ $169/night x 4 persons x 1 trip $3,380 Per Diem: 5 days @ $46/day x 4 persons x 1 trip $920 Travel Fees:  4 persons @ $12.00 x 1 trip $48 Baggage Fees-determined by carrier: 4 persons @ $50 x 1 trip $200 b. Travel description: The   State   Veterinarian   and   one   laboratory   arbovirus   team   member   to attend the Annual ELC Grantee Meeting in Atlanta in 2020. $1,850 Mileage:  # trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 2 persons @ $450 r/t x 1 trip $900 Ground Transportation:  2 persons @ $35 x 1 trip $70 Lodging:  2 nights @ $120/night x 2 persons x 1 trip $480 Per Diem:  3 days @ $46/day x 2 persons x 1 trip $276 Travel Fees:  2 persons @ $12.00 x 1 trip $24 Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $100 2. Budget Template ECO a. H41000 H21400 ECO b. H41000 H21400 TX-DSHS-19-1309-A-001813 #P of ]  K 59 60 61 62 L M N O P Q R S T U V $3,080 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 $4,024 $4,024 $925 $925 2. Budget Template TX-DSHS-19-1309-A-001814 #P of ]  A 91 92 93 94 95 96 97 98 99 I I I B C D E F Travel description: - One   Laboratory   Staff   to   attend   the   Florida   Advanced   Mosquito c.  --Identification and Certification Course in 2020 for continued proficiency and skills needed for mosquito surveillance in Texas.  This advanced coursework for mosquito identification is not offered in Texas. $5,408 I I I Mileage:  trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 1 person @ $500 r/t  x 1 trip $500 I Ground Transportation:  1 person @ $80 X 17 trips $1,360 I Lodging:  16 nights @ $169/night x 1 person x 1 trip $2,704 Per Diem:  17 days @ $46/day x 1 person x 1 trip $782 Travel Fees:  1 persons @ $12.00 x 1 trip $12 Baggage Fees-determined by carrier: 1 persons @ $50 x 1 trip $50 2. Budget Template G H ECO I J c. H41000 TX-DSHS-19-1309-A-001815 #P of ]  K 91 92 93 94 95 96 97 98 99 L M N O P Q R S T U V $5,408 2. Budget Template TX-DSHS-19-1309-A-001816 #P of ]  A 100 101 102 103 104 105 106 107 108 109 110 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 D E F G I J d. H21400 H41000 ECO $0 Item Requested Qty Unit Cost $0 Amount 0.00 $191,262 Supplies Item Requested 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 H Equipment 1. [Item Name] -  Description: 117 E. 118 119 C d. Travel description: The State Medical Entomologist and One arbovirus Laboratory staff  to attend   the   CDC   Vector-borne   Disease   Meeting   in   Fort   Collins,   Colorado   (Spring   2020). Opportunity to discuss VBD collaborations and training activities with CDC colleagues. $2,084 Mileage:  trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 2 persons @ $300 r/t x 1 trip $600 Ground Transportation:  2 persons @ $50 x 1 trip $100 Lodging: 3 nights @ $116/night x 2 persons x 1 trip $696 Per Diem:  4 days @ $61/day x 2 persons x 1 trip $488 Travel Fees:  2 persons @ $50.00 x 1 trip $100 Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $100 111 D. 112 113 114 115 116 B CDC Light Traps BG Sentinel Traps 12 Volt Batteries CDC gravid traps 6 volt batteries Hanging dry ice dispensers aspirators Shipping mosquito samples to lab Battery Chargers Iphone (RME) DPP ZIKA IgM Reagents DPP ZIKA IgM Controls DENV Detect IgM Kit Dengue IgM Positive Control Dengue IgM Negative Control CHIKV IgM Kit Sample Tube 4 mL Screwcap w/ O-ring 50 mL Conical Tube Control Vials 1.5 mL microcentrifuge tube EP Tips 2-20 uL EP Tips 2-100 uL Pipette tips 1250ul  tips 250µl  tips 10µl 50 50 50 50 100 50 20 250 10 1 16 2 16 20 20 14 1 1 1 1 1 1 1 2 3 2 Qty Unit Cost 90.95 165.85 112.65 97.00 29.00 18.00 160.00 20.00 50.00 99.99 490.00 45.00 504.00 53.00 53.00 497.00 130.31 120.84 90.33 12.75 36.26 192.16 162.19 90.32 28.28 20.00 Amount 4,547.50 8,292.50 5,632.50 4,850.00 2,900.00 900.00 3,200.00 5,000.00 500.00 99.99 7,840.00 90.00 8,064.00 1,060.00 1,060.00 6,958.00 130.31 120.84 90.33 12.75 36.26 192.16 162.19 180.64 84.84 40.00 2. Budget Template H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 ECO ECO ECO ECO ECO ECO ECO ECO ECO ECO LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB $35,922 H21400 $155,340 H41000 Serology TX-DSHS-19-1309-A-001817 #P of ]  K L M N O P Q R S T U V 100 101 102 103 104 105 106 107 108 109 110 $1,042 $1,042 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 2. Budget Template TX-DSHS-19-1309-A-001818 #P of ]  A 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 B EP Tips 50-1250 uL Sleeve Protectors Nitrile Gloves all sizes Latex Gloves all sizes Face Shield Full N95 Disposable Respirator Shoe Covers Sleeve Protectors VWR Impervious Gown U Sharps 1 quart Sharps 8 quart Biohazard bags 14x19 Biohazard bags 32 quart Biohazard container DSX Sample Tip DSX Reagent Tip DSX Reagent Tube Deep Well Dilution TMB ELISA HRP Substrate 10ml glass pipets 5ml glass pipets Pipette 5 mL Volumetric Pipette 5 mL Lockwell Frame 2HB Immulon plates Culture tubes 12x75mm Culture tubes 16x100mm Parafilm Film Polyester Sulfuric Acid 1.0N VWR Reagent Reservoir 6B6C-1 Affinity HRP Conj Goat Affinity Purified Ab IgM EL22-WNV antigen EL325 – WNV tissue control AG/TC diluent Paper Towel 6B6C-1 Affinity HRP Conj Goat Affinity Purified Ab IgM EL22-WNV antigen EL325 – WNV tissue control AG/TC diluent Nitrile Gloves all sizes Face Shield Full VWR Reagent Reservoir Yellow Tips, 200 uL 20 ul tips 96-well Microtiter, 2205 Volumetric Pipette 5 mL I C 2 2 31 2 1 2 2 3 1 52 52 1 5 52 3 2 24 1 2 1 1 3 1 2 3 1 1 30 1 2 1 5 2 8 8 3 1 5 2 8 8 3 21 1 1 8 1 3 1 D E 104.09 83.06 7.54 9.92 678.92 186.35 38.38 203.94 112.11 1.81 3.63 59.49 64.55 10.90 51.00 51.00 24.00 104.55 165.57 113.55 148.59 113.55 113.55 240.67 227.00 35.89 47.74 19.75 37.18 8.00 153.73 625.00 158.60 63.00 33.00 20.00 19.54 625.00 158.60 63.00 33.00 20.00 7.54 678.92 153.73 8.10 20.00 61.89 113.55 F 208.18 166.12 233.74 19.84 678.92 372.70 76.76 611.82 112.11 94.12 188.76 59.49 322.75 566.80 153.00 102.00 576.00 104.55 331.14 113.55 148.59 340.65 113.55 481.34 681.00 35.89 47.74 592.50 37.18 16.00 153.73 3,125.00 317.20 504.00 264.00 60.00 19.54 3,125.00 317.20 504.00 264.00 60.00 158.34 678.92 153.73 64.80 20.00 185.67 113.55 2. Budget Template G H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB I J TX-DSHS-19-1309-A-001819 #P of ]  A 195 196 197 198 199 200 201 76 77 78 79 80 81 82 202 83 203 84 204 85 205 86 206 87 207 88 208 89 209 90 210 91 211 92 212 93 213 94 214 95 215 96 216 97 217 98 218 99 219 100 220 221 222 223 224 225 101 102 103 104 105 106 226 107 I B C Culture Tubes 12x75mm Sharps 1 quart Biohazard bag 12-well slides Goat Serum Tween-80 FITC-conjugate Invitrogen Platinum SS III One Step qRTPCR Eppendorf 0.1-10 µL epTips Filtered Pipette Tips (Case of 960) Eppendorf .5-20 µL epTip Filtered Pipette Tips  (Case of 960) Eppendorf 2-200 µL epTip Filtered Pipette Tips   (Case of 960) Eppendorf 50-1000 µL epTip Filtered Pipette Tips  PCR  (Case of 960) Eppendorf 20-300 µL Dualfilter T.I.P.S Seal Max filtered tips (Case of 960) 1-100 µL Sorenson Multiguard Barrier Pipette Tips (Case of 960) ThermoScientific 2160P Extended Length ART 200 µL (pack of 768) Applied Biosystems MicroAmp Optical 8-Cap Strips (Box of 300) Applied Biosystems MicroAmp Optical Adhesive Film (Box of 100) Applied Biosystems MicroAmp Fast Optical 96-well Reaction Plates (Box of 20) Eppendorf 1.5 mL Natural Safe-Lock Micrcentrifuge Tubes (Box of 500) Invitrogen Nuclease-Free Water (10 bottles x 50 mL) Kimberly-Clark Profesional Kimtech Science Kimwipes 11.8 x 11.8 in (Case of 2940) Kimberly-Clark Profesional Kimtech Science Kimwipes 8.4 x 4.4 in (Case of 60) Kimberly-Clark Small Surgical Gown, Case of 34 Kimberly-Clark Basic Plus Lab-Coat/Blue, Small Kimberly-Clark Basic Lab-Coat/Blue, Medium Kimberly-Clark Basic Plus LabCoat/Blue,Large Kimberly-Clark Basic Lab-Coat/Blue, X-Large Rnase Away (6 x 475 ml) Bleachrite (Case of 4 bottles) QIAamp DSP viral RNA mini Kit (Qiagen) Ethanol (Molecular Grade) 500 mL Nunc Cryotubes 1.8 mL Starfoot Vials w/ Marking Area, Round Bottom Vials (Case of 1800) 1 104 1 2 2 1 1 12 40 D E 35.89 1.81 64.55 52.85 115.00 26.80 187.85 1,876.00 141.91 F H41000 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB LAB H I 22,512.00 H41000 LAB Viral Isolation 5,676.40 H41000 LAB 35.89 188.24 64.55 105.70 230.00 26.80 187.85 G 20 141.91 2,838.20 H41000 LAB 20 210.00 4,200.00 H41000 LAB 30 141.50 4,245.00 H41000 LAB 6 126.84 761.04 H41000 LAB 5 158.27 791.35 H41000 LAB 10 112.43 1,124.30 H41000 LAB 5 111.00 555.00 H41000 LAB 4 209.10 836.40 H41000 LAB 89.50 1,790.00 H41000 LAB 39.66 1,586.40 H41000 LAB 109.00 327.00 H41000 LAB 121.20 363.60 H41000 LAB 132.24 396.72 H41000 LAB 242.70 485.40 H41000 LAB 178.24 356.48 H41000 354.30 H41000 LAB LAB 20 40 3 3 3 2 2 2 2 2 2 3 5 8 1 177.15 180.00 180.00 370.48 73.18 219.62 27.50 1,588.89 360.00 360.00 740.96 219.54 1,098.10 220.00 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB 1,588.89 H41000 LAB 2. Budget Template J TX-DSHS-19-1309-A-001820 #P of ]  A 227 228 229 230 231 108 109 110 111 112 232 113 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 248 249 250 251 252 129 130 131 132 253 F. 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 1. A. B. C. D. B C MagNA Pure LC Total Nucleic Acid Isolation kits MagNA Pure LC Cartridge Seals MagNA Pure LC Sample Cartridges (120) MagNA Pure LC Tip Stands (200) MagNA Pure LC Reaction Tips, Large (960) MagNA Pure LC Medium Reagent Tubs 20 (150) MagNA Pure LC Tub Lids, Small/Medium (300) MagNA Pure 96 system fluid MagNA Pure 96 1000 Tips MagNA Pure 96 Lysis MagNA Pure96 Processing Cartridges MagNA Pure 96 Output MagNA Pure 96 Seal Foil MagNA Pure Small Volume Extraction Kits MagNA Pure 96 Needle (4) EasyMag Silica (48 tubes) EasyMag Lysis buffer (4 x 1L bottles) EasyMag Buffer 1 (4 x 1L bottles) EasyMag Buffer 2 (4 x 1L bottles) EasyMag Buffer 3 (4 x 1L bottles) EasyMag Disposables (48 sets) PerfeCTa MultiPlex qPCR SuperMix, Low ROX (200 x 50 mL) QIAamp DSP DNA Blood Mini Kit Human Genomic DNA Trizma hydrochloride solution D E F 4 3 3 2 2 499.00 170.00 121.52 274.00 381.00 2 212.00 2 40 9 9 9 4 2 11 2 2 2 2 2 2 2 2 5 4 7 G 1,996.00 510.00 364.56 548.00 762.00 H H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB 424.00 H41000 LAB 335.00 117.90 936.90 135.00 275.40 246.60 244.80 2,108.70 279.90 901.13 707.60 282.54 194.16 353.43 812.74 670.00 4,716.00 8,432.10 1,215.00 2,478.60 986.40 489.60 23,195.70 559.80 1,802.26 1,415.20 565.08 388.32 706.86 1,625.48 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB 418.65 837.30 850.00 1,133.60 244.30 H41000 H41000 H41000 H41000 LAB LAB LAB LAB 170.00 283.40 34.90 I $0 Contractual Sub-recipient (category 4000) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: J $0 $0 E. Method of Accountability: [Enter accountibility method here] F. Budget Detail and Justification: 1. A. B. C. D. Vendor (category 2001 or 2009) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: $0 2. Budget Template $0 TX-DSHS-19-1309-A-001821 #P of ]  K L M N O P Q R S T U V 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 The contractual dollar amounts must be manually entered into the Tab 4. DSHS Indirect Cost ,__ 254 to populate the Indirect Charges below. 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 2. Budget Template TX-DSHS-19-1309-A-001822 #P of ]  A 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 B I C D I E F G H I J E. Method of Accountability: [Enter accountibility method here] F. Budget Detail and Justification: 1. A. B. C. D. E. F. Vendor (category 2001 or 2009) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: [Enter SOW detail here] Method of Accountability: [Enter accountibility method here] Budget Detail and Justification: I I $0 $0 I I I I I 2. Budget Template TX-DSHS-19-1309-A-001823 #P of ]  A 289 G. 290 291 292 293 294 295 296 297 298 299 300 301 302 303 B C D E F Item Requested Number of Months Estimated Cost per Month Number of Staff Amount Requested Other 1. 2. 3. Item Requested 1. 7500 Fast Dx Service Contracts (Clinical Arbo Testing) 2. EasyMag Extractor Service Contract (clinical arbo PCR testing) 3. Roche MagNA Pure 96 Service Contract (Clinical Arbo PCR) 4. Roche MagNA Pure LC 2.0 (Clinical Arbo PCR) 5. Dynex DSX Service Contract (Serology testing) 6. TMCA Registration 7. AMCA Registration 8. Advanced Mosquito Identification Course Registration 9. Diseases In Nature Conference Registration, Epi/H21400 304 305 306 Total Direct Cost: 307 Total Indirect Charges: Number Needed G I J $68,475 $0 Amount Requested Unit Cost H H41000 H21400 $68,475 2 9,500.00 19,000.00 LAB 1 11,000.00 11,000.00 LAB 1 17,500.00 17,500.00 LAB 2 3,500.00 7,000.00 LAB 1 5 4 10,000.00 95.00 400.00 10,000.00 475.00 1,600.00 LAB ECO ECO 1 500.00 500.00 ECO 4 350.00 1,400.00 EPI $482,053 $134,300 Please see attached DSHS Indirect Cost attachment for calculation. 308 309 Total Budget: $616,353 2. Budget Template TX-DSHS-19-1309-A-001824 #P of ]  K L M 289 A list of "Other" items are listed on the tab 1. 290 291 292 293 294 N O P Q R S T U V $66,085 $2,390 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 2. Budget Template TX-DSHS-19-1309-A-001825 #P of ]  A 1 - ~ D E F G OMB Approval No. 0348-0044 SECTION A - BUDGET SUMMARY 5 6 7 - C BUDGET INFORMATION - Non-Construction Programs 2 3 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 -40 41 42 43 44 45 46 47 48 B Grant Program Catalog of Federal Function or Activity Domestic Assistance Number Federal Non-Federal Federal Non-Federal Total (a) (b) ( c ) (d) (e) (f) (g) 1. Project H: VectorBorne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tier 1) Estimated Unobligated Funds 93.323 New or Revised Budget $0 $0 $616,353 $0 $616,353 $0 $0 $616,353 $0 $616,353 2. 3. 4. 5.  TOTALS SECTION B - BUDGET CATEGORIES 6.  Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) a.  Personnel Total (5) (4) $144,153 $144,153 b.  Fringe Benefits $52,789 $52,789 c.  Travel $25,374 $25,374 d.  Equipment $0 $0 $191,262 $191,262 f.  Contractual $0 $0 g.  Construction $0 $0 $68,475 $68,475 e.  Supplies h.  Other i.  Total Direct Charges (sum of 6a - 6h) $482,053 j. Indirect Charge $134,300 $0 $0 $0 k.  TOTALS (sum of 6i and 6j) $616,353 $0 $0 $0 $616,353 $0 $0 $0 $0 $0 7.  Program Income $482,053 $134,300 Standard Form 424A     (7-97) Prescribed by OMB Circular A-102 SECTION C - NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12.  TOTALS (sum of lines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $616,353 $154,088 $154,088 $154,088 $154,089 $0 $0 $0 $0 $0 $616,353 $154,088 $154,088 $154,088 $154,089 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 13.  Federal 14. NonFederal 15. TOTAL (sum of lines 13 and 14) SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b) First (c) Second (d) Third 16. 3. PHS 424A (e) Fourth I I TX-DSHS-19-1309-A-001826 49 50 51 52 53 54 55 56 A I B C D E F G 17. 18. 19. 20.  Totals (sum of lines 16-19) 21. Direct Charges:   I $0 SECTION F - OTHER BUDGET INFORMATION $482,053 22.  Indirect Changes: $0 $0 $0 $134,300 23.  Remarks:  The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.9%. I SF 424A (7-97)    Page 2 3. PHS 424A TX-DSHS-19-1309-A-001827 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 B C D E F ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018 @ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (Sub-recipient in excess of $25,000) Contractual (Sub-recipient up to $25,000) Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other Total - Health Programs LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (sub-contracts in excess of $25,000) Contractual (sub-contracts up to $25,000) Contractual (Vendor contracts - DSHS Category 2000) Sub-total Contractual Other Total - Laboratory Services TOTAL INDIRECT COST Direct # of Charges Total contracts $98,995 $36,252 $10,721 $0 $35,922 $98,995 $36,252 $10,721 $0 $35,922 $17,918 $6,562 $1,940 $0 $6,502 $0 0 $0 $0 $0 $0 $2,390 $184,280 0 0 0 $0 $0 0 $2,390 $184,280 Direct # of Charges Total contracts $45,158 $16,537 $14,653 $0 $155,340 H I J K L Applicable IDC Rate Amount at 18.1% charged IDC $0 0 G The contractual dollar amounts must be manually entered into the appropriate row to populate the "Direct Charges Total" field.  In addition, the number of contracts will need to $0 be included in the "# of contracts" field.  The Sub-total Contractual row will ensure that the $0 contractual categorical dollar amount and the number of contracts equal those on the $0 Budget Template tab. $433 $33,355 $217,635 Applicable IDC Rate Amount at 33.9% charged IDC $45,158 $16,537 $14,653 $0 $155,340 $15,309 $5,606 $4,967 $0 $52,660 $616,353 $0 The contractual dollar amounts must be manually entered into the appropriate row to populate $0 0 $0 $0 $0 $0 $66,085 $297,773 0 0 0 0 $0 $0 $0 $66,085 $297,773 $0 "# of contracts" field.  The Sub-total Contractual row will ensure that the contractual categorical dollar $0 amount and the number of contracts equal those on the Budget Template tab. $0 $22,403 $100,945 $398,718 $482,053 0 $482,053 $134,300 the "Direct Charges Total" field.  In addition, the number of contracts will need to be included in the The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; 33 Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%.  At DSHS these contracts are expended in the Other 34 category and full indirect cost is charged. 35 Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. 36 37 -38 -39 40 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001828 41 A I B I C I D I E F G H I J K **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect 42 cost rate. 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001829 L 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 A B I C I I I I I I I D E F G H Sub-Contract Template Instructions I J K L Revised 02/01/2017 I I This tab contains instructions for completing the Sub-Contract Template and should not be included in the grant application package. In some cases, DSHS policy is cited in the definition to assist the budget developer in determining proper use of funds within the categorical budget. Personnel I I Definition: Actual costs of salaries and wages of employees devoted to working on activities directly related to carrying out the Scope of Work of the DSHS funded project. These costs are allowable to the extent that they are reasonable and conform to the established, consistently applied policy of the organization and reflect no more than the time actually devoted to the project. The salaries and wages of employees that do not work on activities described in the Scope of Work of the DSHS funded project should be allocated as indirect costs and budget under the Indirect Cost category. Instructions: Enter the following information for each requested position in the Personnel category: Functional Title and Code, indicating E for existing positions and P for proposed positions. % of Time I I Number of months of anticipated employment Total Annual Salary of individual Amount of funding requested for individual will be automatically calculated by the spreadsheet, which multiplies 'percentage of time' by 'Total Annual Salary' Last, First Name of Individual Budget # I I Position # I I Position Description and justification of the position, including primary responsibilities, appropriateness of classification with regard to required certification or licensure, and relevance to project . Insert additional rows and copy the format to add additional personnel. If rows are added, the formula in the cell containing the 19 Personnel category total must be revised to include the added rows. 20 I I 21 Fringe I I Definition: Fringe benefits are allowances and services provided by the organization to its employees as compensation in addition to regular salaries and wages. Fringe benefits include but are not limited to the cost of employee insurance, pensions, and unemployment benefit plans. The cost of fringe benefits is allowable (in proportion to the amount of time or effort employees devote to the grant funded project), to the extent that the benefits are reasonable and are incurred under 22 formally established and consistently applied policies of the organization. 23 Instructions: Enter the following information:  24 Itemized elements of fringe benefits: List the types of costs that comprise your organization's fringe benefits. Fringe Benefit Rate: The fringe benefit rate should be based on your organization's actual experience and is typically calculated by dividing your organization's total fringe benefit costs by total wage/salary costs. Enter your organization's fringe benefit rate on the budget sheet.  The total fringe benefit amount will be automatically calculated by the spreadsheet. 25 26 I I 27 Travel I I Definition: The cost of transportation, lodging, meals and related expenses incurred by employees of the organization while performing duties relevant to the proposed project. This includes auto mileage paid to employees on the basis of a fixed mileage rate for the use of their personal vehicle. Costs related to client transportation and conference registration fees should be budgeted under the 'Other' budget category. Travel costs incurred by a third party under contract should be 28 included within the terms of the contract and be budgeted under the "Contractual" expense category. 29 Instructions: Enter the following information.: In State and Out of State Travel: 30 31 Travel description and justification:  Provide a description of the travel, including destination and number of personnel for each trip, and justification of how the travel will directly benefit the project and why it is necessary to accomplish the project. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001830 #P of 39 A 32 33 34 35 36 37 38 39 40 41 I I I I I I I I I B C D E F G H I J K L Mileage: For travel that includes mileage, provide the number of miles to be travelled, the reimbursement rate per mile, and the number of employees requiring reimbursement. The spreadsheet will automatically calculate the total requested for mileage. For travel requests involving solely mileage, provide the mileage information only and leave all other information blank. Airfare: Provide the cost of airfare and the number of persons requiring airfare. Ground Transportation: Provide the cost of ground transportation, the number of persons requiring ground transportation, and the number of days the ground transportation is required. Lodging: Provide the cost per night for lodging, the number of persons requiring lodging, and the number of days lodging will be required. Per Diem: Provide the cost per day provided for meals, the number of persons travelling, and the number of days reimbursement for meals is required. Other Costs: Provide a description of the other travel costs (such as baggage fees or reservation fees) the number of employees requiring the other cost, and the number of days the other cost will be required. Total:  Totals for each component, each trip, In State and Out of State Travel will be calculated by the spreadsheet. I I I I I I I I I I I I I I I I I I Enter an 'X' in the appropriate box to indicate respondent's use of DSHS Travel Policy or the Respondent's Travel Policy. Attach a copy of Respondent's Travel Policy if it is used to determine travel reimbursement rates. Insert additional rows and copy the format to add additional travel requests. If rows are added, the formula in the cell containing the 'Travel' category total must be revised to include the added rows. 42 43 I I I I I I I I I 44 Equipment I I I I I I I I I Definition: Equipment and Controlled Assets Purchases. Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more. Contractor must inventory equipment and controlled assets, which include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more: desktop and laptop computers, non-portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. If purchase of equipment is approved in writing by the Department, Contractor is required to initiate the purchase of that equipment in the first quarter of the Contract or Program Attachment term, as applicable. Failure to initiate the purchase of equipment may 45 result in loss of availability of funds for the purchase of equipment. 46 Instructions: Enter the following information: I I I I I I I 47 48 49 50 51 Description and Justification: Provide each item of equipment to be purchased and the purpose for the item(s) and why the equipment is necessary. Attach a complete specification or a copy of the purchase order. If a portion of the equipment cost will be funded by non-DSHS sources, name the funding source and the percentage of the cost being funded by DSHS. Unit Cost: Enter the unit cost of each item of equipment requested. Number of Units Requested: Enter the number of units requested. Total: This information will be automatically computed by the spreadsheet. I I I I I I I I I I I I Insert additional rows and copy the format to add additional equipment requests. If rows are added, the formula in the cell 52 containing the 'Equipment' category total must be revised to include the added rows. 53 I I I I I I I I I 54 Supplies I I I I I I I I I Definition: Supplies are defined as consumable items necessary to carry out the services under this DSHS project, including medical supplies, drugs, office supplies, patient educational supplies, software, and any items of tangible personal property 55 other than those defined as equipment. 56 Instructions: Enter the following information: I I I I I I I 57 For General Office supplies (Item 1): I I I I I I I Describe and justify: List the items of general office supplies utilized by the personnel funded by this contract, for example: pens, pencils, paper etc. and indicate relevance to the project. 58 Number of FTEs: Enter the number of FTEs to be funded by the contract and provided general office supplies. 59 Amount per month: Enter the amount spent per month for general office supplies for each FTE funded on the contract. 60 Number of months: Number of months for which general office supplies are to be provided. 61 Total: This total will be automatically computed by the spreadsheet. 62 I I I I I I I I 63 For all other supplies: I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001831 #P of 39 64 65 66 67 68 A I I I I I B C D E F G H I J K L Describe and justify: Provide a description of the item requested and indicate the relevance of the item to the project. Unit Price: Enter the unit price of the item requested. I Number of Units: Enter the number of units of the item requested. Total: The total will be automatically computed by the spreadsheet.  I I I I I Insert additional rows and copy the format to add additional supplies requests. If rows are added, the formula in the cell 69 containing the 'Supplies' category total must be revised to include the added rows. 70 I I I I I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001832 #P of 39 I I A B C D E F G H I J K L 71 Contractual I I Definition: The costs of activities directly associated with carrying out the statement of work that are contracted by the organization to a third party are recorded in the 'Contractual' category. A contract with a subrecipeint must comply with Article XII, section titled "Contracts with Subrecipient Subcontractors" of the DSHS General Provisions. The contractor may enter into contracts with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program Attachment(s). Prior to entering into an agreement equaling $100,000 or more of a Program Attachment amount, Contractor shall obtain written approval from DSHS. Contracts with subcontractors shall be in writing and include the following: Name and address of all parties; A detailed description of the services to be provided; Measurable method and rate of payment and total amount of contract; Clearly defined and executable termination clause; Beginning and ending dates that coincide with the dates of the applicable Program Attachment(s) or cover a term within the beginning and ending dates of the applicable Program Attachment(s); 72 Access to inspect the work and the premises on which any work is performed, in accordance with the General Provisions; and a copy of these General Provisions and a copy of the Statement of Work and any Special Provisions in the Program Attachment(s) applicable to the subcontract. Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall monitor both financial and programmatic performance and maintain pertinent records that shall be available for inspection by DSHS. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state/federal statutes and regulations and under this Contract. Contractor shall not contract with a subcontractor, at any tier, that is debarred or suspended or excluded from or ineligible for participation in federal assistance programs. When subcontracting, Contractor is required to meet all applicable HUB requirements. 73 74 Instructions: Enter the following information for each contract in the Contractual category: Name of Contractor I 75 Method of Selection I 76 Period of Performance 77 Scope of Work 78 I Method of Accountability 79 80 Attach a fully justified 8 category budget for each contractor. 81 I I Insert additional rows and copy the format to add additional contracts. If rows are added, the formula in the cell containing 82 the 'Contractual' category total must be revised to include the added rows. 83 I I 84 Other I I Definition: All other allowable direct costs not listed in any of the above categories are to be included in the 'Other' category. Some of the costs listed below may also be treated as indirect cost. Their treatment as 'Other' (direct) or indirect must be consistent throughout the respondent's organization. Typical costs that may be budgeted in the 'Other' category are the 85 approved DSHS program attachment's share of: 86 * equipment rental if used solely on the DSHS project, otherwise include in 'Indirect Costs;" 87 * single audit services if allocated directly to each funding source; otherwise include in "Indirect Costs;" 88 * long distance telephone expenses (general telephone expenses should be included in "Indirect Costs;" 89 * printing and reproduction expenses directly related to the DSHS project; 90 * postage and shipping directly related to the DSHS project; 91 * contract personnel services for individuals that work solely on activities described in the DSHS Statement of Work; 92 * equipment repairs or service maintenance agreements for equipment used solely on the DSHS funded project; 93 * periodicals; I 94 * advertising that promotes the DSHS project; 95 * registration fees; I 96 * patient transportation; I 97 * training costs, speakers fees and stipends. I I 98 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001833 #P of 39 I I I I I I A B C D E F G H I J K L 99 Instructions: Enter the following information for each request for 'Other' costs: I 100 Format for building or equipment rental, telephone or internet service, postage or other such costs. Description/Justification: Provide a general description of the service to be purchased and an explanation of the purpose of 101 the service and why it is necessary for the completion of the activity. 102 Cost per month: The monthly cost of providing the service. I 103 Number of Months: Number of months the service is to be provided. 104 Number of FTEs: The number of FTEs to receive the service. I 105 Total: The Total is automatically calculated by the spreadsheet. I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001834 #P of 39 I I I I I A B C D E F G H I J K L 106 I I I I I 107 Format for all other types of goods or services in the 'Other' category:  Description/Justification: Provide a general description of the good or service to be purchased and an explanation of the 108 purpose of the good or service and why it is necessary for the completion of the activity. 109 Total: Enter the total cost of the good or service. I 110 I I I I I Insert additional rows and copy the format to add additional requests. If rows are added, the formula in the cell containing 111 the 'Other' category total must be revised to include the added rows. 112 I I I I I 113 Indirect Cost I I I I I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information 114 services). 115 Instructions: Enter the following information: I I I 116 Total of Amount of Indirect Costs allocable to the projectI Indirect Costs are based on: Enter an X in the box that corresponds to the  basis on which respondent is charging indirect costs. 117 Organizations that have an approved indirect cost rate should mark the first option by marking the box and * indicating the rate and base. A copy of the approved rate agreement that will be in effect during the contract 118 term should be attached. If a rate agreement is pending, submit the latest approved agreement. OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial * Procedures Manual (CFPM) available on the internet at http://www.dshs.stae.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be address in 119 Part V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. If using a central service or indirect cost rate, identify the types of costs that are included (being allocated in the rate: Salary/expenses of executive office staff (CEO, CFO), accounting office, personnel office; depreciation; facility maintenance; utility costs; general liability and property insurance. Organizations that do not use an indirect cost rate and governmental entities with only a central service rate must identify * the types of costs that will be allocated as indirect costs and the methodology used to allocate these costs in the space provided. The costs/methodology must also be disclosed in Part V- Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Identify the types of costs that are being allocated as indirect costs, the allocation methodology, and 120 the allocation base. 121 I I I I I Instructions: OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial Procedures Manual (CFPM) available on the internet at 122 http://www.dshs.state.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be addressed in Part V - Indirect Cost Allocation of 123 the Cost Allocation Plan that is submitted to DSHS. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001835 #P of 39 A B C D E F G H I Name of Contractor: 1 ELC 2Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Budget Request Period: 8/1/19-7/31/20 3 4 5 A. Personnel 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Position Total Salaries Time (%) # of months Total Salary Amt Requested $0 $0 1. Functional Title and Code 0% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 2. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 3. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 4. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 5. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Sub-Contract Template 6. Sub-Contract Template TX-DSHS-19-1309-A-001836 #P of 39 A 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 B C D E F G H 7. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 8. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 9. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 10. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 59 B. 60 61 Fringe Benefits Itemized elements of fringe benefits: $0 Rate (%) 32.00000% $0 62 C. 63 64 65 66 67 68 69 70 71 72 73 I Travel 1. In-State a. Travel description and justification: $0 # Miles Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 6. Sub-Contract Template 0.00 Rate/unit cost $0.0000 $0 $0 $0 $0 $0 # Persons 0 0 0 0 0 0 #Days Total 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001837 #P of 39 A 74 75 B 2. Out-of-State a. Travel description and justification : 76 77 78 79 80 81 82 83 84 85 Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 86 Respondents Travel Policy* 87 88 DSHS Travel Policy C D E F G # Miles Rate/unit cost # Persons #Days Total 0.00 $0.0000 $0 $0 $0 $0 $0 100 101 102 103 104 105 106 107 108 $0 $0 $0 $0 $0 $0 $0 0 0 0 0 # of Units $0.00 $0 Tot. 0 $0 $0 # of staff 0.00 Amt/Month # of Months Unit Cost # of Units $0.00 $0.00 2. Description/justification of Supplies: F. 1. A. B. C. D. E. Unit Cost Supplies 1. General Office supplies: (describe/justify) 109 G. 110 111 112 113 114 115 116 117 I *include a copy of the policy with the application Equipment For computer requests, attach Vendor Certification for Computer Equipment purchased by DSHS Contractor form): 1. Description/justification of Equipment 93 E. 94 95 96 97 98 99 $0 Indicate with an 'X' which policy is used for travel: 89 D. 90 91 92 0 0 0 0 0 0 H 0 0 Tot. Tot. $0 $0 Contractual $0 Project Title Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Description of how contract(s) will be accounted for and the number of contract(s) anticipated. $0 Other $0 Use format of item 1 for building or equipment rental, telephone or internet service, postage or other such costs. 1. Description/justification: Cost/mo. # of months # FTEs Total $0 Use format of item 2 for all other requests in this category. 2. Description/justification: 6. Sub-Contract Template Total $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001838 #P of 39 A III 118 119 B C D E F G H Total Direct Charges 6. Sub-Contract Template I $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001839 #P of 39 A B 120 H. Total Indirect Charges 121 122 123 124 125 126 127 128 129 Total Amount of Indirect Costs Allocable to the project: Indirect Costs are based on (mark the statement that is applicable and provide the rate, base and type, as applicable): C D E F G H I $0 Amount $0 The respondent's most recent indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency. Expired rate agreements are not acceptable. Attach a copy of the rate agreement to the budget. Applies only to governmental entities. The respondent's current central service cost rate or indirect cost rate based on a rate proposal prepared in accordance with OMB Circular A-87. Attach a copy of Certification of Cost Allocation Plan or Certification of Indirect Costs. Note: Governmental units with a Central Service Cost Rate must also include the indirect cost of the governmental units department (i.e., Health Department). In this case indirect costs will be comprised of central service costs (determined by applying the rate) and the indirect costs of the governmental department. The allocation of indirect costs must be addressed in Park V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Rate Base Type (central service or indirect) 0.00000% 0.00000% A cost allocation plan. A cost allocation plan as specified in the DSHS Contractor's Financial Procedures Manual (CFPM), Appendix A must be submitted to DSHS within 60 days of the contract start date. The CFPM is available on the following internet web link: http://www.dshs.state.tx.us/contracts/. 130 131 Total Budget 6. Sub-Contract Template $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001840 #P of 39 A 1 2 3 4 5 6 7 8 9 10 11 12 13 B Contents: Tab 1.  Tab 2.  Tab 3.  Tab 4. Tab 5.  Tab 6. C D 29 30 31 32 33 34 35 36 37 38 39 F G H Budget Template Instructions Budget Template PHS 424A DSHS Indirect Cost Calculator Sub-Contract Template Instructions Sub-Contract Template Funds Coordination and Management Branch (FCMB) staff members are available to provide assistance in completing the tool.  In addition, detailed training in either a group setting or one-onone can be provided on DSHS Grant processes. FCMB Contact list: Elaine McHard (512) 776 - 6646 Branch Manager Sharon Golden (512) 776 - 6562 Team Lead Grants Budget Analysts: Anna Layfield (512) 776-2388 David de la Rosa (512) 776-3217 Karen Cathey (512) 776-3125 Community Health Improvement 14 15 16 17 18 19 20 21 22 Environmental Epidemiology & Disease Registries Joy Counce (512) 776 - 6564 23 24 Health Promotion & Chronic Disease Prevention Joy Counce (512) 776 - 6564 25 26 Maternal & Child Health Suzanne Lucignani (512) 776 - 2591 27 28 E DSHS Grant Budget Template Funds Coordination and Management Branch Revised 01/07/2019 Sharon Golden (512) 776 - 6562 Joy Counce (512) 776 - 6564 Elaine McHard Sharon Golden Joy Counce Sharon Golden Sharon Golden Elaine McHard  All Sections All Sections All Sections, except below Maternal and Child Health Block Grant National Violent Death Reporting System Zika Health Program Grant (512) 776 - 6646 Executive Offices (512) 776 - 6562 All Sections Consumer Protection (512) 776 - 6564 All Sections Laboratory & Infectious Disease Services (512) 776 - 6562 All Sections Regional & Local Health Operations (512) 776 - 6562 All Sections, except below PPHF Preventive Health and Health (512) 776 - 6646 Services Block Grant 40 Contents TX-DSHS-19-1309-A-001841 A I B C D E F I G I H Vacant areas - Please contact Elaine McHard (512) 776 - 6646 or Sharon Golden (512) 776 - 6562 for assistance. 41 42 I 43 44 I 45 DSHS Grant Budget Tool.xlsx I I I I I IRevised 01/07/2019 Contents TX-DSHS-19-1309-A-001842 A 1 2 3 4 B C I D E F G H I J Budget Template Instructions Funds Coordination and Management Branch Revised 01/07/2019 K L M This tab contains instructions for completing the Budget Template and should not be included in the grant application package.  In some cases, DSHS policy is cited in the definition to assist the grant developer in determining proper use of funds within the categorical budget. 5 6 I 7 A. Personnel Definition: Actual salaries and wages for all staff position in the proposed project. 8 9 *Enter the following information for each position in the Personnel category: 10 Position Title  11 % of Time 12 Last, First Name of Staff 13 Budget # I 14 Position # 15 Position Description 16 Annual Salary 17 Longevity, if applicable 18 Benefit Replacement Pay (BRP), if applicable 19 20 I Merits are no longer accounted for on grant applications. 21 22 I 23 B. Fringe I I I I - -24 -25 -26 -27 -28 -29 -30 -31 32 Definition: Fringe benefits paid by the employer on behalf of its employees. This includes employer contributions for social security, retirement, health and accident insurance and workers' compensation insurance. Fringe benefits requested should represent actual benefits paid for employees. *Current Fringe benefits rate is 36.62% effective 9/1/2017 The fringe benefit breakout is: Social Security - 7.65% Retirement - 10.00% Health Insurance -18.97%  (this includes the health insurance surcharge of 1%) C. Travel Definition: The cost of transportation, lodging, meals and related expenses incurred by staff while traveling to perform duties required by the proposed project. Please utilize the DSHS Travel Office website: http://online.dshs.internal/traveloffice.aspx to ensure proper costs are charged when completing the Tab 2 Budget template. *Current In-State lodging rate for 2019 is $85/night.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. *Current In-State Per Diem for 2019 is $46/day.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001843 Page #P of 35 A -33 -34 -35 -36 -37 38 I I I I G I I I I I I B I C D E F H I J K L M Please Note: Per DSHS Travel Office (12/2018), the DSHS maximum Lodging rate without an approved exception form is $85.00 for Lodging.  From the DSHS Travel office website refer to Rate section, GSA Maximum Lodging and Mileage Rates Within Texas for the appropriate State Fiscal Year and link to the GSA website. *Current Mileage reimbursement is $.58/mile effective 01/01/2019-12/31/2019 per HHSC Connection 01/07/2019. *Current Travel Reservation Fee is $12.00 based on the National Travel System's (NTS) contract for full service arrangements or $19.50  based on the Short's Travel Management System's contract for full service arrangements at: https://www.comptroller.texas.gov/purchasing/programs/travel-management/travel-agency/.  State Contract effective September 1, 2014 through August 31, 2019. *Current state airline contract with American Airlines and JetBlue Airways, effective 10/01/2015 - 08/31/2019. This section identifies baggage charges related to state business are reimbursable.  It is assumed that the first checked bag is necessary to complete business travel. Charges for excessive baggage may be reimbursed as long as the travel is related to state business (e.g. state-owned equipment). Agencies are responsible for ensuing the reasonableness of the reimbursement and number of baggage's necessary.  For additional information and updates, please utilize the DSHS Travel website at http://online.dshs.internal/traveloffice.aspx or contact the DSHS Travel Coordinator for assistance. NOTE: The sample spreadsheet reflects the $12.00 reservation fee for NTS full-service travel arrangements and should be adjusted based on the service requested. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001844 Page #P of 35 A B C 39 40 D. Equipment D E F G H I J K L M Definition: Equipment is defined by DSHS as non-expendable personal property with a unit cost of more than $5,000 and a useful life of more than one year. 41 *Detailed description of equipment is required. 42 NOTE: Indirect Cost is not charged on equipment. 43 44 45 E. Supplies Definition: Costs for materials and supplies necessary to carry out the program. 46 *Detailed description of supplies is required. 47 48 49 F. Contractual Definition: Activities identified in the scope of work that are delegated by the applicant to a second party; the cost of providing these activities are recorded in this category as either Sub-recipient or Vendor. Travel costs incurred by a second party while performing these activities should be included in this category. Contracts for administrative services are not included in this category; they are properly classified in the Other category. *Enter the following information for each contract in the Contractual category: A. Name of Contractor B. Method of Selection C. Period of Performance D. Scope of Work E. Method of Accountability F. Budget Justification and Detail: This maybe required by the Federal Agency 50 51 52 53 54 55 56 57 NOTE: Indirect Cost is charged up to the 1st $25,000 of each sub-recipient Category 4000 contract. 58 59 60 G. Other 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Definition: All other allowable direct costs not listed in any of the above categories are to be included in this category. Some of the major costs that should be budgeted in this category are: *contracts for administrative services *space and equipment rental *utilities and telephone expenses *data processing services *printing and reproduction expenses *postage and shipping *contract clerical or other personnel services *janitorial services *exterminating services *security services *insurance and bonds *equipment repairs or service maintenance agreements *books, periodicals, pamphlets, and memberships *advertising *registration fees *patient transportation *training costs, speaker fees and stipends *The Other Budget Category requires a general description of the service and cost.  The justification should include an explanation of the purpose of the service. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001845 Page #P of 35 I A B C 75 H. Indirect Cost I 76 77 78 79 80 81 82 83 84 85 - -86 -87 88 D I E F G H I J K L M I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information services). *Current I/C rate agreement dated 09/17/2018.  Rates are as follows: I I FIXED rate 9/1/2017 - 8/31/2018 Health Programs - 18.1% Laboratory Services - 33.9% Lab percentage should only be used for funds that will be budgeted on lab program IDs. Provisional rate 9/1/2018 - 8/31/2021 Health Programs - 18.1% Lab percentage should only be used for funds Laboratory Services - 33.9% that will be budgeted on lab program IDs. NOTE: *The categorical totals, excluding the contractual category, will automatically "link" to the PHS 424A, and DSHS Indirect Cost tabs upon completion of the Budget Template tab. In the DSHS Indirect Cost tab, the contractual dollar amounts from the Budget Template tab will need to be manually entered into the contractual category rows in the "Budget Template Total" column. Placement of the contractual items are determined by identifying contracts as either "sub-contracts in excess of $25,000" or "sub-contracts up to $25,000". The contract dollar amounts will need to be manually entered into the appropriate row to populate the "Budget Template Total" field. In addition, the number of contracts will need to be included in the "# of contracts" field. The Sub-total Contractual row will ensure that the contractual categorical dollar amount and the number of contracts equal those on the Budget Template tab. **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate for the "Effective Period" of 9/1/2017 - 8/31/2018 and 9/1/2018 - 8/31/2021. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect cost rate. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001846 Page #P of 35 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 B C D E F G H I Texas Department of State Health Services ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: 8/1/19-7/31/20 A. J $179,070 Personnel Position % of Time Annual Salary Benefit Annual Longevity Replacement Pay (BRP) Months Total 1. Microbiologist II 100% $40,086 $480 $0 12 $40,566 ECO Hancock, Joseph (H41000/8703) Position Description: Participates in all aspects of the Texas Department of State Health Services Arbovirus Laboratory (DSHSAL)   mosquito   surveillance   program.   Responsibilities   include   data   entry   into   the   Laboratory   Information Management   System   (LIMS),   mosquito   species   identification   and   pooling   of   vector   species,   arbovirus   testing,   and insecticide resistance testing for jurisdictions in Texas. Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents.  Coordinates and assists with maintenance of laboratory mosquito colonies and specimens submitted for insecticide resistance testing. Coordinates and assists with data   analysis   and   organization,   data   requests   from   stakeholders,   and   data   reporting   requirements.   Participates   in preparation of standard operating procedure (SOP) documents and training other staff.  Tier 2, Assists with Tier 1-3 activities. 2. Microbiologist II 100% $41,823 $2,160 $0 12 $43,983 ECO Day, Joanne (H41000/8706) Position Description: Participates in all aspects of the DSHSAL mosquito surveillance program. Responsibilities include data entry into the LIMS, mosquito species identification and pooling of vector species, arbovirus testing, and insecticide resistance testing for jurisdictions in Texas. Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents.  Coordinates and assists with maintenance of laboratory mosquito colonies and specimens submitted for insecticide resistance testing. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting requirements. Participates in preparation of SOP documents and training other staff.  Tier 2, Assists with Tier 1-3 activities. 3. Program Specialist III NEW (H21400/Position # TBD) 100% $55,000 $0 $0 2. Budget Template 12 $55,000 ECO TX-DSHS-19-1309-A-001847 #P of ]  K L M N O P Q R S T U V 1 2 3 4 5 PERSONNEL TOTAL 6 7 H41000 H21400 8 9 10 11 TOTAL SALARIES $179,070 $104,309.26 $74,760.50 Months are NOT included in the Total calculation 12 13 14 15 16 17 18 19 2. Budget Template TX-DSHS-19-1309-A-001848 #P of ]  A 20 21 22 23 24 25 I I I I I I I I I 4. Geographic Information Specialist I I 100% I $39,521 I $0 $0 12 $39,521 ECO NEW (H21400/H41000 (50/50)/Position # TBD) Position Description: This will be a split position between the Arbovirus Laboratory and the Zoonosis Control Branch. Primary   responsibilities   will   include   organizing   mosquito   surveillance   and   insecticide   resistance   testing   data   and generating reports from them; coordinating and assisting with maintenance of databases to capture relevant spatial and temporal   information;   documenting   procedures;   validating   data   for   accuracy   and   completeness;   completing   approved metadata forms; and producing maps to display the data; coordinating and assisting with the generation of maps and summary tables for distribution between epi and laboratory staff, for MosquitoNET reporting, for responding to submitter requests, and for updating the DSHS website.  Tier 2, Will assist with Tier 1-3 activities. 26 B. 27 28 I I I B C D E F G H Position Description: Border entomologist to cover international border areas in Public Health Regions 8, 9, 10, and 11. They should have a Master’s Degree in Entomology or related field.  They will support local border jurisdictions as a subject matter expert. Duties will include consultation and training on, and, at times, performance of a range of integrated vector management-related activities, e.g. conducting vector surveillance, the analysis and interpretation of which informs timely control activities; conducting IR testing, the results of which inform decisions on product selection and application; and   disseminating   findings.   The   position   will   submit   data   for   entry   into   MosquitoNet;   assist   local   jurisdictions   in coordinating   investigation   and   response   to   VBD   outbreaks;   implementing   emergency   vector   control   activities;   and composing routine and emergency-related risk communication plans.  Tier 2, Will Assist with Tier 1-3 activities. Fringe Benefits I I I Fringe benefits are applicable to direct salaries and treated as direct costs.  Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% 2. Budget Template I J H41000 (ECO) Fringe $65,575 H21400 (ECO) Fringe TX-DSHS-19-1309-A-001849 #P of ]  K L M N O P Q R S T U V 20 21 22 23 24 25 $38,198 26 $27,377 27 28 2. Budget Template TX-DSHS-19-1309-A-001850 #P of ]  A 29 C. 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Travel B C D E F G 1. In-State b. Travel description: The border entomologist will have weekly duties that will require them to travel throughout the public health regions where they have responsibilities.  We estimate that they will travel at least three times per week up to 350 miles per week. We expect at least one trip will be an overnight trip to set out and pick up mosquito traps.  The border entomologist will also travel once a quarter to Regional Headquarters to work with the State Medical Entomologist.  ECO/H21400 Assist with Tier 1-3 activities $37,427 Mileage:  56 trips x  1 person x 350 miles r/t @ $.58/mile $11,368 Airfare: 1 person @ $450 r/t  x 2 trips $900 Ground Transportation:  1 person @ $167 x 3 trips $501 Lodging:  3 nights @ $85/night x 1 person x 56 trips $14,280 Per Diem:  4 days @ $46/day x 1 person x 56 trips $10,304 Travel Fees:  1 person @ $12.00 x 2 trips $24 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $50 2. Out-of-State Mileage:  trips x  # persons x ? miles r/t @ $.58/mile Airfare: # persons @  r/t Ground Transportation:  1 persons @ $ Lodging:   nights @ $/night x  persons x  trips Per Diem:   days @ $/day x  persons x  trips Travel Fees:   persons @ $12.00 x  trips Baggage Fees-determined by carrier:# persons @ $? I $46,135 H21400 J $46,135 a. Travel description: The medical entomologist will travel once to visit with the PS III  to assist with any trainings or assistance in working with the LHD or the vector control jurisdictions. The medical entomologist will travel once to each of the Public Health Regions to assist with any trainings or assistance in working with entities that receive the surveillance kits. Enhancing mosquito surveillance capacity throughout the state.    ECO/H21400 Assist with Tier 1-3 activities $8,708 Mileage:  15 trips x  1 person x 244 miles r/t @ $.58/mile $2,123 Airfare: # persons @ $? r/t $0 Ground Transportation:  # persons @ $? $0 Lodging:  3 nights @ $85/night x 1 person x 15 trips $3,825 Per Diem:  4 days @ $46/day x 1 person x 15 trips $2,760 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 a. Travel description: H ECO ECO $0 $0 $0 $0 $0 $0 $0 $0 $0 2. Budget Template TX-DSHS-19-1309-A-001851 #P of ]  A 65 66 D. 67 68 69 70 71 B C D 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 86 12. 87 13. 88 14. 89 15. 90 16. 91 17. 92 18. 93 19. 94 20. 95 96 97 98 99 100 21. 22. 23. 24. 25. 26. 101 27. 102 28. G H I J $0 Item Requested 73 74 75 76 77 78 79 80 81 82 83 84 85 F Equipment Qty 1. [Item Name] -  Description: 72 E. E Unit Cost $0 Amount 0.00 $172,285 Supplies Item Requested Culex insecticide resistance testing supplies CDC Light Traps CDC gravid traps BG sentinel 2 traps 6 volt batteries 12 volt batteries binocular stero microscope hanging dry ice dispenser Mosquito ID Books Iphone Pipet Basins (case of 200) Thermo Scientific™ ClipTip™ Pipette Tips (960 tips in each unit) MagMax Deep well plates (50 plates in each unit) MagMax Standard plates (48 standard plates in each unit) MagMax Deep well tip combs (100 combs in each unit) Corning universal lid with corner notch (Corning 3099) case of 50 Axygen™ 5mL Snaplock Microcentrifuge Tubes-Case of 5 packs (pack = 250 tubes) SuperScript III Platinum 1-Step qRT-PCR kit (500 rxns) MicroAmp® 96-Well  Plate Barcode (10 plate barcodes in each unit) MicroAmp® Optical 8-cap strips (300 strips in each unit) MagMax-96 Viral RNA Isolation Kit (5 x 96 preps)-automated White Labeling Tape (19mm x 54.9m) 2-Propanol (case of 6 bottles x 500ml) 100% ethanol (500 ml) Nuclease-free H2O (10 in each unit x 50 ml) Rnase Away (6 in each unit x 475 ml) Eppendorf filter tips 0.1-10 ul (960 in each unit) Eppendorf filter tips 2-200 ul (960 in each unit) 1 25 25 25 50 25 1 25 1 1 6 Qty Unit Cost 2,500.00 90.95 97.00 165.85 29.00 112.65 424.64 18.00 54.95 99.00 135.90 50 116.59 5,829.50 H41000 ECO/Tier 2 10 366.00 3,660.00 H41000 ECO/Tier 2 27 172.00 4,644.00 H41000 ECO/Tier 2 3 587.00 1,761.00 H41000 ECO/Tier 2 10 126.03 1,260.30 H41000 ECO/Tier 2 1 419.99 419.99 H41000 ECO/Tier 2 1,840.00 42,320.00 H41000 ECO/Tier 2 996.50 H41000 ECO/Tier 2 1,110.00 H41000 ECO/Tier 2 23 25 10 42 6 2 14 3 4 25 3 39.86 111.00 1,484.00 32.00 180.00 29.54 110.09 370.48 190.03 190.03 Amount 2,500.00 H21400 2,273.75 H21400 2,425.00 H21400 4,146.25 H21400 1,450.00 H21400 2,816.25 H21400 424.64 H21400 450.00 H21400 54.95 H21400 99.00 H21400 815.40 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 H41000 H41000 H41000 H41000 H41000 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 4,750.75 H41000 ECO/Tier 2 570.09 H41000 ECO/Tier 2 62,328.00 192.00 360.00 413.56 330.27 1,481.92 2. Budget Template $16,640 H21400 $155,645 H41000/Arbovirus (Molecular Testing) Funding supports real time RT-PCR and identification TX-DSHS-19-1309-A-001852 #P of ]  A 103 29. 104 30. 105 31. 106 32. 107 33. 108 34. 109 35. 110 36. 111 112 113 114 115 116 37. 38. 39. 40. 41. 42. 117 43. 118 44. 119 45. 120 46. 121 47. 122 48. 123 49. 124 50. 125 51. 126 52. 127 128 F. 129 130 131 132 133 134 135 B C Eppendorf filter tips 20-300 ul (960 in each unit) USA Scientific Inc 2ML MICRO TUBE W/GASKET PK/100 BBs (6000 in each unit) Microcentrifuge tubes 1.5 ml (500 in each unit) Front closure lab coat Small (25 in each unit) Front closure lab coat Medium (25 in each unit) Front closure lab coat Large (25 in each unit) BA Diluent 2 ml each -prep in house Whatman Filter Paper Circles  Grade 4, 110 mm (#1004110) 100/pack $20.40 Labels for tubes, $60/pack, 2,380/pack Infection supplies for cell culture Processing supplies for cell culture Equine processing Disposable micro pipettes (pk of 500) Pipette Filler (wheel) Pack of 3 (2, 10, & 25 ml) 250 ml Glass Wheaton bottles (case of 48) Acetone (100%) 4 L Plastic Graduated Cylinders (100 ml) case of 12 Heavy-duty Glass Beakers (250 ml) pack of 12 Covidien Tendersorb™ Underpads (case of 150) Aspirators ULINE 2 MIL RECLOSABLE BAGS 10" x 12" (1 carton = 1000 bags) Labeling tape-Rainbow pack (case of 24) Richmond Braided Cotton Roll 3/8" diameter, 6" length (pk of 200) D E F G H 1,327.20 H41000 ECO/Tier 2 6.00 6,638.00 H41000 24.00 H41000 ECO/Tier 2 ECO/Tier 2 5 59.15 295.75 H41000 ECO/Tier 2 2 268.70 537.40 H41000 ECO/Tier 2 2 268.70 537.40 H41000 ECO/Tier 2 2 20,000 268.70 0.08 537.40 H41000 1,600.00 H41000 ECO/Tier 2 ECO/Tier 2 20,000 20,000 4,000 4,000 100 2 0.03 0.03 0.83 0.90 3.30 105.64 600.00 600.00 3,320.00 3,600.00 330.00 211.28 H41000 H41000 H41000 H41000 H41000 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 271.46 H41000 347.75 H41000 236.38 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 329.37 H41000 ECO/Tier 2 117.40 H41000 ECO/Tier 2 90.00 233.96 H41000 180.00 H41000 ECO/Tier 2 ECO/Tier 2 1 2 93.00 156.64 93.00 H41000 313.28 H41000 ECO/Tier 2 ECO/Tier 2 5 24.20 121.00 H41000 ECO/Tier 2 7 200 4 2 1 1 1 1 4 2 189.60 33.19 135.73 347.75 236.38 329.37 117.40 58.49 A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work: J Supplies/Reagents Cost of 20,000 Mosquito ID Processing & Cell culture testing of 4000 mosquito po Insecticide Resistance Testing $468,556 Contractual Sub-recipient (category 4000): 1. Project Title: I Harris County Public Health Vector and $50,000 ECO/ Tier 2 Mosquito Control Program Harris County Public Health Mosquito Vector Control District (HCPHMVCD) Sole Source 8/1/19-7/31/20 2. Budget Template $50,000 H41000 H21400 TX-DSHS-19-1309-A-001853 #P of ]  K L M N O P Q R S T U V 103 104 105 106 107 108 109 es/Reagents Cost of 20,000 Mosquito ID 110 111 112 sing & Cell culture testing of 4000 mosquito pools 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 - 128 The contractual dollar amounts must be manually entered into the Tab 4. DSHS Indirect Cost 129 to populate the Indirect Charges below. $25,000 130 131 $443,556 132 133 134 135 2. Budget Template TX-DSHS-19-1309-A-001854 #P of ]  A 136 137 138 139 140 141 I I B C D E F The funding to HCPHMVCD will fund one technician that will be involved in the surveillance and testing of mosquitoes.  The technician will conduct surveillance to monitor mosquitoes and wild bird (avian) specimens for the presence of arboviruses, including SLE and WN viruses, collect routine mosquito and avian specimens, screen mosquito pools for SLE and WN, Zika, CHIK, DEN virus, report significant results to DSHS within twenty-four hours, and provide DSHS program with a final progress report. E. Method of Accountability: Sole Source System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. F. Budget Detail and Justification: See attachment. 1. 142 143 144 145 146 A. B. C. D. 147 148 E. 149 150 151 152 153 F. 1. A. 154 155 156 157 B. C. D. 158 159 E. 160 161 162 F. I I I I I I G Vendor (category 2001 or 2009) Project Title: Improve Information Reach and Retention Update and enhance $25,000 Arbovirus Laboratory website by adding informational training videos $75,000 to produce a series of 5 videos: Arbovirus Surveillance in Texas, Mosquito ECO/Tier Trapping, Collecting GPS Coordinates, Shipping Mosquitoes to DSHS 2 Laboratory, Forms and Data Quality.H41000 Name of Contractor(s): ARROWHEAD FILM AND VIDEO INC Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: Improve Information Reach and Retention Update and enhance Arbovirus Laboratory website by adding informational training videos to produce a series of 5 videos: Arbovirus Surveillance in Texas, Mosquito Trapping, Collecting GPS Coordinates, Shipping Mosquitoes to DSHS Laboratory, Forms and Data Quality. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. Budget Detail and Justification: Based on estimated total cost of $75,000 for 5 videos over 3 years.  $25,000 estimated for first year. Vendor (category 2001 or 2009) Project Title: Vector-borne disease and insecticide resistance surveillance $293,556 ECO/Tier 2 along the Texas-Mexico Border: H21400 University of Texas Rio Grande Valley Name of Contractor(s): (UTRGV) Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: The goal of this project is to continue the ongoing surveillance of vector mosquitoes and monitoring of insecticide resistance along the Texas-Mexico border, a region that is of particular concern for introduction and local transmission of vector-borne diseases such as Zika, dengue, and chikungunya. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. Budget Detail and Justification: 2. Budget Template H I J $25,000 $293,556 TX-DSHS-19-1309-A-001855 #P of ]  K L M N O P Q R S T U V 136 137 138 139 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 140 $393,556 H21400 141 142 143 144 145 146 147 148 149 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 150 151 152 153 154 155 156 157 158 159 160 161 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 162 2. Budget Template TX-DSHS-19-1309-A-001856 #P of ]  A 163 164 165 166 167 168 169 170 171 172 173 174 I B C D Vendor (category 2001 or 2009) 1. Project Title: Insecticide Resistance testing: H21400 A. B. C. D. I E F G $100,000 ECO/Tier 2 H $100,000 I J Name of Contractor(s): Texas Tech University Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: A. Receive mosquito eggs for rearing and subsequent insecticide resistance testing from as many as 50 submitting jurisdictions up to twice annually as coordinated by System Agency. B. Use the Centers for Disease Control and Prevention (CDC) bottle bioassay for detecting resistance to insecticides in vector mosquito populations. C. Determine the diagnostic dose and diagnostic time for each insecticide, for each region and for each vector species that is tested. D. Provide testing of resistance/susceptibility of mosquito populations from each submitter of mosquitoes against a panel of at least 2 different insecticides (types/families) at 3 concentrations (high/med/low) and controls. E. Electronically submit, in a format provided by DSHS, a bi-annual report of the testing data to DSHS at Whitney.Qualls@dshs.texas.gov. E. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. F. Budget Detail and Justification: See attachment. I I I I 2. Budget Template TX-DSHS-19-1309-A-001857 #P of ]  K L M N O P Q R S T U V 163 164 165 166 167 168 169 170 171 172 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 173 174 2. Budget Template TX-DSHS-19-1309-A-001858 #P of ]  A 175 G. 176 177 178 179 180 181 182 183 B C D E F Item Requested Number of Months Estimated Cost per Month Number of Staff Amount Requested Other 1. 2. 3. Item Requested Number Needed 184 185 186 Total Direct Cost: 187 Total Indirect Charges: 9,000.00 ECO/Tier 2 9,500.00 38,000.00 ECO/Tier 2 26,250.00 I J $73,250 H41000 H21400 $73,250 4,500.00 26,250.00 H $0 Amount Requested Unit Cost 1. Kingfisher Flex Extractor Service Contract 2 (Mosquito Surveillance Testing) 2. 7500 Fast Dx Service Contracts (Mosquito 4 Surveillance) 3. DSHS is requesting $26,250 (equal to the last ELC award for this activity) to increase the Disease In Nature conference attendance by reducing the registration fee. With the full award, the fee will be reduced from $350 to $250. This significant reduction in cost will assist in attracting speakers and broadly facilitate attendance by physicians, nurses, veterinarians, and public health professionals such as epidemiologists for whom DIN is the only opportunity to attend a zoonosis-focused, 1 One Health in-state conference. Epi/H21400 G EPI $1,004,871 $235,841 Please see attached DSHS Indirect Cost attachment for calculation. 188 189 Total Budget: $1,240,712 2. Budget Template TX-DSHS-19-1309-A-001859 #P of ]  K L M 175 A list of "Other" items are listed on the tab 1. 176 177 178 179 180 N O P Q R S T U V $47,000 $26,250 181 182 183 184 185 186 187 188 189 2. Budget Template TX-DSHS-19-1309-A-001860 #P of ]  A 1 C F G OMB Approval No. 0348-0044 Grant Program Catalog of Federal Function or Activity Domestic Assistance Number Federal Non-Federal Federal Non-Federal Total (a) (b) ( c ) (d) (e) (f) (g) 1. Project H - Vector Borne Diseases - Tiers 2 and 3 Estimated Unobligated Funds 93.323 New or Revised Budget $0 $0 $1,240,712 $0 $1,240,712 $0 $0 $1,240,712 $0 $1,240,712 2. 3. 4. 5.  TOTALS =::J - E SECTION A - BUDGET SUMMARY 5 6 7 - D BUDGET INFORMATION - Non-Construction Programs 2 3 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 B SECTION B - BUDGET CATEGORIES 6.  Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) a.  Personnel Total (5) (4) $179,070 $179,070 b.  Fringe Benefits $65,575 $65,575 c.  Travel $46,135 $46,135 d.  Equipment $0 $0 e.  Supplies $172,285 $172,285 f.  Contractual $468,556 $468,556 g.  Construction h.  Other i.  Total Direct Charges (sum of 6a - 6h) j. Indirect Charge $0 $0 $73,250 $73,250 $1,004,871 $0 $0 $0 $1,004,871 $1,240,712 $0 $0 $0 $1,240,712 $0 $0 $0 $0 $0 $235,841 k.  TOTALS (sum of 6i and 6j) 7.  Program Income $235,841 Standard Form 424A     (7-97) Prescribed by OMB Circular A-102 SECTION C - NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12.  TOTALS (sum of lines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $1,240,712 $310,178 $310,178 $310,178 $310,178 $0 $0 $0 $0 $0 $1,240,712 $310,178 $310,178 $310,178 $310,178 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 13.  Federal 14. NonFederal 15. TOTAL (sum of lines 13 and 14) SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT - (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b) First (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20.  Totals (sum of lines 16-19) $0 $0 3. PHS 424A $0 $0 TX-DSHS-19-1309-A-001861 53 54 55 56 A 21. Direct Charges:   I B I C I $1,004,871 I I22.  Indirect Changes: I I I I D I E I SECTION F - OTHER BUDGET INFORMATION $235,841 F I I I I I G 23.  Remarks:  The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.9%. I I 3. PHS 424A SF 424A (7-97)    Page 2 TX-DSHS-19-1309-A-001862 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 B C D E F ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018 @ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Direct # of Charges Total contracts $74,761 $27,377 $46,135 $0 $16,640 Contractual (Sub-recipient in excess of $25,000) $50,000 1 $25,000 $0 $393,556 $443,556 $26,250 $634,718 0 2 3 $0 $393,556 418,556 $26,250 $609,718 LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (sub-contracts in excess of $25,000) Contractual (sub-contracts up to $25,000) Contractual (Vendor contracts - DSHS Category 2000) Sub-total Contractual Other Total - Laboratory Services TOTAL INDIRECT COST $74,761 $27,377 $46,135 $0 $16,640 3 Direct # of Charges Total contracts $104,309 $38,198 $0 $0 $155,645 H I J K L Applicable IDC Rate Amount at 18.1% charged IDC Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (Sub-recipient up to $25,000) Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other Total - Health Programs G $13,532 $4,955 $8,350 $0 $3,012 The contractual dollar amounts must be manually entered into the appropriate row to populate the "Direct Charges Total" field.  In addition, the number of contracts will need to $0 be included in the "# of contracts" field.  The Sub-total Contractual row will ensure that the $71,234 contractual categorical dollar amount and the number of contracts equal those on the $75,759 Budget Template tab. $4,751 $110,359 $745,077 $4,525 Applicable IDC Rate Amount at 33.9% charged IDC $104,309 $38,198 $0 $0 $155,645 $35,361 $12,949 $0 $0 $52,764 $0 0 $0 $0 The contractual dollar amounts must be manually entered into the appropriate row to populate $0 $25,000 $25,000 $47,000 $370,153 0 1 1 1 $0 $25,000 $25,000 $47,000 $370,153 $0 of contracts" field.  The Sub-total Contractual row will ensure that the contractual categorical dollar $8,475 amount and the number of contracts equal those on the Budget Template tab. $8,475 $15,933 $125,482 $495,635 $1,004,871 4 $979,871 $235,841 the "Direct Charges Total" field.  In addition, the number of contracts will need to be included in the "# The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; 33 Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%.  At DSHS these contracts are expended in the Other 34 category and full indirect cost is charged. 35 Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. 36 37 -38 -39 40 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001863 41 A I B I C I D I E F G H I J K **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect 42 cost rate. 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001864 L 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 A B I C I I I I I I I D E F G H Sub-Contract Template Instructions I J K L Revised 02/01/2017 I I This tab contains instructions for completing the Sub-Contract Template and should not be included in the grant application package. In some cases, DSHS policy is cited in the definition to assist the budget developer in determining proper use of funds within the categorical budget. Personnel I I Definition: Actual costs of salaries and wages of employees devoted to working on activities directly related to carrying out the Scope of Work of the DSHS funded project. These costs are allowable to the extent that they are reasonable and conform to the established, consistently applied policy of the organization and reflect no more than the time actually devoted to the project. The salaries and wages of employees that do not work on activities described in the Scope of Work of the DSHS funded project should be allocated as indirect costs and budget under the Indirect Cost category. Instructions: Enter the following information for each requested position in the Personnel category: Functional Title and Code, indicating E for existing positions and P for proposed positions. % of Time I I Number of months of anticipated employment Total Annual Salary of individual Amount of funding requested for individual will be automatically calculated by the spreadsheet, which multiplies 'percentage of time' by 'Total Annual Salary' Last, First Name of Individual Budget # I I Position # I I Position Description and justification of the position, including primary responsibilities, appropriateness of classification with regard to required certification or licensure, and relevance to project . Insert additional rows and copy the format to add additional personnel. If rows are added, the formula in the cell containing the 19 Personnel category total must be revised to include the added rows. 20 I I 21 Fringe I I Definition: Fringe benefits are allowances and services provided by the organization to its employees as compensation in addition to regular salaries and wages. Fringe benefits include but are not limited to the cost of employee insurance, pensions, and unemployment benefit plans. The cost of fringe benefits is allowable (in proportion to the amount of time or effort employees devote to the grant funded project), to the extent that the benefits are reasonable and are incurred under 22 formally established and consistently applied policies of the organization. 23 Instructions: Enter the following information:  24 Itemized elements of fringe benefits: List the types of costs that comprise your organization's fringe benefits. Fringe Benefit Rate: The fringe benefit rate should be based on your organization's actual experience and is typically calculated by dividing your organization's total fringe benefit costs by total wage/salary costs. Enter your organization's fringe benefit rate on the budget sheet.  The total fringe benefit amount will be automatically calculated by the spreadsheet. 25 26 I I 27 Travel I I Definition: The cost of transportation, lodging, meals and related expenses incurred by employees of the organization while performing duties relevant to the proposed project. This includes auto mileage paid to employees on the basis of a fixed mileage rate for the use of their personal vehicle. Costs related to client transportation and conference registration fees should be budgeted under the 'Other' budget category. Travel costs incurred by a third party under contract should be 28 included within the terms of the contract and be budgeted under the "Contractual" expense category. 29 Instructions: Enter the following information.: In State and Out of State Travel: 30 31 Travel description and justification:  Provide a description of the travel, including destination and number of personnel for each trip, and justification of how the travel will directly benefit the project and why it is necessary to accomplish the project. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001865 #P of 35 A 32 33 34 35 36 37 38 39 40 41 I I I I I I I I I B C D E F G H I J K L Mileage: For travel that includes mileage, provide the number of miles to be travelled, the reimbursement rate per mile, and the number of employees requiring reimbursement. The spreadsheet will automatically calculate the total requested for mileage. For travel requests involving solely mileage, provide the mileage information only and leave all other information blank. Airfare: Provide the cost of airfare and the number of persons requiring airfare. Ground Transportation: Provide the cost of ground transportation, the number of persons requiring ground transportation, and the number of days the ground transportation is required. Lodging: Provide the cost per night for lodging, the number of persons requiring lodging, and the number of days lodging will be required. Per Diem: Provide the cost per day provided for meals, the number of persons travelling, and the number of days reimbursement for meals is required. Other Costs: Provide a description of the other travel costs (such as baggage fees or reservation fees) the number of employees requiring the other cost, and the number of days the other cost will be required. Total:  Totals for each component, each trip, In State and Out of State Travel will be calculated by the spreadsheet. I I I I I I I I I I I I I I I I I I Enter an 'X' in the appropriate box to indicate respondent's use of DSHS Travel Policy or the Respondent's Travel Policy. Attach a copy of Respondent's Travel Policy if it is used to determine travel reimbursement rates. Insert additional rows and copy the format to add additional travel requests. If rows are added, the formula in the cell containing the 'Travel' category total must be revised to include the added rows. 42 43 I I I I I I I I I 44 Equipment I I I I I I I I I Definition: Equipment and Controlled Assets Purchases. Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more. Contractor must inventory equipment and controlled assets, which include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more: desktop and laptop computers, non-portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. If purchase of equipment is approved in writing by the Department, Contractor is required to initiate the purchase of that equipment in the first quarter of the Contract or Program Attachment term, as applicable. Failure to initiate the purchase of equipment may 45 result in loss of availability of funds for the purchase of equipment. 46 Instructions: Enter the following information: I I I I I I I 47 48 49 50 51 Description and Justification: Provide each item of equipment to be purchased and the purpose for the item(s) and why the equipment is necessary. Attach a complete specification or a copy of the purchase order. If a portion of the equipment cost will be funded by non-DSHS sources, name the funding source and the percentage of the cost being funded by DSHS. Unit Cost: Enter the unit cost of each item of equipment requested. Number of Units Requested: Enter the number of units requested. Total: This information will be automatically computed by the spreadsheet. I I I I I I I I I I I I Insert additional rows and copy the format to add additional equipment requests. If rows are added, the formula in the cell 52 containing the 'Equipment' category total must be revised to include the added rows. 53 I I I I I I I I I 54 Supplies I I I I I I I I I Definition: Supplies are defined as consumable items necessary to carry out the services under this DSHS project, including medical supplies, drugs, office supplies, patient educational supplies, software, and any items of tangible personal property 55 other than those defined as equipment. 56 Instructions: Enter the following information: I I I I I I I 57 For General Office supplies (Item 1): I I I I I I I Describe and justify: List the items of general office supplies utilized by the personnel funded by this contract, for example: pens, pencils, paper etc. and indicate relevance to the project. 58 Number of FTEs: Enter the number of FTEs to be funded by the contract and provided general office supplies. 59 Amount per month: Enter the amount spent per month for general office supplies for each FTE funded on the contract. 60 Number of months: Number of months for which general office supplies are to be provided. 61 Total: This total will be automatically computed by the spreadsheet. 62 I I I I I I I I 63 For all other supplies: I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001866 #P of 35 64 65 66 67 68 A I I I I I B C D E F G H I J K L Describe and justify: Provide a description of the item requested and indicate the relevance of the item to the project. Unit Price: Enter the unit price of the item requested. I Number of Units: Enter the number of units of the item requested. Total: The total will be automatically computed by the spreadsheet.  I I I I I Insert additional rows and copy the format to add additional supplies requests. If rows are added, the formula in the cell 69 containing the 'Supplies' category total must be revised to include the added rows. 70 I I I I I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001867 #P of 35 I I A B C D E F G H I J K L 71 Contractual I I Definition: The costs of activities directly associated with carrying out the statement of work that are contracted by the organization to a third party are recorded in the 'Contractual' category. A contract with a subrecipeint must comply with Article XII, section titled "Contracts with Subrecipient Subcontractors" of the DSHS General Provisions. The contractor may enter into contracts with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program Attachment(s). Prior to entering into an agreement equaling $100,000 or more of a Program Attachment amount, Contractor shall obtain written approval from DSHS. Contracts with subcontractors shall be in writing and include the following: Name and address of all parties; A detailed description of the services to be provided; Measurable method and rate of payment and total amount of contract; Clearly defined and executable termination clause; Beginning and ending dates that coincide with the dates of the applicable Program Attachment(s) or cover a term within the beginning and ending dates of the applicable Program Attachment(s); 72 Access to inspect the work and the premises on which any work is performed, in accordance with the General Provisions; and a copy of these General Provisions and a copy of the Statement of Work and any Special Provisions in the Program Attachment(s) applicable to the subcontract. Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall monitor both financial and programmatic performance and maintain pertinent records that shall be available for inspection by DSHS. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state/federal statutes and regulations and under this Contract. Contractor shall not contract with a subcontractor, at any tier, that is debarred or suspended or excluded from or ineligible for participation in federal assistance programs. When subcontracting, Contractor is required to meet all applicable HUB requirements. 73 74 Instructions: Enter the following information for each contract in the Contractual category: Name of Contractor I 75 Method of Selection I 76 Period of Performance 77 Scope of Work 78 I Method of Accountability 79 80 Attach a fully justified 8 category budget for each contractor. 81 I I Insert additional rows and copy the format to add additional contracts. If rows are added, the formula in the cell containing 82 the 'Contractual' category total must be revised to include the added rows. 83 I I 84 Other I I Definition: All other allowable direct costs not listed in any of the above categories are to be included in the 'Other' category. Some of the costs listed below may also be treated as indirect cost. Their treatment as 'Other' (direct) or indirect must be consistent throughout the respondent's organization. Typical costs that may be budgeted in the 'Other' category are the 85 approved DSHS program attachment's share of: 86 * equipment rental if used solely on the DSHS project, otherwise include in 'Indirect Costs;" 87 * single audit services if allocated directly to each funding source; otherwise include in "Indirect Costs;" 88 * long distance telephone expenses (general telephone expenses should be included in "Indirect Costs;" 89 * printing and reproduction expenses directly related to the DSHS project; 90 * postage and shipping directly related to the DSHS project; 91 * contract personnel services for individuals that work solely on activities described in the DSHS Statement of Work; 92 * equipment repairs or service maintenance agreements for equipment used solely on the DSHS funded project; 93 * periodicals; I 94 * advertising that promotes the DSHS project; 95 * registration fees; I 96 * patient transportation; I 97 * training costs, speakers fees and stipends. I I 98 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001868 #P of 35 I I I I I I A B C D E F G H I J K L 99 Instructions: Enter the following information for each request for 'Other' costs: I 100 Format for building or equipment rental, telephone or internet service, postage or other such costs. Description/Justification: Provide a general description of the service to be purchased and an explanation of the purpose of 101 the service and why it is necessary for the completion of the activity. 102 Cost per month: The monthly cost of providing the service. I 103 Number of Months: Number of months the service is to be provided. 104 Number of FTEs: The number of FTEs to receive the service. I 105 Total: The Total is automatically calculated by the spreadsheet. I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001869 #P of 35 I I I I I A B C D E F G H I J K L 106 I I I I I 107 Format for all other types of goods or services in the 'Other' category:  Description/Justification: Provide a general description of the good or service to be purchased and an explanation of the 108 purpose of the good or service and why it is necessary for the completion of the activity. 109 Total: Enter the total cost of the good or service. I 110 I I I I I Insert additional rows and copy the format to add additional requests. If rows are added, the formula in the cell containing 111 the 'Other' category total must be revised to include the added rows. 112 I I I I I 113 Indirect Cost I I I I I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information 114 services). 115 Instructions: Enter the following information: I I I 116 Total of Amount of Indirect Costs allocable to the projectI Indirect Costs are based on: Enter an X in the box that corresponds to the  basis on which respondent is charging indirect costs. 117 Organizations that have an approved indirect cost rate should mark the first option by marking the box and * indicating the rate and base. A copy of the approved rate agreement that will be in effect during the contract 118 term should be attached. If a rate agreement is pending, submit the latest approved agreement. OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial * Procedures Manual (CFPM) available on the internet at http://www.dshs.stae.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be address in 119 Part V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. If using a central service or indirect cost rate, identify the types of costs that are included (being allocated in the rate: Salary/expenses of executive office staff (CEO, CFO), accounting office, personnel office; depreciation; facility maintenance; utility costs; general liability and property insurance. Organizations that do not use an indirect cost rate and governmental entities with only a central service rate must identify * the types of costs that will be allocated as indirect costs and the methodology used to allocate these costs in the space provided. The costs/methodology must also be disclosed in Part V- Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Identify the types of costs that are being allocated as indirect costs, the allocation methodology, and 120 the allocation base. 121 I I I I I Instructions: OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial Procedures Manual (CFPM) available on the internet at 122 http://www.dshs.state.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be addressed in Part V - Indirect Cost Allocation of 123 the Cost Allocation Plan that is submitted to DSHS. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001870 #P of 35 A B C D E F G H I Name of Contractor: 1 Category 2 H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) Budget Request Period: 8/1/19-7/31/20 3 4 5 A. Personnel 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Position Total Salaries Time (%) # of months Total Salary Amt Requested $0 $0 1. Functional Title and Code 0% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 2. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 3. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 4. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 5. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Sub-Contract Template 6. Sub-Contract Template TX-DSHS-19-1309-A-001871 #P of 35 A 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 B C D E F G H 7. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 8. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 9. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 10. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 59 B. 60 61 Fringe Benefits Itemized elements of fringe benefits: $0 Rate (%) 32.00000% $0 62 C. 63 64 65 66 67 68 69 70 71 72 73 I Travel 1. In-State a. Travel description and justification: $0 # Miles Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 6. Sub-Contract Template 0.00 Rate/unit cost $0.0000 $0 $0 $0 $0 $0 # Persons 0 0 0 0 0 0 #Days Total 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001872 #P of 35 A 74 75 B 2. Out-of-State a. Travel description and justification : 76 77 78 79 80 81 82 83 84 85 Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 86 Respondents Travel Policy* 87 88 DSHS Travel Policy C D E F G # Miles Rate/unit cost # Persons #Days Total 0.00 $0.0000 $0 $0 $0 $0 $0 100 101 102 103 104 105 106 107 108 $0 $0 $0 $0 $0 $0 $0 0 0 0 0 # of Units $0.00 $0 Tot. 0 $0 $0 # of staff 0.00 Amt/Month # of Months Unit Cost # of Units $0.00 $0.00 2. Description/justification of Supplies: F. 1. A. B. C. D. E. Unit Cost Supplies 1. General Office supplies: (describe/justify) 109 G. 110 111 112 113 114 115 116 117 I *include a copy of the policy with the application Equipment For computer requests, attach Vendor Certification for Computer Equipment purchased by DSHS Contractor form): 1. Description/justification of Equipment 93 E. 94 95 96 97 98 99 $0 Indicate with an 'X' which policy is used for travel: 89 D. 90 91 92 0 0 0 0 0 0 H 0 0 Tot. Tot. $0 $0 Contractual $0 Project Title Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Description of how contract(s) will be accounted for and the number of contract(s) anticipated. $0 Other $0 Use format of item 1 for building or equipment rental, telephone or internet service, postage or other such costs. 1. Description/justification: Cost/mo. # of months # FTEs Total $0 Use format of item 2 for all other requests in this category. 2. Description/justification: 6. Sub-Contract Template Total $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001873 #P of 35 A III 118 119 B C D E F G H Total Direct Charges 6. Sub-Contract Template I $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001874 #P of 35 A B 120 H. Total Indirect Charges 121 122 123 124 125 126 127 128 129 Total Amount of Indirect Costs Allocable to the project: Indirect Costs are based on (mark the statement that is applicable and provide the rate, base and type, as applicable): C D E F G H I $0 Amount $0 The respondent's most recent indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency. Expired rate agreements are not acceptable. Attach a copy of the rate agreement to the budget. Applies only to governmental entities. The respondent's current central service cost rate or indirect cost rate based on a rate proposal prepared in accordance with OMB Circular A-87. Attach a copy of Certification of Cost Allocation Plan or Certification of Indirect Costs. Note: Governmental units with a Central Service Cost Rate must also include the indirect cost of the governmental units department (i.e., Health Department). In this case indirect costs will be comprised of central service costs (determined by applying the rate) and the indirect costs of the governmental department. The allocation of indirect costs must be addressed in Park V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Rate Base Type (central service or indirect) 0.00000% 0.00000% A cost allocation plan. A cost allocation plan as specified in the DSHS Contractor's Financial Procedures Manual (CFPM), Appendix A must be submitted to DSHS within 60 days of the contract start date. The CFPM is available on the following internet web link: http://www.dshs.state.tx.us/contracts/. 130 131 Total Budget 6. Sub-Contract Template $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001875 #P of 35 A 1 2 3 4 5 6 7 8 9 10 11 12 13 B Contents: Tab 1.  Tab 2.  Tab 3.  Tab 4. Tab 5.  Tab 6. C D 29 30 31 32 33 34 35 36 37 38 39 F G H Budget Template Instructions Budget Template PHS 424A DSHS Indirect Cost Calculator Sub-Contract Template Instructions Sub-Contract Template Funds Coordination and Management Branch (FCMB) staff members are available to provide assistance in completing the tool.  In addition, detailed training in either a group setting or one-onone can be provided on DSHS Grant processes. FCMB Contact list: Elaine McHard (512) 776 - 6646 Branch Manager Sharon Golden (512) 776 - 6562 Team Lead Grants Budget Analysts: Anna Layfield (512) 776-2388 David de la Rosa (512) 776-3217 Karen Cathey (512) 776-3125 Community Health Improvement 14 15 16 17 18 19 20 21 22 Environmental Epidemiology & Disease Registries Joy Counce (512) 776 - 6564 23 24 Health Promotion & Chronic Disease Prevention Joy Counce (512) 776 - 6564 25 26 Maternal & Child Health Suzanne Lucignani (512) 776 - 2591 27 28 E DSHS Grant Budget Template Funds Coordination and Management Branch Revised 01/07/2019 Sharon Golden (512) 776 - 6562 Joy Counce (512) 776 - 6564 Elaine McHard Sharon Golden Joy Counce Sharon Golden Sharon Golden Elaine McHard  All Sections All Sections All Sections, except below Maternal and Child Health Block Grant National Violent Death Reporting System Zika Health Program Grant (512) 776 - 6646 Executive Offices (512) 776 - 6562 All Sections Consumer Protection (512) 776 - 6564 All Sections Laboratory & Infectious Disease Services (512) 776 - 6562 All Sections Regional & Local Health Operations (512) 776 - 6562 All Sections, except below PPHF Preventive Health and Health (512) 776 - 6646 Services Block Grant 40 Contents TX-DSHS-19-1309-A-001876 A I B C D E F I G I H Vacant areas - Please contact Elaine McHard (512) 776 - 6646 or Sharon Golden (512) 776 - 6562 for assistance. 41 42 I 43 44 I 45 DSHS Grant Budget Tool.xlsx I I I I I IRevised 01/07/2019 Contents TX-DSHS-19-1309-A-001877 A 1 2 3 4 B C I D E F G H I J Budget Template Instructions Funds Coordination and Management Branch Revised 01/07/2019 K L M This tab contains instructions for completing the Budget Template and should not be included in the grant application package.  In some cases, DSHS policy is cited in the definition to assist the grant developer in determining proper use of funds within the categorical budget. 5 6 I 7 A. Personnel Definition: Actual salaries and wages for all staff position in the proposed project. 8 9 *Enter the following information for each position in the Personnel category: 10 Position Title  11 % of Time 12 Last, First Name of Staff 13 Budget # I 14 Position # 15 Position Description 16 Annual Salary 17 Longevity, if applicable 18 Benefit Replacement Pay (BRP), if applicable 19 20 I Merits are no longer accounted for on grant applications. 21 22 I 23 B. Fringe I I I I - -24 -25 -26 -27 -28 -29 -30 -31 32 Definition: Fringe benefits paid by the employer on behalf of its employees. This includes employer contributions for social security, retirement, health and accident insurance and workers' compensation insurance. Fringe benefits requested should represent actual benefits paid for employees. *Current Fringe benefits rate is 36.62% effective 9/1/2017 The fringe benefit breakout is: Social Security - 7.65% Retirement - 10.00% Health Insurance -18.97%  (this includes the health insurance surcharge of 1%) C. Travel Definition: The cost of transportation, lodging, meals and related expenses incurred by staff while traveling to perform duties required by the proposed project. Please utilize the DSHS Travel Office website: http://online.dshs.internal/traveloffice.aspx to ensure proper costs are charged when completing the Tab 2 Budget template. *Current In-State lodging rate for 2019 is $85/night.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. *Current In-State Per Diem for 2019 is $46/day.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001878 Page #P of 39 A -33 -34 -35 -36 -37 38 I I I I G I I I I I I B I C D E F H I J K L M Please Note: Per DSHS Travel Office (12/2018), the DSHS maximum Lodging rate without an approved exception form is $85.00 for Lodging.  From the DSHS Travel office website refer to Rate section, GSA Maximum Lodging and Mileage Rates Within Texas for the appropriate State Fiscal Year and link to the GSA website. *Current Mileage reimbursement is $.58/mile effective 01/01/2019-12/31/2019 per HHSC Connection 01/07/2019. *Current Travel Reservation Fee is $12.00 based on the National Travel System's (NTS) contract for full service arrangements or $19.50  based on the Short's Travel Management System's contract for full service arrangements at: https://www.comptroller.texas.gov/purchasing/programs/travel-management/travel-agency/.  State Contract effective September 1, 2014 through August 31, 2019. *Current state airline contract with American Airlines and JetBlue Airways, effective 10/01/2015 - 08/31/2019. This section identifies baggage charges related to state business are reimbursable.  It is assumed that the first checked bag is necessary to complete business travel. Charges for excessive baggage may be reimbursed as long as the travel is related to state business (e.g. state-owned equipment). Agencies are responsible for ensuing the reasonableness of the reimbursement and number of baggage's necessary.  For additional information and updates, please utilize the DSHS Travel website at http://online.dshs.internal/traveloffice.aspx or contact the DSHS Travel Coordinator for assistance. NOTE: The sample spreadsheet reflects the $12.00 reservation fee for NTS full-service travel arrangements and should be adjusted based on the service requested. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001879 Page #P of 39 A B C 39 40 D. Equipment D E F G H I J K L M Definition: Equipment is defined by DSHS as non-expendable personal property with a unit cost of more than $5,000 and a useful life of more than one year. 41 *Detailed description of equipment is required. 42 NOTE: Indirect Cost is not charged on equipment. 43 44 45 E. Supplies Definition: Costs for materials and supplies necessary to carry out the program. 46 *Detailed description of supplies is required. 47 48 49 F. Contractual Definition: Activities identified in the scope of work that are delegated by the applicant to a second party; the cost of providing these activities are recorded in this category as either Sub-recipient or Vendor. Travel costs incurred by a second party while performing these activities should be included in this category. Contracts for administrative services are not included in this category; they are properly classified in the Other category. *Enter the following information for each contract in the Contractual category: A. Name of Contractor B. Method of Selection C. Period of Performance D. Scope of Work E. Method of Accountability F. Budget Justification and Detail: This maybe required by the Federal Agency 50 51 52 53 54 55 56 57 NOTE: Indirect Cost is charged up to the 1st $25,000 of each sub-recipient Category 4000 contract. 58 59 60 G. Other 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Definition: All other allowable direct costs not listed in any of the above categories are to be included in this category. Some of the major costs that should be budgeted in this category are: *contracts for administrative services *space and equipment rental *utilities and telephone expenses *data processing services *printing and reproduction expenses *postage and shipping *contract clerical or other personnel services *janitorial services *exterminating services *security services *insurance and bonds *equipment repairs or service maintenance agreements *books, periodicals, pamphlets, and memberships *advertising *registration fees *patient transportation *training costs, speaker fees and stipends *The Other Budget Category requires a general description of the service and cost.  The justification should include an explanation of the purpose of the service. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001880 Page #P of 39 I A B C 75 H. Indirect Cost I 76 77 78 79 80 81 82 83 84 85 - -86 -87 88 D I E F G H I J K L M I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information services). *Current I/C rate agreement dated 09/17/2018.  Rates are as follows: I I FIXED rate 9/1/2017 - 8/31/2018 Health Programs - 18.1% Laboratory Services - 33.9% Lab percentage should only be used for funds that will be budgeted on lab program IDs. Provisional rate 9/1/2018 - 8/31/2021 Health Programs - 18.1% Lab percentage should only be used for funds Laboratory Services - 33.9% that will be budgeted on lab program IDs. NOTE: *The categorical totals, excluding the contractual category, will automatically "link" to the PHS 424A, and DSHS Indirect Cost tabs upon completion of the Budget Template tab. In the DSHS Indirect Cost tab, the contractual dollar amounts from the Budget Template tab will need to be manually entered into the contractual category rows in the "Budget Template Total" column. Placement of the contractual items are determined by identifying contracts as either "sub-contracts in excess of $25,000" or "sub-contracts up to $25,000". The contract dollar amounts will need to be manually entered into the appropriate row to populate the "Budget Template Total" field. In addition, the number of contracts will need to be included in the "# of contracts" field. The Sub-total Contractual row will ensure that the contractual categorical dollar amount and the number of contracts equal those on the Budget Template tab. **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate for the "Effective Period" of 9/1/2017 - 8/31/2018 and 9/1/2018 - 8/31/2021. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect cost rate. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001881 Page #P of 39 A B C D E F G H I J 1 Texas Department of State Health Services 2 3 4 5 ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond CK14-140105PPHF18, Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Budget Request Period: 8/1/19-7/31/20 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 A. $144,153 Personnel Position % of Time Annual Salary Benefit Annual Longevity Replacement Pay (BRP) Months Total 1. Epidemiologist II 100% $51,508 $1,200 $0 12 $52,708 EPI Arshadmansab, Sepehr (H21400/Position # 85197) Position Description: Provides expertise and complex consultative support and technical assistance on zoonotic diseases with emphasis on arboviral diseases. In coordination with Zoonosis Control Branch (ZCB) epidemiologists, communicates with public health regions and local health departments, laboratories, and other disease data providers for issues involving case   reporting   and   data   management.   The   position   supports   the   ZCB   epidemiologists   in   data   management   including document intake, quality assurance, data entry, and filing that facilitate the ultimate reporting of data to CDC.  This position is currently federally-funded by ELC Zika Response funds that expire 7/31/2019. This position is vital to the day-to-day ZCB ELC activities. Currently ELC Zika Response funded 2. Program Specialist IV 100% $46,287 $0 $0 12 $46,287 EPI Owens, Kamesha (H21400/Position # 85198) Position Description:   Performs   advanced   work   related   to   epidemiology   of   and   surveillance   for   vector-borne   diseases including arboviral diseases. The position also provides advanced consultative services and technical assistance to health care   providers,   public   health   regions   and   local   health   departments   on   the   diagnosis,   treatment,   and   reporting   of   these notifiable conditions. This position is currently federally-funded by ELC Zika Response funds that expire 7/31/2019. This position is vital to the day-to-day ZCB ELC activities. Currently ELC Zika Response funded 3. Molecular Biologist III 100% $45,158 $0 $0 12 $45,158 LAB/ECO NEW (H41000/Position # TBD) Position Description:   This   will   be   a   split   position   between   the   Arbovirus   Laboratory   and   the   Viral   Isolation   Laboratory. Performs   highly   complex   (senior-level)   molecular   biology   work.   Primary   responsibilities   include   supervising,   training   and conducting   arbovirus   testing   on   mosquito   specimens   and   clinical   specimens.   Coordinates   and   performs   all   aspects   of arbovirus diagnostic work including nucleic acid extractions, real-time multiplex RT-PCR analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting   requirements.     Consults   with   medical   personnel/Epidemiologists   regarding   test   application   and   interpretation. Participates in the preparation and supervision of validation studies. Prepares SOP documents. Supervises and trains staff. 22 B. H41000 Fringe $52,789 H21400 Fringe Fringe Benefits 2. Budget Template TX-DSHS-19-1309-A-001882 #P of ]  K L M N O P Q R S T U V 1 2 3 4 5 PERSONNEL TOTAL 6 7 H41000 H21400 8 9 TOTAL SALARIES $144,153 $45,158.00 $98,995.00 Months are NOT included in the Total calculation 10 11 12 13 14 15 16 17 18 19 20 21 $16,537 22 $36,252 2. Budget Template TX-DSHS-19-1309-A-001883 #P of ]  A 23 24 I I I I I I B C D E F G Fringe benefits are applicable to direct salaries and treated as direct costs.  Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% I I I I 2. Budget Template I H I J I TX-DSHS-19-1309-A-001884 #P of ]  A 25 C. 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 Travel B C D E F G H 1. In-State $7,984 a. Travel description: DSHS Medical Entomologist, PSIII (Border Entomologist), and three arbovirus laboratory staff will travel to the Texas Mosquito Control Association (TMCA) meeting.  Opportunity to gain knowledge and discuss current trends in arbovirus surveillance for Texas. Requesting attendance to develop presentation skills and to provide networking opportunities. ECO $3,210 Mileage:  1 trip x  5 persons x 350 miles r/t @ $.58/mile $1,015 Airfare: # persons @ $? r/t $0 Ground Transportation:  # persons @ $? $0 Lodging:  3 nights @ $85/night x 5 persons x 1 trip $1,275 Per Diem:  4 days @ $46/day x 5 persons x 1 trip $920 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 b. Travel description: The State Medical Entomologist and one arbovirus Laboratory staff to attend the South Texas Tropical Medicine and Vector-borne Diseases Conference (South Padre Island, Feb 2020). Opportunity to give a presentation on guidance for integrated vector management and the services provided by the DSHS Arbovirus Surveillance Program in Texas. ECO $978 Mileage:  # trips x  # persons x # miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $50 x 1 trip (2 staff traveling in state $100 vehicle. Includes gas.) Lodging:  3 nights @ $85/night x 2 persons x 1 trip $510 Per Diem:  4 days @ $46/day x 2 persons x 1 trip $368 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 c Travel description: The State Medical Entomologist and One arbovirus Laboratory staff  to attend the Western Gulf Center of Excellence for Vector-borne Diseases 4th Annual Conference (Location and Date TBD). Opportunity to discuss ongoing collaborations and training activities with local health departments and academic partners. ECO $716 Mileage:  # trips x  # persons x # miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $50 x 1 trip (2 staff traveling in state vehicle. Includes gas.) $100 Lodging:  2 nights @ $85/night x 2 persons x 1 trip $340 Per Diem:  3 days @ $46/day x 2 persons x 1 trip $276 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 2. Budget Template ECO ECO I $25,374 TOTAL J TOTAL a H41000 H21400 b H41000 H21400 ECO c H41000 H21400 TX-DSHS-19-1309-A-001885 #P of ]  K 25 H41000 26 H21400 L M N O P Q R S T U V $14,654 $10,721 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 $2,408 $803 $489 $489 43 44 45 46 47 48 49 50 51 52 $358 $358 53 54 55 56 57 58 2. Budget Template TX-DSHS-19-1309-A-001886 #P of ]  A 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 B C D E F d Travel description: Travel for four zoonosis control branch staff to attend Diseases in Nature Conference (DIN) to be held in Austin or San Antonio in the Spring of 2020. DIN is a onehealth, zoonotic disease-focused annual conference which includes vector-borne disease topics. Attendees include physicians, nurses, veterinarians, and public health professionals such as epidemiologists. Attending staff will have the opportunity to receive current, authoritative information on zoonotic diseases, including surveillance, prevention, detection and control. Attending staff may also be on the conference agenda to speak or present poster(s) based upon conference acceptance of abstracts.  EPI $3,080 Mileage:  1 trip x  2 persons x 0 miles r/t @ $.58/mile $0 Airfare: # persons @ $? r/t $0 Ground Transportation:  2 persons @ $200 rental cars (2 staff travelling from Rio Grande Valley and Houston areas. 2 staff travelling in state vehicles.) $400 Lodging:  3 nights @ $158/night x 4 persons x 1 trip $1,896 Per Diem:  4 days @ $46/day x 4 persons x 1 trip $736 Travel Fees:  4 persons @ $12.00 x 1 trip $48 Baggage Fees-determined by carrier:# persons @ $? $0 G H EPI 2. Out-of-State I J d H21400 $17,390 a. Travel description: The   medical   entomologist,   regional   medical   entomologist,   and   two arbovirus team members will travel to the American Mosquito Control Association (AMCA) meeting in Portland, Oregon. Opportunity to discuss current trends and protocols in arbovirus surveillance nationwide. Also, meet with colleagues from other state health departments and CDC to discuss high throughput mosquito testing programs and mutual challenges we all face regarding endemic and newly emerging arboviruses. $8,048 Mileage:  # trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 4 persons @ $800 r/t  x 1 trip $3,200 Ground Transportation:  4 persons @ $75 x 1 trip $300 Lodging:  5 nights @ $169/night x 4 persons x 1 trip $3,380 Per Diem: 5 days @ $46/day x 4 persons x 1 trip $920 Travel Fees:  4 persons @ $12.00 x 1 trip $48 Baggage Fees-determined by carrier: 4 persons @ $50 x 1 trip $200 b. Travel description: The   State   Veterinarian   and   one   laboratory   arbovirus   team   member   to attend the Annual ELC Grantee Meeting in Atlanta in 2020. $1,850 Mileage:  # trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 2 persons @ $450 r/t x 1 trip $900 Ground Transportation:  2 persons @ $35 x 1 trip $70 Lodging:  2 nights @ $120/night x 2 persons x 1 trip $480 Per Diem:  3 days @ $46/day x 2 persons x 1 trip $276 Travel Fees:  2 persons @ $12.00 x 1 trip $24 Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $100 2. Budget Template ECO a. H41000 H21400 ECO b. H41000 H21400 TX-DSHS-19-1309-A-001887 #P of ]  K 59 60 61 62 L M N O P Q R S T U V $3,080 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 $4,024 $4,024 $925 $925 2. Budget Template TX-DSHS-19-1309-A-001888 #P of ]  A 91 92 93 94 95 96 97 98 99 I I I B C D E F Travel description: - One   Laboratory   Staff   to   attend   the   Florida   Advanced   Mosquito c.  --Identification and Certification Course in 2020 for continued proficiency and skills needed for mosquito surveillance in Texas.  This advanced coursework for mosquito identification is not offered in Texas. $5,408 I I I Mileage:  trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 1 person @ $500 r/t  x 1 trip $500 I Ground Transportation:  1 person @ $80 X 17 trips $1,360 I Lodging:  16 nights @ $169/night x 1 person x 1 trip $2,704 Per Diem:  17 days @ $46/day x 1 person x 1 trip $782 Travel Fees:  1 persons @ $12.00 x 1 trip $12 Baggage Fees-determined by carrier: 1 persons @ $50 x 1 trip $50 2. Budget Template G H ECO I J c. H41000 TX-DSHS-19-1309-A-001889 #P of ]  K 91 92 93 94 95 96 97 98 99 L M N O P Q R S T U V $5,408 2. Budget Template TX-DSHS-19-1309-A-001890 #P of ]  A 100 101 102 103 104 105 106 107 108 109 110 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 D E F G I J d. H21400 H41000 ECO $0 Item Requested Qty Unit Cost $0 Amount 0.00 $191,262 Supplies Item Requested 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 H Equipment 1. [Item Name] -  Description: 117 E. 118 119 C d. Travel description: The State Medical Entomologist and One arbovirus Laboratory staff  to attend   the   CDC   Vector-borne   Disease   Meeting   in   Fort   Collins,   Colorado   (Spring   2020). Opportunity to discuss VBD collaborations and training activities with CDC colleagues. $2,084 Mileage:  trips x  # persons x ? miles r/t @ $.58/mile $0 Airfare: 2 persons @ $300 r/t x 1 trip $600 Ground Transportation:  2 persons @ $50 x 1 trip $100 Lodging: 3 nights @ $116/night x 2 persons x 1 trip $696 Per Diem:  4 days @ $61/day x 2 persons x 1 trip $488 Travel Fees:  2 persons @ $50.00 x 1 trip $100 Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $100 111 D. 112 113 114 115 116 B CDC Light Traps BG Sentinel Traps 12 Volt Batteries CDC gravid traps 6 volt batteries Hanging dry ice dispensers aspirators Shipping mosquito samples to lab Battery Chargers Iphone (RME) DPP ZIKA IgM Reagents DPP ZIKA IgM Controls DENV Detect IgM Kit Dengue IgM Positive Control Dengue IgM Negative Control CHIKV IgM Kit Sample Tube 4 mL Screwcap w/ O-ring 50 mL Conical Tube Control Vials 1.5 mL microcentrifuge tube EP Tips 2-20 uL EP Tips 2-100 uL Pipette tips 1250ul  tips 250µl  tips 10µl 50 50 50 50 100 50 20 250 10 1 16 2 16 20 20 14 1 1 1 1 1 1 1 2 3 2 Qty Unit Cost 90.95 165.85 112.65 97.00 29.00 18.00 160.00 20.00 50.00 99.99 490.00 45.00 504.00 53.00 53.00 497.00 130.31 120.84 90.33 12.75 36.26 192.16 162.19 90.32 28.28 20.00 Amount 4,547.50 8,292.50 5,632.50 4,850.00 2,900.00 900.00 3,200.00 5,000.00 500.00 99.99 7,840.00 90.00 8,064.00 1,060.00 1,060.00 6,958.00 130.31 120.84 90.33 12.75 36.26 192.16 162.19 180.64 84.84 40.00 2. Budget Template H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H21400 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 ECO ECO ECO ECO ECO ECO ECO ECO ECO ECO LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB $35,922 H21400 $155,340 H41000 Serology TX-DSHS-19-1309-A-001891 #P of ]  K L M N O P Q R S T U V 100 101 102 103 104 105 106 107 108 109 110 $1,042 $1,042 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 2. Budget Template TX-DSHS-19-1309-A-001892 #P of ]  A 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 B EP Tips 50-1250 uL Sleeve Protectors Nitrile Gloves all sizes Latex Gloves all sizes Face Shield Full N95 Disposable Respirator Shoe Covers Sleeve Protectors VWR Impervious Gown U Sharps 1 quart Sharps 8 quart Biohazard bags 14x19 Biohazard bags 32 quart Biohazard container DSX Sample Tip DSX Reagent Tip DSX Reagent Tube Deep Well Dilution TMB ELISA HRP Substrate 10ml glass pipets 5ml glass pipets Pipette 5 mL Volumetric Pipette 5 mL Lockwell Frame 2HB Immulon plates Culture tubes 12x75mm Culture tubes 16x100mm Parafilm Film Polyester Sulfuric Acid 1.0N VWR Reagent Reservoir 6B6C-1 Affinity HRP Conj Goat Affinity Purified Ab IgM EL22-WNV antigen EL325 – WNV tissue control AG/TC diluent Paper Towel 6B6C-1 Affinity HRP Conj Goat Affinity Purified Ab IgM EL22-WNV antigen EL325 – WNV tissue control AG/TC diluent Nitrile Gloves all sizes Face Shield Full VWR Reagent Reservoir Yellow Tips, 200 uL 20 ul tips 96-well Microtiter, 2205 Volumetric Pipette 5 mL I C 2 2 31 2 1 2 2 3 1 52 52 1 5 52 3 2 24 1 2 1 1 3 1 2 3 1 1 30 1 2 1 5 2 8 8 3 1 5 2 8 8 3 21 1 1 8 1 3 1 D E 104.09 83.06 7.54 9.92 678.92 186.35 38.38 203.94 112.11 1.81 3.63 59.49 64.55 10.90 51.00 51.00 24.00 104.55 165.57 113.55 148.59 113.55 113.55 240.67 227.00 35.89 47.74 19.75 37.18 8.00 153.73 625.00 158.60 63.00 33.00 20.00 19.54 625.00 158.60 63.00 33.00 20.00 7.54 678.92 153.73 8.10 20.00 61.89 113.55 F 208.18 166.12 233.74 19.84 678.92 372.70 76.76 611.82 112.11 94.12 188.76 59.49 322.75 566.80 153.00 102.00 576.00 104.55 331.14 113.55 148.59 340.65 113.55 481.34 681.00 35.89 47.74 592.50 37.18 16.00 153.73 3,125.00 317.20 504.00 264.00 60.00 19.54 3,125.00 317.20 504.00 264.00 60.00 158.34 678.92 153.73 64.80 20.00 185.67 113.55 2. Budget Template G H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB I J TX-DSHS-19-1309-A-001893 #P of ]  A 195 196 197 198 199 200 201 76 77 78 79 80 81 82 202 83 203 84 204 85 205 86 206 87 207 88 208 89 209 90 210 91 211 92 212 93 213 94 214 95 215 96 216 97 217 98 218 99 219 100 220 221 222 223 224 225 101 102 103 104 105 106 226 107 I B C Culture Tubes 12x75mm Sharps 1 quart Biohazard bag 12-well slides Goat Serum Tween-80 FITC-conjugate Invitrogen Platinum SS III One Step qRTPCR Eppendorf 0.1-10 µL epTips Filtered Pipette Tips (Case of 960) Eppendorf .5-20 µL epTip Filtered Pipette Tips  (Case of 960) Eppendorf 2-200 µL epTip Filtered Pipette Tips   (Case of 960) Eppendorf 50-1000 µL epTip Filtered Pipette Tips  PCR  (Case of 960) Eppendorf 20-300 µL Dualfilter T.I.P.S Seal Max filtered tips (Case of 960) 1-100 µL Sorenson Multiguard Barrier Pipette Tips (Case of 960) ThermoScientific 2160P Extended Length ART 200 µL (pack of 768) Applied Biosystems MicroAmp Optical 8-Cap Strips (Box of 300) Applied Biosystems MicroAmp Optical Adhesive Film (Box of 100) Applied Biosystems MicroAmp Fast Optical 96-well Reaction Plates (Box of 20) Eppendorf 1.5 mL Natural Safe-Lock Micrcentrifuge Tubes (Box of 500) Invitrogen Nuclease-Free Water (10 bottles x 50 mL) Kimberly-Clark Profesional Kimtech Science Kimwipes 11.8 x 11.8 in (Case of 2940) Kimberly-Clark Profesional Kimtech Science Kimwipes 8.4 x 4.4 in (Case of 60) Kimberly-Clark Small Surgical Gown, Case of 34 Kimberly-Clark Basic Plus Lab-Coat/Blue, Small Kimberly-Clark Basic Lab-Coat/Blue, Medium Kimberly-Clark Basic Plus LabCoat/Blue,Large Kimberly-Clark Basic Lab-Coat/Blue, X-Large Rnase Away (6 x 475 ml) Bleachrite (Case of 4 bottles) QIAamp DSP viral RNA mini Kit (Qiagen) Ethanol (Molecular Grade) 500 mL Nunc Cryotubes 1.8 mL Starfoot Vials w/ Marking Area, Round Bottom Vials (Case of 1800) 1 104 1 2 2 1 1 12 40 D E 35.89 1.81 64.55 52.85 115.00 26.80 187.85 1,876.00 141.91 F H41000 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB LAB H I 22,512.00 H41000 LAB Viral Isolation 5,676.40 H41000 LAB 35.89 188.24 64.55 105.70 230.00 26.80 187.85 G 20 141.91 2,838.20 H41000 LAB 20 210.00 4,200.00 H41000 LAB 30 141.50 4,245.00 H41000 LAB 6 126.84 761.04 H41000 LAB 5 158.27 791.35 H41000 LAB 10 112.43 1,124.30 H41000 LAB 5 111.00 555.00 H41000 LAB 4 209.10 836.40 H41000 LAB 89.50 1,790.00 H41000 LAB 39.66 1,586.40 H41000 LAB 109.00 327.00 H41000 LAB 121.20 363.60 H41000 LAB 132.24 396.72 H41000 LAB 242.70 485.40 H41000 LAB 178.24 356.48 H41000 354.30 H41000 LAB LAB 20 40 3 3 3 2 2 2 2 2 2 3 5 8 1 177.15 180.00 180.00 370.48 73.18 219.62 27.50 1,588.89 360.00 360.00 740.96 219.54 1,098.10 220.00 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB 1,588.89 H41000 LAB 2. Budget Template J TX-DSHS-19-1309-A-001894 #P of ]  A 227 228 229 230 231 108 109 110 111 112 232 113 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 248 249 250 251 252 129 130 131 132 253 F. 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 1. A. B. C. D. B C MagNA Pure LC Total Nucleic Acid Isolation kits MagNA Pure LC Cartridge Seals MagNA Pure LC Sample Cartridges (120) MagNA Pure LC Tip Stands (200) MagNA Pure LC Reaction Tips, Large (960) MagNA Pure LC Medium Reagent Tubs 20 (150) MagNA Pure LC Tub Lids, Small/Medium (300) MagNA Pure 96 system fluid MagNA Pure 96 1000 Tips MagNA Pure 96 Lysis MagNA Pure96 Processing Cartridges MagNA Pure 96 Output MagNA Pure 96 Seal Foil MagNA Pure Small Volume Extraction Kits MagNA Pure 96 Needle (4) EasyMag Silica (48 tubes) EasyMag Lysis buffer (4 x 1L bottles) EasyMag Buffer 1 (4 x 1L bottles) EasyMag Buffer 2 (4 x 1L bottles) EasyMag Buffer 3 (4 x 1L bottles) EasyMag Disposables (48 sets) PerfeCTa MultiPlex qPCR SuperMix, Low ROX (200 x 50 mL) QIAamp DSP DNA Blood Mini Kit Human Genomic DNA Trizma hydrochloride solution D E F 4 3 3 2 2 499.00 170.00 121.52 274.00 381.00 2 212.00 2 40 9 9 9 4 2 11 2 2 2 2 2 2 2 2 5 4 7 G 1,996.00 510.00 364.56 548.00 762.00 H H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB 424.00 H41000 LAB 335.00 117.90 936.90 135.00 275.40 246.60 244.80 2,108.70 279.90 901.13 707.60 282.54 194.16 353.43 812.74 670.00 4,716.00 8,432.10 1,215.00 2,478.60 986.40 489.60 23,195.70 559.80 1,802.26 1,415.20 565.08 388.32 706.86 1,625.48 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB 418.65 837.30 850.00 1,133.60 244.30 H41000 H41000 H41000 H41000 LAB LAB LAB LAB 170.00 283.40 34.90 I $0 Contractual Sub-recipient (category 4000) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: J $0 $0 E. Method of Accountability: [Enter accountibility method here] F. Budget Detail and Justification: 1. A. B. C. D. Vendor (category 2001 or 2009) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: $0 2. Budget Template $0 TX-DSHS-19-1309-A-001895 #P of ]  K L M N O P Q R S T U V 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 The contractual dollar amounts must be manually entered into the Tab 4. DSHS Indirect Cost ,__ 254 to populate the Indirect Charges below. 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 2. Budget Template TX-DSHS-19-1309-A-001896 #P of ]  A 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 B I C D I E F G H I J E. Method of Accountability: [Enter accountibility method here] F. Budget Detail and Justification: 1. A. B. C. D. E. F. Vendor (category 2001 or 2009) Project Title: Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: [Enter SOW detail here] Method of Accountability: [Enter accountibility method here] Budget Detail and Justification: I I $0 $0 I I I I I 2. Budget Template TX-DSHS-19-1309-A-001897 #P of ]  A 289 G. 290 291 292 293 294 295 296 297 298 299 300 301 302 303 B C D E F Item Requested Number of Months Estimated Cost per Month Number of Staff Amount Requested Other 1. 2. 3. Item Requested 1. 7500 Fast Dx Service Contracts (Clinical Arbo Testing) 2. EasyMag Extractor Service Contract (clinical arbo PCR testing) 3. Roche MagNA Pure 96 Service Contract (Clinical Arbo PCR) 4. Roche MagNA Pure LC 2.0 (Clinical Arbo PCR) 5. Dynex DSX Service Contract (Serology testing) 6. TMCA Registration 7. AMCA Registration 8. Advanced Mosquito Identification Course Registration 9. Diseases In Nature Conference Registration, Epi/H21400 304 305 306 Total Direct Cost: 307 Total Indirect Charges: Number Needed G I J $68,475 $0 Amount Requested Unit Cost H H41000 H21400 $68,475 2 9,500.00 19,000.00 LAB 1 11,000.00 11,000.00 LAB 1 17,500.00 17,500.00 LAB 2 3,500.00 7,000.00 LAB 1 5 4 10,000.00 95.00 400.00 10,000.00 475.00 1,600.00 LAB ECO ECO 1 500.00 500.00 ECO 4 350.00 1,400.00 EPI $482,053 $134,300 Please see attached DSHS Indirect Cost attachment for calculation. 308 309 Total Budget: $616,353 2. Budget Template TX-DSHS-19-1309-A-001898 #P of ]  K L M 289 A list of "Other" items are listed on the tab 1. 290 291 292 293 294 N O P Q R S T U V $66,085 $2,390 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 2. Budget Template TX-DSHS-19-1309-A-001899 #P of ]  A 1 - ~ D E F G OMB Approval No. 0348-0044 SECTION A - BUDGET SUMMARY 5 6 7 - C BUDGET INFORMATION - Non-Construction Programs 2 3 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 -40 41 42 43 44 45 46 47 48 B Grant Program Catalog of Federal Function or Activity Domestic Assistance Number Federal Non-Federal Federal Non-Federal Total (a) (b) ( c ) (d) (e) (f) (g) 1. Project H: VectorBorne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tier 1) Estimated Unobligated Funds 93.323 New or Revised Budget $0 $0 $616,353 $0 $616,353 $0 $0 $616,353 $0 $616,353 2. 3. 4. 5.  TOTALS SECTION B - BUDGET CATEGORIES 6.  Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) a.  Personnel Total (5) (4) $144,153 $144,153 b.  Fringe Benefits $52,789 $52,789 c.  Travel $25,374 $25,374 d.  Equipment $0 $0 $191,262 $191,262 f.  Contractual $0 $0 g.  Construction $0 $0 $68,475 $68,475 e.  Supplies h.  Other i.  Total Direct Charges (sum of 6a - 6h) $482,053 j. Indirect Charge $134,300 $0 $0 $0 k.  TOTALS (sum of 6i and 6j) $616,353 $0 $0 $0 $616,353 $0 $0 $0 $0 $0 7.  Program Income $482,053 $134,300 Standard Form 424A     (7-97) Prescribed by OMB Circular A-102 SECTION C - NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12.  TOTALS (sum of lines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $616,353 $154,088 $154,088 $154,088 $154,089 $0 $0 $0 $0 $0 $616,353 $154,088 $154,088 $154,088 $154,089 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 13.  Federal 14. NonFederal 15. TOTAL (sum of lines 13 and 14) SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b) First (c) Second (d) Third 16. 3. PHS 424A (e) Fourth I I TX-DSHS-19-1309-A-001900 49 50 51 52 53 54 55 56 A I B C D E F G 17. 18. 19. 20.  Totals (sum of lines 16-19) 21. Direct Charges:   I $0 SECTION F - OTHER BUDGET INFORMATION $482,053 22.  Indirect Changes: $0 $0 $0 $134,300 23.  Remarks:  The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.9%. I SF 424A (7-97)    Page 2 3. PHS 424A TX-DSHS-19-1309-A-001901 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 B C D E F ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018 @ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (Sub-recipient in excess of $25,000) Contractual (Sub-recipient up to $25,000) Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other Total - Health Programs LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (sub-contracts in excess of $25,000) Contractual (sub-contracts up to $25,000) Contractual (Vendor contracts - DSHS Category 2000) Sub-total Contractual Other Total - Laboratory Services TOTAL INDIRECT COST Direct # of Charges Total contracts $98,995 $36,252 $10,721 $0 $35,922 $98,995 $36,252 $10,721 $0 $35,922 $17,918 $6,562 $1,940 $0 $6,502 $0 0 $0 $0 $0 $0 $2,390 $184,280 0 0 0 $0 $0 0 $2,390 $184,280 Direct # of Charges Total contracts $45,158 $16,537 $14,653 $0 $155,340 H I J K L Applicable IDC Rate Amount at 18.1% charged IDC $0 0 G The contractual dollar amounts must be manually entered into the appropriate row to populate the "Direct Charges Total" field.  In addition, the number of contracts will need to $0 be included in the "# of contracts" field.  The Sub-total Contractual row will ensure that the $0 contractual categorical dollar amount and the number of contracts equal those on the $0 Budget Template tab. $433 $33,355 $217,635 Applicable IDC Rate Amount at 33.9% charged IDC $45,158 $16,537 $14,653 $0 $155,340 $15,309 $5,606 $4,967 $0 $52,660 $616,353 $0 The contractual dollar amounts must be manually entered into the appropriate row to populate $0 0 $0 $0 $0 $0 $66,085 $297,773 0 0 0 0 $0 $0 $0 $66,085 $297,773 $0 "# of contracts" field.  The Sub-total Contractual row will ensure that the contractual categorical dollar $0 amount and the number of contracts equal those on the Budget Template tab. $0 $22,403 $100,945 $398,718 $482,053 0 $482,053 $134,300 the "Direct Charges Total" field.  In addition, the number of contracts will need to be included in the The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; 33 Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%.  At DSHS these contracts are expended in the Other 34 category and full indirect cost is charged. 35 Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. 36 37 -38 -39 40 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001902 41 A I B I C I D I E F G H I J K **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect 42 cost rate. 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001903 L 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 A B I C I I I I I I I D E F G H Sub-Contract Template Instructions I J K L Revised 02/01/2017 I I This tab contains instructions for completing the Sub-Contract Template and should not be included in the grant application package. In some cases, DSHS policy is cited in the definition to assist the budget developer in determining proper use of funds within the categorical budget. Personnel I I Definition: Actual costs of salaries and wages of employees devoted to working on activities directly related to carrying out the Scope of Work of the DSHS funded project. These costs are allowable to the extent that they are reasonable and conform to the established, consistently applied policy of the organization and reflect no more than the time actually devoted to the project. The salaries and wages of employees that do not work on activities described in the Scope of Work of the DSHS funded project should be allocated as indirect costs and budget under the Indirect Cost category. Instructions: Enter the following information for each requested position in the Personnel category: Functional Title and Code, indicating E for existing positions and P for proposed positions. % of Time I I Number of months of anticipated employment Total Annual Salary of individual Amount of funding requested for individual will be automatically calculated by the spreadsheet, which multiplies 'percentage of time' by 'Total Annual Salary' Last, First Name of Individual Budget # I I Position # I I Position Description and justification of the position, including primary responsibilities, appropriateness of classification with regard to required certification or licensure, and relevance to project . Insert additional rows and copy the format to add additional personnel. If rows are added, the formula in the cell containing the 19 Personnel category total must be revised to include the added rows. 20 I I 21 Fringe I I Definition: Fringe benefits are allowances and services provided by the organization to its employees as compensation in addition to regular salaries and wages. Fringe benefits include but are not limited to the cost of employee insurance, pensions, and unemployment benefit plans. The cost of fringe benefits is allowable (in proportion to the amount of time or effort employees devote to the grant funded project), to the extent that the benefits are reasonable and are incurred under 22 formally established and consistently applied policies of the organization. 23 Instructions: Enter the following information:  24 Itemized elements of fringe benefits: List the types of costs that comprise your organization's fringe benefits. Fringe Benefit Rate: The fringe benefit rate should be based on your organization's actual experience and is typically calculated by dividing your organization's total fringe benefit costs by total wage/salary costs. Enter your organization's fringe benefit rate on the budget sheet.  The total fringe benefit amount will be automatically calculated by the spreadsheet. 25 26 I I 27 Travel I I Definition: The cost of transportation, lodging, meals and related expenses incurred by employees of the organization while performing duties relevant to the proposed project. This includes auto mileage paid to employees on the basis of a fixed mileage rate for the use of their personal vehicle. Costs related to client transportation and conference registration fees should be budgeted under the 'Other' budget category. Travel costs incurred by a third party under contract should be 28 included within the terms of the contract and be budgeted under the "Contractual" expense category. 29 Instructions: Enter the following information.: In State and Out of State Travel: 30 31 Travel description and justification:  Provide a description of the travel, including destination and number of personnel for each trip, and justification of how the travel will directly benefit the project and why it is necessary to accomplish the project. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001904 #P of 39 A 32 33 34 35 36 37 38 39 40 41 I I I I I I I I I B C D E F G H I J K L Mileage: For travel that includes mileage, provide the number of miles to be travelled, the reimbursement rate per mile, and the number of employees requiring reimbursement. The spreadsheet will automatically calculate the total requested for mileage. For travel requests involving solely mileage, provide the mileage information only and leave all other information blank. Airfare: Provide the cost of airfare and the number of persons requiring airfare. Ground Transportation: Provide the cost of ground transportation, the number of persons requiring ground transportation, and the number of days the ground transportation is required. Lodging: Provide the cost per night for lodging, the number of persons requiring lodging, and the number of days lodging will be required. Per Diem: Provide the cost per day provided for meals, the number of persons travelling, and the number of days reimbursement for meals is required. Other Costs: Provide a description of the other travel costs (such as baggage fees or reservation fees) the number of employees requiring the other cost, and the number of days the other cost will be required. Total:  Totals for each component, each trip, In State and Out of State Travel will be calculated by the spreadsheet. I I I I I I I I I I I I I I I I I I Enter an 'X' in the appropriate box to indicate respondent's use of DSHS Travel Policy or the Respondent's Travel Policy. Attach a copy of Respondent's Travel Policy if it is used to determine travel reimbursement rates. Insert additional rows and copy the format to add additional travel requests. If rows are added, the formula in the cell containing the 'Travel' category total must be revised to include the added rows. 42 43 I I I I I I I I I 44 Equipment I I I I I I I I I Definition: Equipment and Controlled Assets Purchases. Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more. Contractor must inventory equipment and controlled assets, which include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more: desktop and laptop computers, non-portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. If purchase of equipment is approved in writing by the Department, Contractor is required to initiate the purchase of that equipment in the first quarter of the Contract or Program Attachment term, as applicable. Failure to initiate the purchase of equipment may 45 result in loss of availability of funds for the purchase of equipment. 46 Instructions: Enter the following information: I I I I I I I 47 48 49 50 51 Description and Justification: Provide each item of equipment to be purchased and the purpose for the item(s) and why the equipment is necessary. Attach a complete specification or a copy of the purchase order. If a portion of the equipment cost will be funded by non-DSHS sources, name the funding source and the percentage of the cost being funded by DSHS. Unit Cost: Enter the unit cost of each item of equipment requested. Number of Units Requested: Enter the number of units requested. Total: This information will be automatically computed by the spreadsheet. I I I I I I I I I I I I Insert additional rows and copy the format to add additional equipment requests. If rows are added, the formula in the cell 52 containing the 'Equipment' category total must be revised to include the added rows. 53 I I I I I I I I I 54 Supplies I I I I I I I I I Definition: Supplies are defined as consumable items necessary to carry out the services under this DSHS project, including medical supplies, drugs, office supplies, patient educational supplies, software, and any items of tangible personal property 55 other than those defined as equipment. 56 Instructions: Enter the following information: I I I I I I I 57 For General Office supplies (Item 1): I I I I I I I Describe and justify: List the items of general office supplies utilized by the personnel funded by this contract, for example: pens, pencils, paper etc. and indicate relevance to the project. 58 Number of FTEs: Enter the number of FTEs to be funded by the contract and provided general office supplies. 59 Amount per month: Enter the amount spent per month for general office supplies for each FTE funded on the contract. 60 Number of months: Number of months for which general office supplies are to be provided. 61 Total: This total will be automatically computed by the spreadsheet. 62 I I I I I I I I 63 For all other supplies: I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001905 #P of 39 64 65 66 67 68 A I I I I I B C D E F G H I J K L Describe and justify: Provide a description of the item requested and indicate the relevance of the item to the project. Unit Price: Enter the unit price of the item requested. I Number of Units: Enter the number of units of the item requested. Total: The total will be automatically computed by the spreadsheet.  I I I I I Insert additional rows and copy the format to add additional supplies requests. If rows are added, the formula in the cell 69 containing the 'Supplies' category total must be revised to include the added rows. 70 I I I I I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001906 #P of 39 I I A B C D E F G H I J K L 71 Contractual I I Definition: The costs of activities directly associated with carrying out the statement of work that are contracted by the organization to a third party are recorded in the 'Contractual' category. A contract with a subrecipeint must comply with Article XII, section titled "Contracts with Subrecipient Subcontractors" of the DSHS General Provisions. The contractor may enter into contracts with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program Attachment(s). Prior to entering into an agreement equaling $100,000 or more of a Program Attachment amount, Contractor shall obtain written approval from DSHS. Contracts with subcontractors shall be in writing and include the following: Name and address of all parties; A detailed description of the services to be provided; Measurable method and rate of payment and total amount of contract; Clearly defined and executable termination clause; Beginning and ending dates that coincide with the dates of the applicable Program Attachment(s) or cover a term within the beginning and ending dates of the applicable Program Attachment(s); 72 Access to inspect the work and the premises on which any work is performed, in accordance with the General Provisions; and a copy of these General Provisions and a copy of the Statement of Work and any Special Provisions in the Program Attachment(s) applicable to the subcontract. Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall monitor both financial and programmatic performance and maintain pertinent records that shall be available for inspection by DSHS. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state/federal statutes and regulations and under this Contract. Contractor shall not contract with a subcontractor, at any tier, that is debarred or suspended or excluded from or ineligible for participation in federal assistance programs. When subcontracting, Contractor is required to meet all applicable HUB requirements. 73 74 Instructions: Enter the following information for each contract in the Contractual category: Name of Contractor I 75 Method of Selection I 76 Period of Performance 77 Scope of Work 78 I Method of Accountability 79 80 Attach a fully justified 8 category budget for each contractor. 81 I I Insert additional rows and copy the format to add additional contracts. If rows are added, the formula in the cell containing 82 the 'Contractual' category total must be revised to include the added rows. 83 I I 84 Other I I Definition: All other allowable direct costs not listed in any of the above categories are to be included in the 'Other' category. Some of the costs listed below may also be treated as indirect cost. Their treatment as 'Other' (direct) or indirect must be consistent throughout the respondent's organization. Typical costs that may be budgeted in the 'Other' category are the 85 approved DSHS program attachment's share of: 86 * equipment rental if used solely on the DSHS project, otherwise include in 'Indirect Costs;" 87 * single audit services if allocated directly to each funding source; otherwise include in "Indirect Costs;" 88 * long distance telephone expenses (general telephone expenses should be included in "Indirect Costs;" 89 * printing and reproduction expenses directly related to the DSHS project; 90 * postage and shipping directly related to the DSHS project; 91 * contract personnel services for individuals that work solely on activities described in the DSHS Statement of Work; 92 * equipment repairs or service maintenance agreements for equipment used solely on the DSHS funded project; 93 * periodicals; I 94 * advertising that promotes the DSHS project; 95 * registration fees; I 96 * patient transportation; I 97 * training costs, speakers fees and stipends. I I 98 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001907 #P of 39 I I I I I I A B C D E F G H I J K L 99 Instructions: Enter the following information for each request for 'Other' costs: I 100 Format for building or equipment rental, telephone or internet service, postage or other such costs. Description/Justification: Provide a general description of the service to be purchased and an explanation of the purpose of 101 the service and why it is necessary for the completion of the activity. 102 Cost per month: The monthly cost of providing the service. I 103 Number of Months: Number of months the service is to be provided. 104 Number of FTEs: The number of FTEs to receive the service. I 105 Total: The Total is automatically calculated by the spreadsheet. I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001908 #P of 39 I I I I I A B C D E F G H I J K L 106 I I I I I 107 Format for all other types of goods or services in the 'Other' category:  Description/Justification: Provide a general description of the good or service to be purchased and an explanation of the 108 purpose of the good or service and why it is necessary for the completion of the activity. 109 Total: Enter the total cost of the good or service. I 110 I I I I I Insert additional rows and copy the format to add additional requests. If rows are added, the formula in the cell containing 111 the 'Other' category total must be revised to include the added rows. 112 I I I I I 113 Indirect Cost I I I I I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information 114 services). 115 Instructions: Enter the following information: I I I 116 Total of Amount of Indirect Costs allocable to the projectI Indirect Costs are based on: Enter an X in the box that corresponds to the  basis on which respondent is charging indirect costs. 117 Organizations that have an approved indirect cost rate should mark the first option by marking the box and * indicating the rate and base. A copy of the approved rate agreement that will be in effect during the contract 118 term should be attached. If a rate agreement is pending, submit the latest approved agreement. OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial * Procedures Manual (CFPM) available on the internet at http://www.dshs.stae.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be address in 119 Part V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. If using a central service or indirect cost rate, identify the types of costs that are included (being allocated in the rate: Salary/expenses of executive office staff (CEO, CFO), accounting office, personnel office; depreciation; facility maintenance; utility costs; general liability and property insurance. Organizations that do not use an indirect cost rate and governmental entities with only a central service rate must identify * the types of costs that will be allocated as indirect costs and the methodology used to allocate these costs in the space provided. The costs/methodology must also be disclosed in Part V- Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Identify the types of costs that are being allocated as indirect costs, the allocation methodology, and 120 the allocation base. 121 I I I I I Instructions: OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial Procedures Manual (CFPM) available on the internet at 122 http://www.dshs.state.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be addressed in Part V - Indirect Cost Allocation of 123 the Cost Allocation Plan that is submitted to DSHS. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001909 #P of 39 A B C D E F G H I Name of Contractor: 1 ELC 2Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond Budget Request Period: 8/1/19-7/31/20 3 4 5 A. Personnel 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Position Total Salaries Time (%) # of months Total Salary Amt Requested $0 $0 1. Functional Title and Code 0% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 2. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 3. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 4. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 5. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Sub-Contract Template 6. Sub-Contract Template TX-DSHS-19-1309-A-001910 #P of 39 A 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 B C D E F G H 7. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 8. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 9. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 10. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 59 B. 60 61 Fringe Benefits Itemized elements of fringe benefits: $0 Rate (%) 32.00000% $0 62 C. 63 64 65 66 67 68 69 70 71 72 73 I Travel 1. In-State a. Travel description and justification: $0 # Miles Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 6. Sub-Contract Template 0.00 Rate/unit cost $0.0000 $0 $0 $0 $0 $0 # Persons 0 0 0 0 0 0 #Days Total 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001911 #P of 39 A 74 75 B 2. Out-of-State a. Travel description and justification : 76 77 78 79 80 81 82 83 84 85 Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 86 Respondents Travel Policy* 87 88 DSHS Travel Policy C D E F G # Miles Rate/unit cost # Persons #Days Total 0.00 $0.0000 $0 $0 $0 $0 $0 100 101 102 103 104 105 106 107 108 $0 $0 $0 $0 $0 $0 $0 0 0 0 0 # of Units $0.00 $0 Tot. 0 $0 $0 # of staff 0.00 Amt/Month # of Months Unit Cost # of Units $0.00 $0.00 2. Description/justification of Supplies: F. 1. A. B. C. D. E. Unit Cost Supplies 1. General Office supplies: (describe/justify) 109 G. 110 111 112 113 114 115 116 117 I *include a copy of the policy with the application Equipment For computer requests, attach Vendor Certification for Computer Equipment purchased by DSHS Contractor form): 1. Description/justification of Equipment 93 E. 94 95 96 97 98 99 $0 Indicate with an 'X' which policy is used for travel: 89 D. 90 91 92 0 0 0 0 0 0 H 0 0 Tot. Tot. $0 $0 Contractual $0 Project Title Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Description of how contract(s) will be accounted for and the number of contract(s) anticipated. $0 Other $0 Use format of item 1 for building or equipment rental, telephone or internet service, postage or other such costs. 1. Description/justification: Cost/mo. # of months # FTEs Total $0 Use format of item 2 for all other requests in this category. 2. Description/justification: 6. Sub-Contract Template Total $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001912 #P of 39 A III 118 119 B C D E F G H Total Direct Charges 6. Sub-Contract Template I $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001913 #P of 39 A B 120 H. Total Indirect Charges 121 122 123 124 125 126 127 128 129 Total Amount of Indirect Costs Allocable to the project: Indirect Costs are based on (mark the statement that is applicable and provide the rate, base and type, as applicable): C D E F G H I $0 Amount $0 The respondent's most recent indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency. Expired rate agreements are not acceptable. Attach a copy of the rate agreement to the budget. Applies only to governmental entities. The respondent's current central service cost rate or indirect cost rate based on a rate proposal prepared in accordance with OMB Circular A-87. Attach a copy of Certification of Cost Allocation Plan or Certification of Indirect Costs. Note: Governmental units with a Central Service Cost Rate must also include the indirect cost of the governmental units department (i.e., Health Department). In this case indirect costs will be comprised of central service costs (determined by applying the rate) and the indirect costs of the governmental department. The allocation of indirect costs must be addressed in Park V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Rate Base Type (central service or indirect) 0.00000% 0.00000% A cost allocation plan. A cost allocation plan as specified in the DSHS Contractor's Financial Procedures Manual (CFPM), Appendix A must be submitted to DSHS within 60 days of the contract start date. The CFPM is available on the following internet web link: http://www.dshs.state.tx.us/contracts/. 130 131 Total Budget 6. Sub-Contract Template $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001914 #P of 39 A 1 2 3 4 5 6 7 8 9 10 11 12 13 B Contents: Tab 1.  Tab 2.  Tab 3.  Tab 4. Tab 5.  Tab 6. C D 29 30 31 32 33 34 35 36 37 38 39 F G H Budget Template Instructions Budget Template PHS 424A DSHS Indirect Cost Calculator Sub-Contract Template Instructions Sub-Contract Template Funds Coordination and Management Branch (FCMB) staff members are available to provide assistance in completing the tool.  In addition, detailed training in either a group setting or one-onone can be provided on DSHS Grant processes. FCMB Contact list: Elaine McHard (512) 776 - 6646 Branch Manager Sharon Golden (512) 776 - 6562 Team Lead Grants Budget Analysts: Anna Layfield (512) 776-2388 David de la Rosa (512) 776-3217 Karen Cathey (512) 776-3125 Community Health Improvement 14 15 16 17 18 19 20 21 22 Environmental Epidemiology & Disease Registries Joy Counce (512) 776 - 6564 23 24 Health Promotion & Chronic Disease Prevention Joy Counce (512) 776 - 6564 25 26 Maternal & Child Health Suzanne Lucignani (512) 776 - 2591 27 28 E DSHS Grant Budget Template Funds Coordination and Management Branch Revised 01/07/2019 Sharon Golden (512) 776 - 6562 Joy Counce (512) 776 - 6564 Elaine McHard Sharon Golden Joy Counce Sharon Golden Sharon Golden Elaine McHard  All Sections All Sections All Sections, except below Maternal and Child Health Block Grant National Violent Death Reporting System Zika Health Program Grant (512) 776 - 6646 Executive Offices (512) 776 - 6562 All Sections Consumer Protection (512) 776 - 6564 All Sections Laboratory & Infectious Disease Services (512) 776 - 6562 All Sections Regional & Local Health Operations (512) 776 - 6562 All Sections, except below PPHF Preventive Health and Health (512) 776 - 6646 Services Block Grant 40 Contents TX-DSHS-19-1309-A-001915 A I B C D E F I G I H Vacant areas - Please contact Elaine McHard (512) 776 - 6646 or Sharon Golden (512) 776 - 6562 for assistance. 41 42 I 43 44 I 45 DSHS Grant Budget Tool.xlsx I I I I I IRevised 01/07/2019 Contents TX-DSHS-19-1309-A-001916 A 1 2 3 4 B C I D E F G H I J Budget Template Instructions Funds Coordination and Management Branch Revised 01/07/2019 K L M This tab contains instructions for completing the Budget Template and should not be included in the grant application package.  In some cases, DSHS policy is cited in the definition to assist the grant developer in determining proper use of funds within the categorical budget. 5 6 I 7 A. Personnel Definition: Actual salaries and wages for all staff position in the proposed project. 8 9 *Enter the following information for each position in the Personnel category: 10 Position Title  11 % of Time 12 Last, First Name of Staff 13 Budget # I 14 Position # 15 Position Description 16 Annual Salary 17 Longevity, if applicable 18 Benefit Replacement Pay (BRP), if applicable 19 20 I Merits are no longer accounted for on grant applications. 21 22 I 23 B. Fringe I I I I - -24 -25 -26 -27 -28 -29 -30 -31 32 Definition: Fringe benefits paid by the employer on behalf of its employees. This includes employer contributions for social security, retirement, health and accident insurance and workers' compensation insurance. Fringe benefits requested should represent actual benefits paid for employees. *Current Fringe benefits rate is 36.62% effective 9/1/2017 The fringe benefit breakout is: Social Security - 7.65% Retirement - 10.00% Health Insurance -18.97%  (this includes the health insurance surcharge of 1%) C. Travel Definition: The cost of transportation, lodging, meals and related expenses incurred by staff while traveling to perform duties required by the proposed project. Please utilize the DSHS Travel Office website: http://online.dshs.internal/traveloffice.aspx to ensure proper costs are charged when completing the Tab 2 Budget template. *Current In-State lodging rate for 2019 is $85/night.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. *Current In-State Per Diem for 2019 is $46/day.  Rate per DSHS Travel Website (12/21/2018) for Fiscal 2019 Travel Reimbursement Rates. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001917 Page #P of 35 A -33 -34 -35 -36 -37 38 I I I I G I I I I I I B I C D E F H I J K L M Please Note: Per DSHS Travel Office (12/2018), the DSHS maximum Lodging rate without an approved exception form is $85.00 for Lodging.  From the DSHS Travel office website refer to Rate section, GSA Maximum Lodging and Mileage Rates Within Texas for the appropriate State Fiscal Year and link to the GSA website. *Current Mileage reimbursement is $.58/mile effective 01/01/2019-12/31/2019 per HHSC Connection 01/07/2019. *Current Travel Reservation Fee is $12.00 based on the National Travel System's (NTS) contract for full service arrangements or $19.50  based on the Short's Travel Management System's contract for full service arrangements at: https://www.comptroller.texas.gov/purchasing/programs/travel-management/travel-agency/.  State Contract effective September 1, 2014 through August 31, 2019. *Current state airline contract with American Airlines and JetBlue Airways, effective 10/01/2015 - 08/31/2019. This section identifies baggage charges related to state business are reimbursable.  It is assumed that the first checked bag is necessary to complete business travel. Charges for excessive baggage may be reimbursed as long as the travel is related to state business (e.g. state-owned equipment). Agencies are responsible for ensuing the reasonableness of the reimbursement and number of baggage's necessary.  For additional information and updates, please utilize the DSHS Travel website at http://online.dshs.internal/traveloffice.aspx or contact the DSHS Travel Coordinator for assistance. NOTE: The sample spreadsheet reflects the $12.00 reservation fee for NTS full-service travel arrangements and should be adjusted based on the service requested. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001918 Page #P of 35 A B C 39 40 D. Equipment D E F G H I J K L M Definition: Equipment is defined by DSHS as non-expendable personal property with a unit cost of more than $5,000 and a useful life of more than one year. 41 *Detailed description of equipment is required. 42 NOTE: Indirect Cost is not charged on equipment. 43 44 45 E. Supplies Definition: Costs for materials and supplies necessary to carry out the program. 46 *Detailed description of supplies is required. 47 48 49 F. Contractual Definition: Activities identified in the scope of work that are delegated by the applicant to a second party; the cost of providing these activities are recorded in this category as either Sub-recipient or Vendor. Travel costs incurred by a second party while performing these activities should be included in this category. Contracts for administrative services are not included in this category; they are properly classified in the Other category. *Enter the following information for each contract in the Contractual category: A. Name of Contractor B. Method of Selection C. Period of Performance D. Scope of Work E. Method of Accountability F. Budget Justification and Detail: This maybe required by the Federal Agency 50 51 52 53 54 55 56 57 NOTE: Indirect Cost is charged up to the 1st $25,000 of each sub-recipient Category 4000 contract. 58 59 60 G. Other 61 62 63 64 65 66 67 68 69 70 71 72 73 74 Definition: All other allowable direct costs not listed in any of the above categories are to be included in this category. Some of the major costs that should be budgeted in this category are: *contracts for administrative services *space and equipment rental *utilities and telephone expenses *data processing services *printing and reproduction expenses *postage and shipping *contract clerical or other personnel services *janitorial services *exterminating services *security services *insurance and bonds *equipment repairs or service maintenance agreements *books, periodicals, pamphlets, and memberships *advertising *registration fees *patient transportation *training costs, speaker fees and stipends *The Other Budget Category requires a general description of the service and cost.  The justification should include an explanation of the purpose of the service. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001919 Page #P of 35 I A B C 75 H. Indirect Cost I 76 77 78 79 80 81 82 83 84 85 - -86 -87 88 D I E F G H I J K L M I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information services). *Current I/C rate agreement dated 09/17/2018.  Rates are as follows: I I FIXED rate 9/1/2017 - 8/31/2018 Health Programs - 18.1% Laboratory Services - 33.9% Lab percentage should only be used for funds that will be budgeted on lab program IDs. Provisional rate 9/1/2018 - 8/31/2021 Health Programs - 18.1% Lab percentage should only be used for funds Laboratory Services - 33.9% that will be budgeted on lab program IDs. NOTE: *The categorical totals, excluding the contractual category, will automatically "link" to the PHS 424A, and DSHS Indirect Cost tabs upon completion of the Budget Template tab. In the DSHS Indirect Cost tab, the contractual dollar amounts from the Budget Template tab will need to be manually entered into the contractual category rows in the "Budget Template Total" column. Placement of the contractual items are determined by identifying contracts as either "sub-contracts in excess of $25,000" or "sub-contracts up to $25,000". The contract dollar amounts will need to be manually entered into the appropriate row to populate the "Budget Template Total" field. In addition, the number of contracts will need to be included in the "# of contracts" field. The Sub-total Contractual row will ensure that the contractual categorical dollar amount and the number of contracts equal those on the Budget Template tab. **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate for the "Effective Period" of 9/1/2017 - 8/31/2018 and 9/1/2018 - 8/31/2021. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect cost rate. Budget Template Instructions 1. Budget Tmp. Instructions TX-DSHS-19-1309-A-001920 Page #P of 35 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 B C D E F G H I Texas Department of State Health Services ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: 8/1/19-7/31/20 A. J $179,070 Personnel Position % of Time Annual Salary Benefit Annual Longevity Replacement Pay (BRP) Months Total 1. Microbiologist II 100% $40,086 $480 $0 12 $40,566 ECO Hancock, Joseph (H41000/8703) Position Description: Participates in all aspects of the Texas Department of State Health Services Arbovirus Laboratory (DSHSAL)   mosquito   surveillance   program.   Responsibilities   include   data   entry   into   the   Laboratory   Information Management   System   (LIMS),   mosquito   species   identification   and   pooling   of   vector   species,   arbovirus   testing,   and insecticide resistance testing for jurisdictions in Texas. Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents.  Coordinates and assists with maintenance of laboratory mosquito colonies and specimens submitted for insecticide resistance testing. Coordinates and assists with data   analysis   and   organization,   data   requests   from   stakeholders,   and   data   reporting   requirements.   Participates   in preparation of standard operating procedure (SOP) documents and training other staff.  Tier 2, Assists with Tier 1-3 activities. 2. Microbiologist II 100% $41,823 $2,160 $0 12 $43,983 ECO Day, Joanne (H41000/8706) Position Description: Participates in all aspects of the DSHSAL mosquito surveillance program. Responsibilities include data entry into the LIMS, mosquito species identification and pooling of vector species, arbovirus testing, and insecticide resistance testing for jurisdictions in Texas. Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents.  Coordinates and assists with maintenance of laboratory mosquito colonies and specimens submitted for insecticide resistance testing. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting requirements. Participates in preparation of SOP documents and training other staff.  Tier 2, Assists with Tier 1-3 activities. 3. Program Specialist III NEW (H21400/Position # TBD) 100% $55,000 $0 $0 2. Budget Template 12 $55,000 ECO TX-DSHS-19-1309-A-001921 #P of ]  K L M N O P Q R S T U V 1 2 3 4 5 PERSONNEL TOTAL 6 7 H41000 H21400 8 9 10 11 TOTAL SALARIES $179,070 $104,309.26 $74,760.50 Months are NOT included in the Total calculation 12 13 14 15 16 17 18 19 2. Budget Template TX-DSHS-19-1309-A-001922 #P of ]  A 20 21 22 23 24 25 I I I I I I I I I 4. Geographic Information Specialist I I 100% I $39,521 I $0 $0 12 $39,521 ECO NEW (H21400/H41000 (50/50)/Position # TBD) Position Description: This will be a split position between the Arbovirus Laboratory and the Zoonosis Control Branch. Primary   responsibilities   will   include   organizing   mosquito   surveillance   and   insecticide   resistance   testing   data   and generating reports from them; coordinating and assisting with maintenance of databases to capture relevant spatial and temporal   information;   documenting   procedures;   validating   data   for   accuracy   and   completeness;   completing   approved metadata forms; and producing maps to display the data; coordinating and assisting with the generation of maps and summary tables for distribution between epi and laboratory staff, for MosquitoNET reporting, for responding to submitter requests, and for updating the DSHS website.  Tier 2, Will assist with Tier 1-3 activities. 26 B. 27 28 I I I B C D E F G H Position Description: Border entomologist to cover international border areas in Public Health Regions 8, 9, 10, and 11. They should have a Master’s Degree in Entomology or related field.  They will support local border jurisdictions as a subject matter expert. Duties will include consultation and training on, and, at times, performance of a range of integrated vector management-related activities, e.g. conducting vector surveillance, the analysis and interpretation of which informs timely control activities; conducting IR testing, the results of which inform decisions on product selection and application; and   disseminating   findings.   The   position   will   submit   data   for   entry   into   MosquitoNet;   assist   local   jurisdictions   in coordinating   investigation   and   response   to   VBD   outbreaks;   implementing   emergency   vector   control   activities;   and composing routine and emergency-related risk communication plans.  Tier 2, Will Assist with Tier 1-3 activities. Fringe Benefits I I I Fringe benefits are applicable to direct salaries and treated as direct costs.  Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% 2. Budget Template I J H41000 (ECO) Fringe $65,575 H21400 (ECO) Fringe TX-DSHS-19-1309-A-001923 #P of ]  K L M N O P Q R S T U V 20 21 22 23 24 25 $38,198 26 $27,377 27 28 2. Budget Template TX-DSHS-19-1309-A-001924 #P of ]  A 29 C. 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 Travel B C D E F G 1. In-State b. Travel description: The border entomologist will have weekly duties that will require them to travel throughout the public health regions where they have responsibilities.  We estimate that they will travel at least three times per week up to 350 miles per week. We expect at least one trip will be an overnight trip to set out and pick up mosquito traps.  The border entomologist will also travel once a quarter to Regional Headquarters to work with the State Medical Entomologist.  ECO/H21400 Assist with Tier 1-3 activities $37,427 Mileage:  56 trips x  1 person x 350 miles r/t @ $.58/mile $11,368 Airfare: 1 person @ $450 r/t  x 2 trips $900 Ground Transportation:  1 person @ $167 x 3 trips $501 Lodging:  3 nights @ $85/night x 1 person x 56 trips $14,280 Per Diem:  4 days @ $46/day x 1 person x 56 trips $10,304 Travel Fees:  1 person @ $12.00 x 2 trips $24 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $50 2. Out-of-State Mileage:  trips x  # persons x ? miles r/t @ $.58/mile Airfare: # persons @  r/t Ground Transportation:  1 persons @ $ Lodging:   nights @ $/night x  persons x  trips Per Diem:   days @ $/day x  persons x  trips Travel Fees:   persons @ $12.00 x  trips Baggage Fees-determined by carrier:# persons @ $? I $46,135 H21400 J $46,135 a. Travel description: The medical entomologist will travel once to visit with the PS III  to assist with any trainings or assistance in working with the LHD or the vector control jurisdictions. The medical entomologist will travel once to each of the Public Health Regions to assist with any trainings or assistance in working with entities that receive the surveillance kits. Enhancing mosquito surveillance capacity throughout the state.    ECO/H21400 Assist with Tier 1-3 activities $8,708 Mileage:  15 trips x  1 person x 244 miles r/t @ $.58/mile $2,123 Airfare: # persons @ $? r/t $0 Ground Transportation:  # persons @ $? $0 Lodging:  3 nights @ $85/night x 1 person x 15 trips $3,825 Per Diem:  4 days @ $46/day x 1 person x 15 trips $2,760 Travel Fees:  # persons @ $12.00 x # trips $0 Baggage Fees-determined by carrier:# persons @ $? $0 a. Travel description: H ECO ECO $0 $0 $0 $0 $0 $0 $0 $0 $0 2. Budget Template TX-DSHS-19-1309-A-001925 #P of ]  A 65 66 D. 67 68 69 70 71 B C D 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 86 12. 87 13. 88 14. 89 15. 90 16. 91 17. 92 18. 93 19. 94 20. 95 96 97 98 99 100 21. 22. 23. 24. 25. 26. 101 27. 102 28. G H I J $0 Item Requested 73 74 75 76 77 78 79 80 81 82 83 84 85 F Equipment Qty 1. [Item Name] -  Description: 72 E. E Unit Cost $0 Amount 0.00 $172,285 Supplies Item Requested Culex insecticide resistance testing supplies CDC Light Traps CDC gravid traps BG sentinel 2 traps 6 volt batteries 12 volt batteries binocular stero microscope hanging dry ice dispenser Mosquito ID Books Iphone Pipet Basins (case of 200) Thermo Scientific™ ClipTip™ Pipette Tips (960 tips in each unit) MagMax Deep well plates (50 plates in each unit) MagMax Standard plates (48 standard plates in each unit) MagMax Deep well tip combs (100 combs in each unit) Corning universal lid with corner notch (Corning 3099) case of 50 Axygen™ 5mL Snaplock Microcentrifuge Tubes-Case of 5 packs (pack = 250 tubes) SuperScript III Platinum 1-Step qRT-PCR kit (500 rxns) MicroAmp® 96-Well  Plate Barcode (10 plate barcodes in each unit) MicroAmp® Optical 8-cap strips (300 strips in each unit) MagMax-96 Viral RNA Isolation Kit (5 x 96 preps)-automated White Labeling Tape (19mm x 54.9m) 2-Propanol (case of 6 bottles x 500ml) 100% ethanol (500 ml) Nuclease-free H2O (10 in each unit x 50 ml) Rnase Away (6 in each unit x 475 ml) Eppendorf filter tips 0.1-10 ul (960 in each unit) Eppendorf filter tips 2-200 ul (960 in each unit) 1 25 25 25 50 25 1 25 1 1 6 Qty Unit Cost 2,500.00 90.95 97.00 165.85 29.00 112.65 424.64 18.00 54.95 99.00 135.90 50 116.59 5,829.50 H41000 ECO/Tier 2 10 366.00 3,660.00 H41000 ECO/Tier 2 27 172.00 4,644.00 H41000 ECO/Tier 2 3 587.00 1,761.00 H41000 ECO/Tier 2 10 126.03 1,260.30 H41000 ECO/Tier 2 1 419.99 419.99 H41000 ECO/Tier 2 1,840.00 42,320.00 H41000 ECO/Tier 2 996.50 H41000 ECO/Tier 2 1,110.00 H41000 ECO/Tier 2 23 25 10 42 6 2 14 3 4 25 3 39.86 111.00 1,484.00 32.00 180.00 29.54 110.09 370.48 190.03 190.03 Amount 2,500.00 H21400 2,273.75 H21400 2,425.00 H21400 4,146.25 H21400 1,450.00 H21400 2,816.25 H21400 424.64 H21400 450.00 H21400 54.95 H21400 99.00 H21400 815.40 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 H41000 H41000 H41000 H41000 H41000 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 4,750.75 H41000 ECO/Tier 2 570.09 H41000 ECO/Tier 2 62,328.00 192.00 360.00 413.56 330.27 1,481.92 2. Budget Template $16,640 H21400 $155,645 H41000/Arbovirus (Molecular Testing) Funding supports real time RT-PCR and identification TX-DSHS-19-1309-A-001926 #P of ]  A 103 29. 104 30. 105 31. 106 32. 107 33. 108 34. 109 35. 110 36. 111 112 113 114 115 116 37. 38. 39. 40. 41. 42. 117 43. 118 44. 119 45. 120 46. 121 47. 122 48. 123 49. 124 50. 125 51. 126 52. 127 128 F. 129 130 131 132 133 134 135 B C Eppendorf filter tips 20-300 ul (960 in each unit) USA Scientific Inc 2ML MICRO TUBE W/GASKET PK/100 BBs (6000 in each unit) Microcentrifuge tubes 1.5 ml (500 in each unit) Front closure lab coat Small (25 in each unit) Front closure lab coat Medium (25 in each unit) Front closure lab coat Large (25 in each unit) BA Diluent 2 ml each -prep in house Whatman Filter Paper Circles  Grade 4, 110 mm (#1004110) 100/pack $20.40 Labels for tubes, $60/pack, 2,380/pack Infection supplies for cell culture Processing supplies for cell culture Equine processing Disposable micro pipettes (pk of 500) Pipette Filler (wheel) Pack of 3 (2, 10, & 25 ml) 250 ml Glass Wheaton bottles (case of 48) Acetone (100%) 4 L Plastic Graduated Cylinders (100 ml) case of 12 Heavy-duty Glass Beakers (250 ml) pack of 12 Covidien Tendersorb™ Underpads (case of 150) Aspirators ULINE 2 MIL RECLOSABLE BAGS 10" x 12" (1 carton = 1000 bags) Labeling tape-Rainbow pack (case of 24) Richmond Braided Cotton Roll 3/8" diameter, 6" length (pk of 200) D E F G H 1,327.20 H41000 ECO/Tier 2 6.00 6,638.00 H41000 24.00 H41000 ECO/Tier 2 ECO/Tier 2 5 59.15 295.75 H41000 ECO/Tier 2 2 268.70 537.40 H41000 ECO/Tier 2 2 268.70 537.40 H41000 ECO/Tier 2 2 20,000 268.70 0.08 537.40 H41000 1,600.00 H41000 ECO/Tier 2 ECO/Tier 2 20,000 20,000 4,000 4,000 100 2 0.03 0.03 0.83 0.90 3.30 105.64 600.00 600.00 3,320.00 3,600.00 330.00 211.28 H41000 H41000 H41000 H41000 H41000 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 271.46 H41000 347.75 H41000 236.38 H41000 ECO/Tier 2 ECO/Tier 2 ECO/Tier 2 329.37 H41000 ECO/Tier 2 117.40 H41000 ECO/Tier 2 90.00 233.96 H41000 180.00 H41000 ECO/Tier 2 ECO/Tier 2 1 2 93.00 156.64 93.00 H41000 313.28 H41000 ECO/Tier 2 ECO/Tier 2 5 24.20 121.00 H41000 ECO/Tier 2 7 200 4 2 1 1 1 1 4 2 189.60 33.19 135.73 347.75 236.38 329.37 117.40 58.49 A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work: J Supplies/Reagents Cost of 20,000 Mosquito ID Processing & Cell culture testing of 4000 mosquito po Insecticide Resistance Testing $468,556 Contractual Sub-recipient (category 4000): 1. Project Title: I Harris County Public Health Vector and $50,000 ECO/ Tier 2 Mosquito Control Program Harris County Public Health Mosquito Vector Control District (HCPHMVCD) Sole Source 8/1/19-7/31/20 2. Budget Template $50,000 H41000 H21400 TX-DSHS-19-1309-A-001927 #P of ]  K L M N O P Q R S T U V 103 104 105 106 107 108 109 es/Reagents Cost of 20,000 Mosquito ID 110 111 112 sing & Cell culture testing of 4000 mosquito pools 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 - 128 The contractual dollar amounts must be manually entered into the Tab 4. DSHS Indirect Cost 129 to populate the Indirect Charges below. $25,000 130 131 $443,556 132 133 134 135 2. Budget Template TX-DSHS-19-1309-A-001928 #P of ]  A 136 137 138 139 140 141 I I B C D E F The funding to HCPHMVCD will fund one technician that will be involved in the surveillance and testing of mosquitoes.  The technician will conduct surveillance to monitor mosquitoes and wild bird (avian) specimens for the presence of arboviruses, including SLE and WN viruses, collect routine mosquito and avian specimens, screen mosquito pools for SLE and WN, Zika, CHIK, DEN virus, report significant results to DSHS within twenty-four hours, and provide DSHS program with a final progress report. E. Method of Accountability: Sole Source System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. F. Budget Detail and Justification: See attachment. 1. 142 143 144 145 146 A. B. C. D. 147 148 E. 149 150 151 152 153 F. 1. A. 154 155 156 157 B. C. D. 158 159 E. 160 161 162 F. I I I I I I G Vendor (category 2001 or 2009) Project Title: Improve Information Reach and Retention Update and enhance $25,000 Arbovirus Laboratory website by adding informational training videos $75,000 to produce a series of 5 videos: Arbovirus Surveillance in Texas, Mosquito ECO/Tier Trapping, Collecting GPS Coordinates, Shipping Mosquitoes to DSHS 2 Laboratory, Forms and Data Quality.H41000 Name of Contractor(s): ARROWHEAD FILM AND VIDEO INC Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: Improve Information Reach and Retention Update and enhance Arbovirus Laboratory website by adding informational training videos to produce a series of 5 videos: Arbovirus Surveillance in Texas, Mosquito Trapping, Collecting GPS Coordinates, Shipping Mosquitoes to DSHS Laboratory, Forms and Data Quality. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. Budget Detail and Justification: Based on estimated total cost of $75,000 for 5 videos over 3 years.  $25,000 estimated for first year. Vendor (category 2001 or 2009) Project Title: Vector-borne disease and insecticide resistance surveillance $293,556 ECO/Tier 2 along the Texas-Mexico Border: H21400 University of Texas Rio Grande Valley Name of Contractor(s): (UTRGV) Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: The goal of this project is to continue the ongoing surveillance of vector mosquitoes and monitoring of insecticide resistance along the Texas-Mexico border, a region that is of particular concern for introduction and local transmission of vector-borne diseases such as Zika, dengue, and chikungunya. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. Budget Detail and Justification: 2. Budget Template H I J $25,000 $293,556 TX-DSHS-19-1309-A-001929 #P of ]  K L M N O P Q R S T U V 136 137 138 139 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 140 $393,556 H21400 141 142 143 144 145 146 147 148 149 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 150 151 152 153 154 155 156 157 158 159 160 161 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 162 2. Budget Template TX-DSHS-19-1309-A-001930 #P of ]  A 163 164 165 166 167 168 169 170 171 172 173 174 I B C D Vendor (category 2001 or 2009) 1. Project Title: Insecticide Resistance testing: H21400 A. B. C. D. I E F G $100,000 ECO/Tier 2 H $100,000 I J Name of Contractor(s): Texas Tech University Method of Selection: Sole Source I Period of Performance: 8/1/19-7/31/20 Scope of Work: A. Receive mosquito eggs for rearing and subsequent insecticide resistance testing from as many as 50 submitting jurisdictions up to twice annually as coordinated by System Agency. B. Use the Centers for Disease Control and Prevention (CDC) bottle bioassay for detecting resistance to insecticides in vector mosquito populations. C. Determine the diagnostic dose and diagnostic time for each insecticide, for each region and for each vector species that is tested. D. Provide testing of resistance/susceptibility of mosquito populations from each submitter of mosquitoes against a panel of at least 2 different insecticides (types/families) at 3 concentrations (high/med/low) and controls. E. Electronically submit, in a format provided by DSHS, a bi-annual report of the testing data to DSHS at Whitney.Qualls@dshs.texas.gov. E. Method of Accountability: System Agency will monitor Performing Agency’s performance of the requirements in the SOW and compliance with the Contract’s terms and conditions. F. Budget Detail and Justification: See attachment. I I I I 2. Budget Template TX-DSHS-19-1309-A-001931 #P of ]  K L M N O P Q R S T U V 163 164 165 166 167 168 169 170 171 172 Please attach itemized - detail budget per contractor or provide explanation that the budget will be provided upon award or selection. 173 174 2. Budget Template TX-DSHS-19-1309-A-001932 #P of ]  A 175 G. 176 177 178 179 180 181 182 183 B C D E F Item Requested Number of Months Estimated Cost per Month Number of Staff Amount Requested Other 1. 2. 3. Item Requested Number Needed 184 185 186 Total Direct Cost: 187 Total Indirect Charges: 9,000.00 ECO/Tier 2 9,500.00 38,000.00 ECO/Tier 2 26,250.00 I J $73,250 H41000 H21400 $73,250 4,500.00 26,250.00 H $0 Amount Requested Unit Cost 1. Kingfisher Flex Extractor Service Contract 2 (Mosquito Surveillance Testing) 2. 7500 Fast Dx Service Contracts (Mosquito 4 Surveillance) 3. DSHS is requesting $26,250 (equal to the last ELC award for this activity) to increase the Disease In Nature conference attendance by reducing the registration fee. With the full award, the fee will be reduced from $350 to $250. This significant reduction in cost will assist in attracting speakers and broadly facilitate attendance by physicians, nurses, veterinarians, and public health professionals such as epidemiologists for whom DIN is the only opportunity to attend a zoonosis-focused, 1 One Health in-state conference. Epi/H21400 G EPI $1,004,871 $235,841 Please see attached DSHS Indirect Cost attachment for calculation. 188 189 Total Budget: $1,240,712 2. Budget Template TX-DSHS-19-1309-A-001933 #P of ]  K L M 175 A list of "Other" items are listed on the tab 1. 176 177 178 179 180 N O P Q R S T U V $47,000 $26,250 181 182 183 184 185 186 187 188 189 2. Budget Template TX-DSHS-19-1309-A-001934 #P of ]  A 1 C F G OMB Approval No. 0348-0044 Grant Program Catalog of Federal Function or Activity Domestic Assistance Number Federal Non-Federal Federal Non-Federal Total (a) (b) ( c ) (d) (e) (f) (g) 1. Project H - Vector Borne Diseases - Tiers 2 and 3 Estimated Unobligated Funds 93.323 New or Revised Budget $0 $0 $1,240,712 $0 $1,240,712 $0 $0 $1,240,712 $0 $1,240,712 2. 3. 4. 5.  TOTALS =::J - E SECTION A - BUDGET SUMMARY 5 6 7 - D BUDGET INFORMATION - Non-Construction Programs 2 3 4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 B SECTION B - BUDGET CATEGORIES 6.  Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) a.  Personnel Total (5) (4) $179,070 $179,070 b.  Fringe Benefits $65,575 $65,575 c.  Travel $46,135 $46,135 d.  Equipment $0 $0 e.  Supplies $172,285 $172,285 f.  Contractual $468,556 $468,556 g.  Construction h.  Other i.  Total Direct Charges (sum of 6a - 6h) j. Indirect Charge $0 $0 $73,250 $73,250 $1,004,871 $0 $0 $0 $1,004,871 $1,240,712 $0 $0 $0 $1,240,712 $0 $0 $0 $0 $0 $235,841 k.  TOTALS (sum of 6i and 6j) 7.  Program Income $235,841 Standard Form 424A     (7-97) Prescribed by OMB Circular A-102 SECTION C - NON-FEDERAL RESOURCES (a) Grant Program (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12.  TOTALS (sum of lines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $1,240,712 $310,178 $310,178 $310,178 $310,178 $0 $0 $0 $0 $0 $1,240,712 $310,178 $310,178 $310,178 $310,178 SECTION D - FORECASTED CASH NEEDS Total for 1st Year 13.  Federal 14. NonFederal 15. TOTAL (sum of lines 13 and 14) SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT - (a) Grant Program FUTURE FUNDING PERIODS (YEARS) (b) First (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20.  Totals (sum of lines 16-19) $0 $0 3. PHS 424A $0 $0 TX-DSHS-19-1309-A-001935 53 54 55 56 A 21. Direct Charges:   I B I C I $1,004,871 I I22.  Indirect Changes: I I I I D I E I SECTION F - OTHER BUDGET INFORMATION $235,841 F I I I I I G 23.  Remarks:  The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.9%. I I 3. PHS 424A SF 424A (7-97)    Page 2 TX-DSHS-19-1309-A-001936 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 B C D E F ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018 @ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Direct # of Charges Total contracts $74,761 $27,377 $46,135 $0 $16,640 Contractual (Sub-recipient in excess of $25,000) $50,000 1 $25,000 $0 $393,556 $443,556 $26,250 $634,718 0 2 3 $0 $393,556 418,556 $26,250 $609,718 LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (sub-contracts in excess of $25,000) Contractual (sub-contracts up to $25,000) Contractual (Vendor contracts - DSHS Category 2000) Sub-total Contractual Other Total - Laboratory Services TOTAL INDIRECT COST $74,761 $27,377 $46,135 $0 $16,640 3 Direct # of Charges Total contracts $104,309 $38,198 $0 $0 $155,645 H I J K L Applicable IDC Rate Amount at 18.1% charged IDC Personnel Fringe Travel Equipment (Greater than $5,000; unless an exception item) Supplies (Less than $5,000; unless an exception item) Contractual (Sub-recipient up to $25,000) Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other Total - Health Programs G $13,532 $4,955 $8,350 $0 $3,012 The contractual dollar amounts must be manually entered into the appropriate row to populate the "Direct Charges Total" field.  In addition, the number of contracts will need to $0 be included in the "# of contracts" field.  The Sub-total Contractual row will ensure that the $71,234 contractual categorical dollar amount and the number of contracts equal those on the $75,759 Budget Template tab. $4,751 $110,359 $745,077 $4,525 Applicable IDC Rate Amount at 33.9% charged IDC $104,309 $38,198 $0 $0 $155,645 $35,361 $12,949 $0 $0 $52,764 $0 0 $0 $0 The contractual dollar amounts must be manually entered into the appropriate row to populate $0 $25,000 $25,000 $47,000 $370,153 0 1 1 1 $0 $25,000 $25,000 $47,000 $370,153 $0 of contracts" field.  The Sub-total Contractual row will ensure that the contractual categorical dollar $8,475 amount and the number of contracts equal those on the Budget Template tab. $8,475 $15,933 $125,482 $495,635 $1,004,871 4 $979,871 $235,841 the "Direct Charges Total" field.  In addition, the number of contracts will need to be included in the "# The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; 33 Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%.  At DSHS these contracts are expended in the Other 34 category and full indirect cost is charged. 35 Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. 36 37 -38 -39 40 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001937 41 A I B I C I D I E F G H I J K **On this sample, the DSHS Indirect Cost tab is set up to capture only the Health Programs indirect costs rate. If Laboratory Services costs are used in the Budget template, the DSHS Indirect Cost tab formulas will need to be manually adjusted to "link" to the Budget template tab in order to reflect the Laboratory Services indirect 42 cost rate. 4. DSHS Indirect Cost TX-DSHS-19-1309-A-001938 L 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 A B I C I I I I I I I D E F G H Sub-Contract Template Instructions I J K L Revised 02/01/2017 I I This tab contains instructions for completing the Sub-Contract Template and should not be included in the grant application package. In some cases, DSHS policy is cited in the definition to assist the budget developer in determining proper use of funds within the categorical budget. Personnel I I Definition: Actual costs of salaries and wages of employees devoted to working on activities directly related to carrying out the Scope of Work of the DSHS funded project. These costs are allowable to the extent that they are reasonable and conform to the established, consistently applied policy of the organization and reflect no more than the time actually devoted to the project. The salaries and wages of employees that do not work on activities described in the Scope of Work of the DSHS funded project should be allocated as indirect costs and budget under the Indirect Cost category. Instructions: Enter the following information for each requested position in the Personnel category: Functional Title and Code, indicating E for existing positions and P for proposed positions. % of Time I I Number of months of anticipated employment Total Annual Salary of individual Amount of funding requested for individual will be automatically calculated by the spreadsheet, which multiplies 'percentage of time' by 'Total Annual Salary' Last, First Name of Individual Budget # I I Position # I I Position Description and justification of the position, including primary responsibilities, appropriateness of classification with regard to required certification or licensure, and relevance to project . Insert additional rows and copy the format to add additional personnel. If rows are added, the formula in the cell containing the 19 Personnel category total must be revised to include the added rows. 20 I I 21 Fringe I I Definition: Fringe benefits are allowances and services provided by the organization to its employees as compensation in addition to regular salaries and wages. Fringe benefits include but are not limited to the cost of employee insurance, pensions, and unemployment benefit plans. The cost of fringe benefits is allowable (in proportion to the amount of time or effort employees devote to the grant funded project), to the extent that the benefits are reasonable and are incurred under 22 formally established and consistently applied policies of the organization. 23 Instructions: Enter the following information:  24 Itemized elements of fringe benefits: List the types of costs that comprise your organization's fringe benefits. Fringe Benefit Rate: The fringe benefit rate should be based on your organization's actual experience and is typically calculated by dividing your organization's total fringe benefit costs by total wage/salary costs. Enter your organization's fringe benefit rate on the budget sheet.  The total fringe benefit amount will be automatically calculated by the spreadsheet. 25 26 I I 27 Travel I I Definition: The cost of transportation, lodging, meals and related expenses incurred by employees of the organization while performing duties relevant to the proposed project. This includes auto mileage paid to employees on the basis of a fixed mileage rate for the use of their personal vehicle. Costs related to client transportation and conference registration fees should be budgeted under the 'Other' budget category. Travel costs incurred by a third party under contract should be 28 included within the terms of the contract and be budgeted under the "Contractual" expense category. 29 Instructions: Enter the following information.: In State and Out of State Travel: 30 31 Travel description and justification:  Provide a description of the travel, including destination and number of personnel for each trip, and justification of how the travel will directly benefit the project and why it is necessary to accomplish the project. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001939 #P of 35 A 32 33 34 35 36 37 38 39 40 41 I I I I I I I I I B C D E F G H I J K L Mileage: For travel that includes mileage, provide the number of miles to be travelled, the reimbursement rate per mile, and the number of employees requiring reimbursement. The spreadsheet will automatically calculate the total requested for mileage. For travel requests involving solely mileage, provide the mileage information only and leave all other information blank. Airfare: Provide the cost of airfare and the number of persons requiring airfare. Ground Transportation: Provide the cost of ground transportation, the number of persons requiring ground transportation, and the number of days the ground transportation is required. Lodging: Provide the cost per night for lodging, the number of persons requiring lodging, and the number of days lodging will be required. Per Diem: Provide the cost per day provided for meals, the number of persons travelling, and the number of days reimbursement for meals is required. Other Costs: Provide a description of the other travel costs (such as baggage fees or reservation fees) the number of employees requiring the other cost, and the number of days the other cost will be required. Total:  Totals for each component, each trip, In State and Out of State Travel will be calculated by the spreadsheet. I I I I I I I I I I I I I I I I I I Enter an 'X' in the appropriate box to indicate respondent's use of DSHS Travel Policy or the Respondent's Travel Policy. Attach a copy of Respondent's Travel Policy if it is used to determine travel reimbursement rates. Insert additional rows and copy the format to add additional travel requests. If rows are added, the formula in the cell containing the 'Travel' category total must be revised to include the added rows. 42 43 I I I I I I I I I 44 Equipment I I I I I I I I I Definition: Equipment and Controlled Assets Purchases. Equipment means an article of nonexpendable, tangible personal property having a useful lifetime of more than one year and an acquisition cost of $5,000 or more. Contractor must inventory equipment and controlled assets, which include firearms regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more: desktop and laptop computers, non-portable printers and copiers, emergency management equipment, communication devices and systems, medical and laboratory equipment, and media equipment. If purchase of equipment is approved in writing by the Department, Contractor is required to initiate the purchase of that equipment in the first quarter of the Contract or Program Attachment term, as applicable. Failure to initiate the purchase of equipment may 45 result in loss of availability of funds for the purchase of equipment. 46 Instructions: Enter the following information: I I I I I I I 47 48 49 50 51 Description and Justification: Provide each item of equipment to be purchased and the purpose for the item(s) and why the equipment is necessary. Attach a complete specification or a copy of the purchase order. If a portion of the equipment cost will be funded by non-DSHS sources, name the funding source and the percentage of the cost being funded by DSHS. Unit Cost: Enter the unit cost of each item of equipment requested. Number of Units Requested: Enter the number of units requested. Total: This information will be automatically computed by the spreadsheet. I I I I I I I I I I I I Insert additional rows and copy the format to add additional equipment requests. If rows are added, the formula in the cell 52 containing the 'Equipment' category total must be revised to include the added rows. 53 I I I I I I I I I 54 Supplies I I I I I I I I I Definition: Supplies are defined as consumable items necessary to carry out the services under this DSHS project, including medical supplies, drugs, office supplies, patient educational supplies, software, and any items of tangible personal property 55 other than those defined as equipment. 56 Instructions: Enter the following information: I I I I I I I 57 For General Office supplies (Item 1): I I I I I I I Describe and justify: List the items of general office supplies utilized by the personnel funded by this contract, for example: pens, pencils, paper etc. and indicate relevance to the project. 58 Number of FTEs: Enter the number of FTEs to be funded by the contract and provided general office supplies. 59 Amount per month: Enter the amount spent per month for general office supplies for each FTE funded on the contract. 60 Number of months: Number of months for which general office supplies are to be provided. 61 Total: This total will be automatically computed by the spreadsheet. 62 I I I I I I I I 63 For all other supplies: I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001940 #P of 35 64 65 66 67 68 A I I I I I B C D E F G H I J K L Describe and justify: Provide a description of the item requested and indicate the relevance of the item to the project. Unit Price: Enter the unit price of the item requested. I Number of Units: Enter the number of units of the item requested. Total: The total will be automatically computed by the spreadsheet.  I I I I I Insert additional rows and copy the format to add additional supplies requests. If rows are added, the formula in the cell 69 containing the 'Supplies' category total must be revised to include the added rows. 70 I I I I I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001941 #P of 35 I I A B C D E F G H I J K L 71 Contractual I I Definition: The costs of activities directly associated with carrying out the statement of work that are contracted by the organization to a third party are recorded in the 'Contractual' category. A contract with a subrecipeint must comply with Article XII, section titled "Contracts with Subrecipient Subcontractors" of the DSHS General Provisions. The contractor may enter into contracts with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program Attachment(s). Prior to entering into an agreement equaling $100,000 or more of a Program Attachment amount, Contractor shall obtain written approval from DSHS. Contracts with subcontractors shall be in writing and include the following: Name and address of all parties; A detailed description of the services to be provided; Measurable method and rate of payment and total amount of contract; Clearly defined and executable termination clause; Beginning and ending dates that coincide with the dates of the applicable Program Attachment(s) or cover a term within the beginning and ending dates of the applicable Program Attachment(s); 72 Access to inspect the work and the premises on which any work is performed, in accordance with the General Provisions; and a copy of these General Provisions and a copy of the Statement of Work and any Special Provisions in the Program Attachment(s) applicable to the subcontract. Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall monitor both financial and programmatic performance and maintain pertinent records that shall be available for inspection by DSHS. Contractor shall ensure that subcontractors are fully aware of the requirements placed upon them by state/federal statutes and regulations and under this Contract. Contractor shall not contract with a subcontractor, at any tier, that is debarred or suspended or excluded from or ineligible for participation in federal assistance programs. When subcontracting, Contractor is required to meet all applicable HUB requirements. 73 74 Instructions: Enter the following information for each contract in the Contractual category: Name of Contractor I 75 Method of Selection I 76 Period of Performance 77 Scope of Work 78 I Method of Accountability 79 80 Attach a fully justified 8 category budget for each contractor. 81 I I Insert additional rows and copy the format to add additional contracts. If rows are added, the formula in the cell containing 82 the 'Contractual' category total must be revised to include the added rows. 83 I I 84 Other I I Definition: All other allowable direct costs not listed in any of the above categories are to be included in the 'Other' category. Some of the costs listed below may also be treated as indirect cost. Their treatment as 'Other' (direct) or indirect must be consistent throughout the respondent's organization. Typical costs that may be budgeted in the 'Other' category are the 85 approved DSHS program attachment's share of: 86 * equipment rental if used solely on the DSHS project, otherwise include in 'Indirect Costs;" 87 * single audit services if allocated directly to each funding source; otherwise include in "Indirect Costs;" 88 * long distance telephone expenses (general telephone expenses should be included in "Indirect Costs;" 89 * printing and reproduction expenses directly related to the DSHS project; 90 * postage and shipping directly related to the DSHS project; 91 * contract personnel services for individuals that work solely on activities described in the DSHS Statement of Work; 92 * equipment repairs or service maintenance agreements for equipment used solely on the DSHS funded project; 93 * periodicals; I 94 * advertising that promotes the DSHS project; 95 * registration fees; I 96 * patient transportation; I 97 * training costs, speakers fees and stipends. I I 98 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001942 #P of 35 I I I I I I A B C D E F G H I J K L 99 Instructions: Enter the following information for each request for 'Other' costs: I 100 Format for building or equipment rental, telephone or internet service, postage or other such costs. Description/Justification: Provide a general description of the service to be purchased and an explanation of the purpose of 101 the service and why it is necessary for the completion of the activity. 102 Cost per month: The monthly cost of providing the service. I 103 Number of Months: Number of months the service is to be provided. 104 Number of FTEs: The number of FTEs to receive the service. I 105 Total: The Total is automatically calculated by the spreadsheet. I 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001943 #P of 35 I I I I I A B C D E F G H I J K L 106 I I I I I 107 Format for all other types of goods or services in the 'Other' category:  Description/Justification: Provide a general description of the good or service to be purchased and an explanation of the 108 purpose of the good or service and why it is necessary for the completion of the activity. 109 Total: Enter the total cost of the good or service. I 110 I I I I I Insert additional rows and copy the format to add additional requests. If rows are added, the formula in the cell containing 111 the 'Other' category total must be revised to include the added rows. 112 I I I I I 113 Indirect Cost I I I I I Definition: Those costs related to the project that are not included in direct costs. Indirect costs are those costs incurred for a common or joint purpose benefiting more than one cost objective and not readily identified with a particular cost center and which may be paid if allowable under the funding source, e.g., depreciation and use allowances, interest, operation and maintenance expenses (janitorial and utility services, repairs and normal alterations of buildings, furniture, equipment, care of grounds, security), general administration and general expenses (central offices such as a director, office of finance, business services, budget and planning, personnel, general counsel, safety and risk management, management information 114 services). 115 Instructions: Enter the following information: I I I 116 Total of Amount of Indirect Costs allocable to the projectI Indirect Costs are based on: Enter an X in the box that corresponds to the  basis on which respondent is charging indirect costs. 117 Organizations that have an approved indirect cost rate should mark the first option by marking the box and * indicating the rate and base. A copy of the approved rate agreement that will be in effect during the contract 118 term should be attached. If a rate agreement is pending, submit the latest approved agreement. OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial * Procedures Manual (CFPM) available on the internet at http://www.dshs.stae.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be address in 119 Part V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. If using a central service or indirect cost rate, identify the types of costs that are included (being allocated in the rate: Salary/expenses of executive office staff (CEO, CFO), accounting office, personnel office; depreciation; facility maintenance; utility costs; general liability and property insurance. Organizations that do not use an indirect cost rate and governmental entities with only a central service rate must identify * the types of costs that will be allocated as indirect costs and the methodology used to allocate these costs in the space provided. The costs/methodology must also be disclosed in Part V- Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Identify the types of costs that are being allocated as indirect costs, the allocation methodology, and 120 the allocation base. 121 I I I I I Instructions: OMB Circular A-87 permits States, Local and Indian Tribal Governments to prepare central service and indirect cost rate proposals in accordance with the requirements of the Circular and maintain the proposal and related supporting documentation for audit. The Circular goes on to state that no rate shall be acceptable unless such costs have been certified by the governmental unit using the Certificate of Cost Allocation Plan or Certificate of Indirect Costs as set forth in Attachments C and E. The certification forms are also available in the Appendix to the DSHS Contractor's Financial Procedures Manual (CFPM) available on the internet at 122 http://www.dshs.state.tx.us/contracts. Note:  Governmental entities must also submit a cost allocation plan as specified in Appendix A of the CFPM to DSHS within 60 days of the contract start date. Governmental entities that only have a central service cost rate must also include the indirect costs of the governmental department. The allocation of indirect costs of the department must be addressed in Part V - Indirect Cost Allocation of 123 the Cost Allocation Plan that is submitted to DSHS. 5. Sub-Contract Template Instr. TX-DSHS-19-1309-A-001944 #P of 35 A B C D E F G H I Name of Contractor: 1 Category 2 H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) Budget Request Period: 8/1/19-7/31/20 3 4 5 A. Personnel 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Position Total Salaries Time (%) # of months Total Salary Amt Requested $0 $0 1. Functional Title and Code 0% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 2. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 3. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 4. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 5. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 6. Sub-Contract Template 6. Sub-Contract Template TX-DSHS-19-1309-A-001945 #P of 35 A 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 B C D E F G H 7. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 8. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 9. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 10. Functional Title and Code 100% 0 $0 $0 (E=Existing; P=Proposed) Last, First Name  Position # Position Description/Justification (include required Certification or Licensure): 59 B. 60 61 Fringe Benefits Itemized elements of fringe benefits: $0 Rate (%) 32.00000% $0 62 C. 63 64 65 66 67 68 69 70 71 72 73 I Travel 1. In-State a. Travel description and justification: $0 # Miles Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 6. Sub-Contract Template 0.00 Rate/unit cost $0.0000 $0 $0 $0 $0 $0 # Persons 0 0 0 0 0 0 #Days Total 0 0 0 0 $0 $0 $0 $0 $0 $0 $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001946 #P of 35 A 74 75 B 2. Out-of-State a. Travel description and justification : 76 77 78 79 80 81 82 83 84 85 Mileage:  Airfare:   Ground Transportation:  Lodging:  Per Diem:  Other Costs (describe): 86 Respondents Travel Policy* 87 88 DSHS Travel Policy C D E F G # Miles Rate/unit cost # Persons #Days Total 0.00 $0.0000 $0 $0 $0 $0 $0 100 101 102 103 104 105 106 107 108 $0 $0 $0 $0 $0 $0 $0 0 0 0 0 # of Units $0.00 $0 Tot. 0 $0 $0 # of staff 0.00 Amt/Month # of Months Unit Cost # of Units $0.00 $0.00 2. Description/justification of Supplies: F. 1. A. B. C. D. E. Unit Cost Supplies 1. General Office supplies: (describe/justify) 109 G. 110 111 112 113 114 115 116 117 I *include a copy of the policy with the application Equipment For computer requests, attach Vendor Certification for Computer Equipment purchased by DSHS Contractor form): 1. Description/justification of Equipment 93 E. 94 95 96 97 98 99 $0 Indicate with an 'X' which policy is used for travel: 89 D. 90 91 92 0 0 0 0 0 0 H 0 0 Tot. Tot. $0 $0 Contractual $0 Project Title Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Description of how contract(s) will be accounted for and the number of contract(s) anticipated. $0 Other $0 Use format of item 1 for building or equipment rental, telephone or internet service, postage or other such costs. 1. Description/justification: Cost/mo. # of months # FTEs Total $0 Use format of item 2 for all other requests in this category. 2. Description/justification: 6. Sub-Contract Template Total $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001947 #P of 35 A III 118 119 B C D E F G H Total Direct Charges 6. Sub-Contract Template I $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001948 #P of 35 A B 120 H. Total Indirect Charges 121 122 123 124 125 126 127 128 129 Total Amount of Indirect Costs Allocable to the project: Indirect Costs are based on (mark the statement that is applicable and provide the rate, base and type, as applicable): C D E F G H I $0 Amount $0 The respondent's most recent indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency. Expired rate agreements are not acceptable. Attach a copy of the rate agreement to the budget. Applies only to governmental entities. The respondent's current central service cost rate or indirect cost rate based on a rate proposal prepared in accordance with OMB Circular A-87. Attach a copy of Certification of Cost Allocation Plan or Certification of Indirect Costs. Note: Governmental units with a Central Service Cost Rate must also include the indirect cost of the governmental units department (i.e., Health Department). In this case indirect costs will be comprised of central service costs (determined by applying the rate) and the indirect costs of the governmental department. The allocation of indirect costs must be addressed in Park V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. Rate Base Type (central service or indirect) 0.00000% 0.00000% A cost allocation plan. A cost allocation plan as specified in the DSHS Contractor's Financial Procedures Manual (CFPM), Appendix A must be submitted to DSHS within 60 days of the contract start date. The CFPM is available on the following internet web link: http://www.dshs.state.tx.us/contracts/. 130 131 Total Budget 6. Sub-Contract Template $0 6. Sub-Contract Template TX-DSHS-19-1309-A-001949 #P of 35 From: Centers for Disease Control and Prevention Sent: Tuesday, May 28, 2019 4:27 PM EDT To: Garcia,Imelda M (DSHS) Subject: NEW: Check out the latest RMSF education tool, and more WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. National Center for Emerging and Zoonotic Infectious Diseases Highlights of our recent work to prevent the spread of infectious diseases May 28, 2019 New Training Tool for Deadly Tickborne Disease The Rocky Mountain spotted fever (RMSF) module is an interactive clinical education tool with case-based scenarios that provides technical training on RMSF. Learn more here. Tick Bite Prevention Comic for Summer Campers Help make sure children have fun in the outdoors without getting tick bites this summer. Download CDC’s tick bite prevention comic that gives tips on keeping ticks away. Unsubscribe Find updates about disease outbreaks, new infographics and videos, and much more on our home page. Follow us on Twitter! Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or problems? TX-DSHS-19-1309-A-001950 From: Centers for Disease Control and Prevention Sent: Thursday, June 06, 2019 11:49 AM EDT To: Garcia,Imelda M (DSHS) Subject: EID Subscription Update WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Emerging Infectious Diseases and the rest of CDC is moving from GovDelivery to Adobe Campaign for e-mail-based subscriptions and information. Adobe Campaign will provide EID with the ability to send more modern, mobile friendly e-mails to its readers. Starting in late June, the journal invites its readers to visit the EID Subscriptions page for instructions to update their subscriber preferences and ensure they receive email notifications about new issues, expedited ahead-of-print articles, free CME articles, and more. Learn More Unsubscribe Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or problems? TX-DSHS-19-1309-A-001951 From: Aldridge,Tiffany (DSHS) Sent: Tuesday, June 11, 2019 5:10 PM EDT To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) ; Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension Attachment(s): "SF424A Combined 785.787.790_06.11.2019.pdf","TX Zika No-Cost Extension Amendment Status Confirmation 06.11.19.pdf","000378CK17 - NU50CK000378 - Texas Zika No-Cost Extension June 2019.pdf" Good Afternoon, The Zika No-Cost Extension for Texas has been submitted into REDCap and GrantSolutions. The REDCap letter and 424 would not print until it’s approved by CDC in REDCap. We used our letter in the place of the REDCap generated letter (see attached). Thank you for the opportunity to complete this No-Cost Extension. Please let me know if you have any questions. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) [mailto:ypg2@cdc.gov] Sent: Tuesday, June 11, 2019 9:40 AM To: Aldridge,Tiffany (DSHS) ; Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension Hi all – There is program approval from DVBD for this NCE. Thanks, Nga From: Aldridge,Tiffany (DSHS) Sent: Tuesday, June 11, 2019 7:05 AM To: Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension Good Morning Karen, We were going to send that once the NCE was approved in REDCap by De’Lisa and Nga. I spoke with De’Lisa and she said they will work on it quickly. Please let me know if we could go ahead and submit into GrantSolutions. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services TX-DSHS-19-1309-A-001952 Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Zion, Karen (CDC/OCOO/OFR/OGS) [mailto:wvf8@cdc.gov] Sent: Tuesday, June 11, 2019 7:58 AM To: Aldridge,Tiffany (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Morning, I looked at the RedCap attachment. OGS requires a cover letter signed by the Authorized Business Official and a budget narrative/justification. You will need to create a cover letter and budget. Please submit all documents to GrantSolutions and choose “No Cost Extension” as the amendment type. Thank you, Karen. From: Aldridge,Tiffany (DSHS) Sent: Monday, June 10, 2019 5:13 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Zion, Karen (CDC/OCOO/OFR/OGS) ; Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: Texas No-Cost Extension Hi De’Lisa, Attached is the PDF of the DRAFT ELC No-Cost Extension and the FFR for Texas. All items are in complete status until we hear back from CDC. Once approved, we will submit the final in GrantSolutions. Please let me know if you have any questions for me. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-001953 TEXAS Texas Department ofStateHealth Services Healthand Human Services JohnHellerstedt,M.D. Commissioner June 11, 2019 Karen Zion DSHS Doc.# Fund 785 = 1918-03-AP - 11 Grants Management Specialist Fund 787 = 1918-03-AP-10 Centers for Disease Control and Prevention Fund 790 = 1918-04-AP-09 Grants Services Office Infectious Disease Service Branch, Team I 2920 Brandywine Road, RM 2015 Atlanta, GA 30341 Reference: Grant Numbers: 6NUS0CK000378 CK14-1401PPHF16, Building and Strengthening Epidemiology, Laboratory, and Health Information Systems Capacity (ELC) in State and Local Health Departments Extension Prior Approval: Request for Zika Supplemental Redirection and No Cost Extension Dear Ms. Zion: The Texas Department of State Health Services (DSHS) requests a twelvemonth no cost extension and redirection to the Grant/ Award document numbers 000378CK17 /NUS0CK000378 as listed above. DSHS requests to utilize unobligated Zika Disease funds in the amount of $2,975 ,379 to continue current activities through the no extension period ending July 31, 2020. These activities include: • Pesticide training with the public health regions and local health departments (LHDs) throughout the state; • Laboratory purchase of supplies and equipment as well as temporary staff to support laboratory functions; • Zika Media Campaign to share the importance of prevention through television, radio ads, and other avenues of advertising that reaches many residents of Texas; and, • Expanded DSHS library outreach targeting to pre-school and elementary school children. Through these activities, DSHS will be able P.O. Box149347 • Austin,Texas7-8714·9347 • Phone: 888-963·7111 • TTY:800-735-2889 • www.dshs.texas.gov TX-DSHS-19-1309-A-001954 Zion, Karen June 11, 2019 Page 2 to identify new opportunities and events to inform target audiences about the risk of mosquito-borne diseases. DSHS identified unused funds in the DSHS Zika Disease LHD contracts which expire July 31, 2019. Once the unliquidated funds are released, DSHS will utilize these funds for the activities listed above and as detailed in the attached Budget Justification. This no-cost extension is requested to complete current activities that have been identified in collaboration with Centers for Disease Control and Prevention for continued Zika surveillance activities. If you have any questions regarding this request, please feel free to contact me, Imelda Garcia, at (512) 776-7679 or via email: ImeldaM.Garcia@dshs.texas.gov . Sincerely, Project Directo Imelda M. Garcia, MPH Director Infectious Disease Prevention Section C cc: Business Official Amanda Hudson Deputy Chief Financial Officer De'Lisa Simpson, CDC Project Officer Angelica O'Connor, CDC Project Officer TX-DSHS-19-1309-A-001955 f--- FEDERALFINANCIAL REPORT ~- F...,_ Gflllltc,r-Ot,or ~ H~ (To,apo,t--~ . -FFR ,._, F-.IAo-yOftd~llala!Eltmefll 1" WNd! Rt""'1 lsSIAlfflillad "1 Federal A90ftCJ Aulpld d CENTERSFOR DISEAS! CONTROLAHO PREVEHTION J. Roopllnl Orp\1,Nome Oftd--,, ad&hst lncludinQZlDcad9 I DU'AIITIIEHT OP STAT! HEALTH Sf!IVICl!S 1110Wl!.5T•trH STUil', AUSTIN,T1!XASffl51 rq , DUffSH ....... I' •~ ElN I HUSO KOOOl71-03-12 · I NU50CilllD0371-4J.14· I MISOCKDDOm.o4-04 Rldptf,1--~0I~~ s,a,,a. 111eFFRA--...,.. Clo,_.,.... Y.7ll-t511 ZIKAELCliUP 715. 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Utn l tlll IN DOD IN 0/1121111 Oll,?011 llll/21111 lll!QDO 1111,?017 11)1121111 IIIU,011 ~ ,,,1ua I IDl.7U .11 8/tnOII Vl/2011 7r.l"l201t 7121121111I ODO ,,-s ..... .~.-..- 11.l'-To find fla■d I ... _... .,, ,..... , • t- 1,_ Sll ,4611 ,_.,. i • · Fldofa11Nt11of f. F-a1-■ ol,__ ,_, ~- ToUIF-~ ._ol!IMs ■ and ll ~- -lledbatancaalFocllnlum (lned 11-.... nt s.... 43111 a_oo •ua11 I.N '·" It.JI H.Jt '·" ltn-1' t .N tlH.11 1'1YKJI 111.TN.■ '·.... " GDO s.oao .... ut T,._. I 1111 .N'I.II lllffl.a:J IIU1UJ 12. R.....,,., . Cumulllwe ffR fot ZJh Funding (lludgtt PMfad INpnn/nf btiw-, 0Mlf/2011, Ot/Dl/2011, UK/'11/2011];(I/ CRIAI ll.J1J/ Subaccoimff : Cl(f.ff401CCOl'AOIIEFY17; Docum.,,11: 000171CIU7; (2} DSHShu ~to lndhct Co,ts lar rtot FY2011NIJAs. lrHlhcf Coll wlfl lie ct.tm.cl on lhe FY20t7HIJA; tJJUM f lfflllqu/d•ledob/lri•llon• (S',191.Zft ,f7J mar N ,nod 10 ""'f'/elt lh• KIM!Je• II raqUUl8dIn die no COIi &llllltlon , onn, l'CJ• ... ,.,. .. ■d •lier Tlll/2019. a wm 13. Ce<1t,cnan llr11gct 9ftCI111ens.lc,ft t w..... H.1t&m n e -2211 1,.1:m11-. I ~ 0 l,.. .. \ L"'\c.• . V -- • lj 11,u "-Yv10.,.,,. • · llalallepan~ 1• (Monr,.0.., . Y""I Cru-, I.. 'l ~ ___ _ _______ _____.... , ~"'"'°'~-Ad.•_,"",__,. __,..,,,,,. __,•~-•-"'--• ......... ••-OMIIC.--llwwtlolOl,lll_,__i.,..,_,,__ .._ ,,__.._..,,,__.,_i._1o ..._ ,1-..,._.,.,,. _~-•...-.·_.,.,......,.11.u-.~ ........._.,. __ ..., __.. ............... _., .,,,.._., ,_,_,,._.,._ _.,,...__ .._,. __ .....,,_1iw-0c:ooe, TX-DSHS-19-1309-A-001956 STATE AND LOCAL GOVERNMENTSRATE AGREEMENT EIN: 32-0113643 DATE:09/17/2018 ORGANIZATION: Texas Department of State 1100 W. 49th Street Health FILING REF.: The preceding agreement was dated 6 2 17 0 /lS/ D Services Austin, TX 78756- The rates agreements approved in this agreement are for use on grants, contracts and other wi ch the Fe=deral Government, subJect to the c ond 1t1ons 1n Section I1 I . SECTION I: RATE TYPES: INDIRECT FIY.£0 COST RATES ~~ov FINAL {PROVISIONAL) PP.ED (PilEDETERMUIED EFFECTIVEPERIOD TYPE FROM FIXED FIXED 09/01/2017 .IQ 08/31/2018 09/01/2017 08/31/2018 PROV. 09/01/2018 08/31/2021 RATE(%) LOCATION 1B.lOOn Site 33. 90 On Site APPLICABLE TO Health Lab Program Program Use same rates conditions as those cited and for fiscal ending August 31, 2018. year ~ Total direct costs excluding capital expenditures (buildings, individual items of equipment; alterations and renovations), that p..,rc.ion of each subaward in flow-through funds and WIC food coses. excess of $25,000, Page 1 of 3 GJ6574 TX-DSHS-19-1309-A-001957 ORGANIZATION:Texas Department of State Health Services AGREEMENT DATE: · 9/17/2018 SECTION II: SPECIAL REMARKS TREATMENT OF FRINGEBENEFITS~ The fringe benefits charged individually lisced below. are specifically identified to each employee and are as direct costs . The direccly claimed fringe benefits are TREATMENT Of P8TP ABSENCES Vacation, holiday, sick leave pay and other paid absences are included in salaries and wages and are claimed on grants, contracts and other agreemen:s as part of the normal cosc for salaries and wages . Separate claims are not made for the cost of these paid absences. Equipment Definition Equipment means an article of nonexpendable, tangible personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. FRINGE BENEFITS: FICA Retirement t•!orker' s Compensation Unemployment rnsurance Health Insurance Post Retirement Health Benefits Your next proposal based on actual was due in our office 02/2B/2018. costs for the fiscal year ending 08/31/2017 Page 2 of 3 TX-DSHS-19-1309-A-001958 ORGANIZATION: Texas Department AGREEMENTDATE: 9/17/2018 SECTION III: A. of State Health Services GENERAL t,•HJTt,T[Cl!lt: ~he r&te~ ln th12 ~9rce~-en~ ~re ,ubjec: to •ny stacutory or ~dninl~tr&:l ·c l!ait~et ~ns •nd •pply to~ gi~en 9ran~ contract or othc: a~rcceent only to the CKtcnt th<>t [unds are •vaildble Accept4ncc of the rates is sub3tct t~ the •11 Only cosc, 1ncurtcd by :he organ1:ocion •ere :nclsdod ,n 1tu indirect cost pool 4s ~,nilly f~llowir.9 cond1tion1: ~L the or9ani:at1on ond ore ollowablc under the governing co,: prlncip!e• a:ce?tcd· ,~ch costs arc ltgol 00J19at,on• (~J The =Qnte c-o~t~ hove b~rn tr~~~cd t~: a 1nd1~cc~ co=t~ are not ctGi~ed 4~ dtrec~ to~t: . typ~= a! cot:~ (JI Stn!l~r tw.ve ~•n e:tabi10~ accorded cont1~tcnt a::,::ounting t:eot.-cnt; and l~l The in!cr~~t~on provided by the o:9anizatlon •hie~ w~; u:c:! to ,a r.ot l4tcr four.~ to be ""1teri4lly ,n=o~µtcte or Inaccurate by the Federal Coverr.~ent In ~u:n the rate: s1tu~t10no the r~t• £1 would be tubjcc~ to rcncgot\at,on at tile d,5 - cetlon of the Federa~ Ccvern~cnt, 8 Arn.111•tr:r;rua:;":ES T!li• :.9ru1,cn: u baaed on the ~ccoanting C/llte:1 purported by the or91nluci0n to be 1n co[hct during the ,.9rcerne"1t pcriO!.! C:hl>ngun to th<: l'!tothod cl occ:ounting fur coot, wluch a!!e , t the ftr,ount a! rcimt1uuea,ent ruulttns !ror:- t.hc use ct this t9recr:,~nt requiro: prior 11p;,r0va\ o! tht aut.hori~cll rep1ennc•:1ve a! the cogm:ant •gcncy . Such ,:ru,ngco ~n;l.llc. but a:e not l!'1!tcd to. ch1n9cs in the cha:9in9 at a partl • ~hr type o! tt [re,:,, JnJirc t t~ direct . Fuhau :o ~:.:au: pppro~al r.~y reuult Ln c ~s~ di•4llQw~n ~a C: t! • t1x~~ r~te o=tual coot, tJ ~ d~Ctcrc~c~ Agree~ent. L: 1c bac~d o~ an ca~irn.stc ~r th~ C~3CS f ~ r che period covc:~d are determined, on adJ.ntcrcnc -,111 be to" rote o! • future ftar!~I bc:.wccn the :octa u~~d to c,:~b11sh :~o £1xoj r•t~ •nd • · tuA\ ~ta 1~ in th~, for :h,~ ""'j" .,,,:,od by thu r~t~ Whrn the to ccw1>on•~·e ro: O t•.i:t Bl mHEP E[Of'P,\L 6'i~Jr! ~s , .-c r~~e~ ir. t s 1l9c~c - ~,t. '-Cre ..,pp:-cvc.d ,n • =rrl~~ e •1tn the .1utho,1:y 10 Ti:.lt:: 2 -.c tht! ~0<1c of Fffleral l\agul.itlon!: P,r: 1 . 0 (2 FR 2 101. •rd ~hould be applied to 9tont,, c:0ntrac:l2 and other 49ree-ent.s .o,erej by: CFR io~, ,ubJe.t to any 1 _,11it<1~icnt1 tn t .. .1b::,:.re the orgon1:.ntSon r.\o1"( provida cop1~:i c:1( the 1'greel'l'len: co other rederml /\g:en~le:,, ~o glv~ thtti ~.1:-ly n""'ti.fi .at1on o f the J\gre:u:rent E ~ I! any Federol - n:rnc::. 9ront or ot~cr a!Jrectt.er.t iS rdm!>o,rs1r.11 lnll1re , : con, by a r.icor.• other than the 011µ:oved rot~ •~ should ll c:rcll:: acc:h ao~u ta the a!(c tcLI p,011ro00, 11nd 121 apply the approved 1r thu ;.grct: cnt . the o:- ,•nl:ot,011 rate 1,1 t~ the appr0pn11:,: boa• to illentl!y the pr:,p~~ a:oou:te cf in,H rcct c:os.- allocable to th:~e r,rogroni,. IIY TIIE :tJSTl'!Vt:O:I OEP,\R.?l:IIT o,. ........... ,..,~ ....," ...~--, ,.,._,, .. ..,.. .....,. Darryl W. Mayes-5 .... -••no,~•,., ( ;11Srt7UT:oi11 • •, I f f>( ..• ' • ...,.,.,. ....... I e...11, .. n .. ,,u ... t· t51C.111'TUJIEJ fSIC.IIATt/RE, for •.1\I· ,., ITITt.CI ~ C11.':iE!ICY J __ OF ll~At.T11 11:1:>lltr.<.'~I SER'IICl:S ', Arif Karir.i l l .l ';. . ,r.: f !TIT!.!: l:'/ITtl o,.n: 65 .; Ml!$ Jl;EPRESEtlTATIVE ~Jand a Rayfiel d ':'clor,hcnc (:?H) 7 67-3261 Page 3 of 3 TX-DSHS-19-1309-A-001959 STATE AND LOCAL GOVERNMENTSRATE AGREEMENT EIN: 32-0113643 DATE:09/17/2018 ORGANIZATION: Texas Department of State 1100 W. 49th Street Austin, FILING Health Services REF.: agreement The preceding was dated 06 15 2 17 1 / 0 TX 78756- The rates approved in this agreement are for use on grants, contracts and other agreements with the Federal Government, subject to the conditions in Section III. SECTION I: RATE TYPES: INDIRECT COST RATES FINAL FIXED PROV. (PROVISIONAL) PRED. (PREDETERMINED) EFFECTIVE PERIOD ~ !:RQM .'.rQ FIXED 09/01/2017 08/31/2018 FIXED 09/01/2017 08/31/2018 PROV. 09/01/2018 08/31/2021 RATE(%) LOCATION 18 .10 On Site 33. 90 On Site APPLICABLE TO Health Program Lab Program Use same rates and conditions as those cited year for fiscal ending August 31, 2018. ~ Total direct costs excluding capital expenditures (buildings, individual items of equipment; alterations and renovations} , that portion of each subaward in excess of $25,000, flow - through funds and WIC food costs . Page 1 of 3 TX-DSHS-19-1309-A-001960 ORGANIZATION:Texas Department AGREEMENTDATE: 9/17/2018 SECTION II: of State Health Services SPECIAL REMARKS TREATMENT OF FRINGEBENEFITS: The fringe benefits charged individually listed below. are specifically as direct costs. identified to each employee and are The directly claimed fringe benefits are IREATMENT OF P8IQ ABSENCES vacation, holiday, sick leave pay and other paid absences are included in salaries and wages and are claimed on grants, contracts and other agreements as part of the normal cost for salaries and wages. Separate claims are not made for the cost of these paid absences. Equipment Definition Equipment means an article of nonexpendable, tangible personal property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. FRINGE BENEFITS: FICA Retirement Worker's Compensation Unemployment Insurance Health Insurance Post Retirement Health Benefits Your next proposal based on actual was due in our office 02/28/2018. costs for the fiscal year ending 08/31/2017 Page 2 of 3 TX-DSHS-19-1309-A-001961 ORGANIZATION:Texas Department AGREEMENT DATE: 9/17/2018 SECTION III: ,. . of State Health Services GENERAL l,JMtTATXQHS • The rotes in thi• Agreement Dr• subject ca any statutory or od~inistrative llmltotlans and apply ta• given grant, ctmtr&ct or other agreement only ta the •~tent thlt funds are ovallablo, Acceptance or the r1tea is subject ta the were Included in lta indirect c:ost pool~• finally (ollllWll!CJ condltio11t1: 111 Only coato incurred by the organi~otian of the organlz~tion and are allow1ble under the governing co,t principles: accepted· auch coats ore legol obllgatlona (21 n:e ••- cooto thot hive been treated•• indirect coaui are not clai~d •• direct co~t•r Ill Siffllior typea of cost~ have been occorded canoiatent ac;cow,tlng trootment; and 141 The inCor,natton pravlded by tho Ol:'lJDnizotlon which w1a uoed to eatabliah the ratea la not later found to be "'-lterially lnco~plete or inac1:1.1r1te by the Fttderal Covon1ment tn ~uch •ltu~tions tho racetal would be 1ubject co ren,:gatiation at the diocretion o( the F•deral Covern...,nt. a. &rt!2UlfIIt.'P CHNfCES· Thia ~reemont la boeed on the accowiting ay ■ cem purported by the organltation to be In effect during the Agreement from the use of period, Chon9ea to the ~ethod of occouncing tor co1ta which aCtect the a010Unt of reimbursement reaultlng thla A Sent: Thursday, June 13, 2019 1:08 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002009 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002010 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:08 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002011 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002012 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:08 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002013 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002014 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:08 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002015 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002016 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:08 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002017 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002018 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002019 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002020 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002021 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002022 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002023 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002024 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002025 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002026 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002027 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002028 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002029 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002030 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002031 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002032 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002033 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP TX-DSHS-19-1309-A-002034 Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. TX-DSHS-19-1309-A-002035 Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002036 From: Centers for Disease Control and Prevention Sent: Monday, June 17, 2019 10:26 AM EDT To: Garcia,Imelda M (DSHS) Subject: Emerging Infectious Diseases Journal - Volume 25, Issue 7 - July 2019 Issue Now Online WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online TABLE OF CONTENTS Ahead of Print Current Cover Podcasts Synopsis Contact EID Announcements CDC EID Podcasts Dispatches, cont. Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018 F. Huang et al. Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA L. Saikia et al. K. Rizzo et al. Medscape CME Activity Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease, Ontario, Canada Nontuberculous Mycobacteria, Botswana, 2011–2014 S. K. Brode et al. Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015 M. Walters et al. Research Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus J. Fuchs et al. Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands S. E. Schoustra et al. High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015– 2018 B. Yakubu et al. Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013 S. Ly et al. Medscape CME Activity Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016 R. Elling et al. B. Mbeha et al. Research Letters Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China S. Chen et al. Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018 R. Hua et al. Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa R. L. Higgitt et al. Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017 J. Lin et al. Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain R. Rodríguez-Pastor et al. Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa W. Takken and S. Lindsay Disseminated Metacestode Versteria Sp. Infection in Woman, Pennsylvania, USA B. Lehman et al. Outbreak of African Swine Fever, Vietnam, 2019 P. A. Armstrong et al. V. Le et al. Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans F. S. Nascimento et al. D. González et al. Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017 Human Enterovirus C105, China, 2017 L. Martens et al. Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom B. S. Lopes et al. Dispatches Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis B. L. Arruda et al. Dengue Outbreak during Ongoing Civil War, Taiz, Yemen M. Li et al. Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy E. Mancuso et al. Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar W. Sohn et al. Letters Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015 M. Thomas et al. Nontoxigenic Corynebacterium diphtheriae Infections, Europe A. A. Zasada and M. Rzeczkowska Etymologia K. A. Alghazali et al. Etymologia: Carbapenem Respiratory Syncytial Virus Infection in R. Henry TX-DSHS-19-1309-A-002037 Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA J. Boonyaratanakornkit et al. Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak A. Fall et al. Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene A. Multani et al. Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018 V. J. Cornelisse et al. Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting J. Voermans et al. R. Henry About the Cover Difficult Places, Unexpected Discoveries B. Breedlove and J. Weber Books and Media Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease S. Zlitni and A. S. Bhatt Historical Review Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era A. S. Bandyopadhyay et al. Online Report Ethical Considerations for Movement Mapping to Identify Disease Transmission Hotspots B. C. de Jong et al. Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers C. Langelier et al. Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002038 From: Centers for Disease Control and Prevention Sent: Monday, June 17, 2019 1:31 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest CME Articles - Emerging Infectious Diseases Journal - July 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online LATEST CME ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Medscape CME Activity Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease, Ontario, Canada Medscape CME Activity Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016 P. A. Armstrong et al. S. K. Brode et al. CDC EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002039 From: Centers for Disease Control and Prevention Sent: Thursday, June 20, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Malaria Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online MALARIA ARTICLES Ahead of Print Current Cover Podcasts High-Complexity Plasmodium falciparum Infections, North Central Nigeria, 2015– 2018 Contact EID Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa W. Takken and S. Lindsay B. Yakubu et al. Announcements CDC EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002040 From: Centers for Disease Control and Prevention Sent: Thursday, June 20, 2019 9:02 AM EDT To: Garcia,Imelda M (DSHS) Subject: One Health Update: Keep Everyone Healthy at Animal Exhibits WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Keep everyone healthy at animal exhibits Interacting with animals at fairs, educational farms, petting zoos, summer camps, aquariums, schools, and other places can be educational and fun, and helps people learn about and experience animals they may not see in their daily lives. But every year, many people get sick from germs like Salmonella , E. coli , Cryptosporidium , and more after visiting animal exhibits. It's important for people who work at, manage, or design animal exhibits to understand the risks associated with animals in public settings. Even healthy animals can carry germs that can make visitors sick. By keeping a few things in mind when designing exhibits, you can help ensure that visitors stay healthy while enjoying animals. • • • • Provide handwashing stations at the exits of animal exhibits. Keep dining and animal areas separate. Post signs for visitors on when and how to wash hands, where to eat, and how to stay healthy while in animal areas. Train and educate staff on zoonotic disease prevention. Get FREE resources • • • • Information for Animal Exhibit Visitors and Managers CDC educational materials Influenza and Zoonoses Education Among Youth in Agriculture Program – Resource Repository Compendium of Measures to Prevent Disease Associated with Animals in Public Settings, 2017(National Association of State Public Health Veterinarians) See educational materials Find updates about One Health, new resources, and more on our website and follow @CDC_NCEZID on Twitter. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002041 From: Centers for Disease Control and Prevention Sent: Thursday, June 20, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Tuberculosis and Other Mycobacteria Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online TUBERCULOSIS AND OTHER MYCOBACTERIA ARTICLES Ahead of Print Current Cover Podcasts Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China Contact EID Announcements CDC Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa R. L. Higgitt et al. F. Huang et al. Nontuberculous Mycobacteria, Botswana, 2011–2014 B. Mbeha et al. EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002042 From: Centers for Disease Control and Prevention Sent: Friday, June 21, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Fungi Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online FUNGI ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands Recent Findings of Potentially Lethal Salamander Fungus Batrachochytrium salamandrivorans S. E. Schoustra et al. D. González et al. Difficult Places, Unexpected Discoveries B. Breedlove and J. Weber CDC EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002043 From: Centers for Disease Control and Prevention Sent: Friday, June 21, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Enteric Infections Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online ENTERIC INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis Contact EID B. L. Arruda et al. Announcements CDC Mitochondrial Junction Region as Genotyping Marker for Cyclospora cayetanensis Human Enterovirus C105, China, 2017 M. Li et al. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA K. Rizzo et al. F. S. Nascimento et al. EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002044 From: Centers for Disease Control and Prevention Sent: Saturday, June 22, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Respiratory Infections Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online RESPIRATORY INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements CDC Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak F. Huang et al. Human Enterovirus C105, China, 2017 Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA M. Li et al. A. Fall et al. J. Boonyaratanakornkit et al. EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002045 From: Centers for Disease Control and Prevention Sent: Saturday, June 22, 2019 7:38 PM EDT To: Garcia,Imelda M (DSHS) Subject: Vector-borne Infections Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online VECTOR-BORNE INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements CDC Dengue Outbreak during Ongoing Civil War, Taiz, Yemen Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain K. A. Alghazali et al. R. Rodríguez-Pastor et al. Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus Increased Threat of Urban Malaria from Anopheles stephensi Mosquitoes, Africa J. Fuchs et al. Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013 W. Takken and S. Lindsay E. Mancuso et al. S. Ly et al. EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002046 From: Centers for Disease Control and Prevention Sent: Sunday, June 23, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Zoonoses Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online ZOONOSES ARTICLES Ahead of Print Current Cover Podcasts Contact EID Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis Echinococcus canadensis G8 Tapeworm Infection in a Sheep, China, 2018 B. L. Arruda et al. Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain Announcements Dengue Outbreak during Ongoing Civil War, Taiz, Yemen CDC K. A. Alghazali et al. Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus R. Hua et al. R. Rodríguez-Pastor et al. Low-Grade Endemicity of Opisthorchiasis, Yangon, Myanmar W. Sohn et al. J. Fuchs et al. EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002047 From: Centers for Disease Control and Prevention Sent: Monday, June 24, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Antimicrobial Resistance Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online ANTIMICROBIAL RESISTANCE ARTICLES Ahead of Print Current Cover Podcasts Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017 Announcements F. Huang et al. CDC Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China Carbapenem-Resistant Pseudomonas aeruginosa at US Emerging Infections Program Sites, 2015 Contact EID S. Chen et al. EID Podcasts L. Martens et al. M. Walters et al. Environmental Hotspots for Azole Resistance Selection of Aspergillus fumigatus, the Netherlands Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom S. E. Schoustra et al. B. S. Lopes et al. Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA C. Langelier et al. Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017 K. Rizzo et al. J. Lin et al. Difficult Places, Unexpected Discoveries Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015 B. Breedlove and J. Weber M. Thomas et al. Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002048 From: Centers for Disease Control and Prevention Sent: Tuesday, June 25, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Viruses Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online VIRUSES ARTICLES Ahead of Print Current Cover Podcasts Dengue Outbreak during Ongoing Civil War, Taiz, Yemen Asymptomatic Dengue Virus Infections, Cambodia, 2012–2013 Contact EID K. A. Alghazali et al. S. Ly et al. Announcements Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA Epidemiology of Human Parechovirus Type 3 Upsurge in 2 Hospitals, Freiburg, Germany, 2018 J. Boonyaratanakornkit et al. CDC Low Circulation of Subclade A1 Enterovirus D68 Strains in Senegal during 2014 North America Outbreak A. Fall et al. Diagnosis of Chagasic Encephalitis by Sequencing of 28S rRNA Gene A. Multani et al. EID Podcasts R. Elling et al. Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era A. S. Bandyopadhyay et al. Outbreak of African Swine Fever, Vietnam, 2019 Essential Role of Interferon Response in Containing Human Pathogenic Bourbon Virus V. Le et al. J. Fuchs et al. Crimean-Congo Hemorrhagic Fever Virus Genome in Tick from Migratory Bird, Italy Whole-Blood Testing for Diagnosis of Acute Zika Virus Infections in Routine Diagnostic Setting Human Enterovirus C105, China, 2017 M. Li et al. E. Mancuso et al. J. Voermans et al. Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002049 From: Centers for Disease Control and Prevention Sent: Tuesday, June 25, 2019 12:45 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - June 25, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — June 25, 2019 Ahead of Print Current Cover Research Letter Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019 Podcasts Kazuma Okada, Ryo Morita, Kazutaka Egawa, Yuki Hirai, Atsushi Kaida, Michinori Shirano, Hideyuki Kubo, Tetsushi Goto, and Seiji P. Yamamoto Abstract Contact EID Announcements CDC The largest outbreak of dengue fever in Tanzania is ongoing. Dengue virus type 1 was diagnosed in a traveler who returned from Tanzania to Japan. In phylogenetic analysis, the detected strain was close to the Singapore 2015 strain, providing a valuable clue for investigating the dengue outbreak in Tanzania. Volume 25, Number 9 - September 2019 EID Stacks EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002050 From: Centers for Disease Control and Prevention Sent: Wednesday, June 26, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Bacteria Articles in the July 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 7 - July 2019 Issue Now Online BACTERIA ARTICLES Ahead of Print Current Cover Podcasts Added Value of Comprehensive Program to Provide Universal Access to Care for Sputum Smear–Negative Drug-Resistant Tuberculosis, China Contact EID Announcements F. Huang et al. CDC Salmonella enterica I 4,[5],12:i:- Associated with Lesions Typical of Swine Enteric Salmonellosis B. L. Arruda et al. Identification of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain FC428, China S. Chen et al. EID Podcasts Oropharyngeal Gonorrhea in Absence of Urogenital Gonorrhea in Sexual Network of Male and Female Participants, Australia, 2018 V. J. Cornelisse et al. Mycobacterium bovis Infection in African Wild Dogs, Kruger National Park, South Africa R. L. Higgitt et al. Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015 M. Thomas et al. Bugs as Drugs: Therapeutic Microbes for the Prevention and Treatment of Disease S. Zlitni and A. S. Bhatt Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017 L. Martens et al. Nontoxigenic Corynebacterium diphtheriae Infections, Europe A. A. Zasada and M. Rzeczkowska Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom B. S. Lopes et al. Carbapenem and Cephalosporin Resistance among Enterobacteriaceae in Healthcare-Associated Infections, California, USA K. Rizzo et al. C. Langelier et al. Nontuberculous Mycobacteria, Botswana, 2011–2014 Elizabethkingia bruuniana Infections in Humans, Taiwan, 2005–2017 B. Mbeha et al. J. Lin et al. Difficult Places, Unexpected Discoveries B. Breedlove and J. Weber Bacillus cereus–Attributable Primary Cutaneous Anthrax-Like Infection in Newborn Infants, India L. Saikia et al. Zoonotic Bacteria in Fleas Parasitizing Common Voles, Northwestern Spain R. Rodríguez-Pastor et al. Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002051 From: Centers for Disease Control and Prevention Sent: Wednesday, June 26, 2019 9:07 AM EDT To: Garcia,Imelda M (DSHS) Subject: One Health Update: Mosquito Control Awareness Week 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Mosquito Control Awareness Week 2019 Mosquito-borne diseases are a One Health challenge, and epidemics from viruses spread by mosquitoes are happening more often. Mosquito-borne diseases can affect people, animals, and the environment, and one mosquito-borne disease – West Nile virus – is a priority zoonotic disease for the United States requiring a multisectoral, One Health approach to effectively address. CDC has mosquito control resources for everyone, from homeowners to professionals: • • • • Mosquito Digital Press Kit for Media Mosquito Control Information West Nile Virus in the United States: Guidelines for Surveillance, Prevention, and Control CDC Feature: Prevent Mosquito Bites Mosquito on arm Find updates about One Health, new resources, and more on our website and follow @CDC_NCEZID on Twitter. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002052 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 10:04 AM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas TX-DSHS-19-1309-A-002053 Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002054 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002055 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 10:04 AM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas TX-DSHS-19-1309-A-002056 Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002057 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002058 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 10:04 AM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas TX-DSHS-19-1309-A-002059 Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002060 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002061 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 10:04 AM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas TX-DSHS-19-1309-A-002062 Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002063 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002064 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 10:04 AM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas TX-DSHS-19-1309-A-002065 Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002066 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002067 From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. TX-DSHS-19-1309-A-002068 For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; TX-DSHS-19-1309-A-002069 Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002070 From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. TX-DSHS-19-1309-A-002071 For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; TX-DSHS-19-1309-A-002072 Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002073 From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. TX-DSHS-19-1309-A-002074 For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; TX-DSHS-19-1309-A-002075 Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002076 From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. TX-DSHS-19-1309-A-002077 For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; TX-DSHS-19-1309-A-002078 Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002079 From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. TX-DSHS-19-1309-A-002080 For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; TX-DSHS-19-1309-A-002081 Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002082 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002083 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002084 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002085 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002086 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002087 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002088 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002089 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002090 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002091 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002092 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002093 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002094 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002095 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002096 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002097 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Wednesday, June 26, 2019 1:22 PM EDT To: Hellerstedt,John W (DSHS) CC: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Thank you John for all your help. From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 TX-DSHS-19-1309-A-002098 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Overview of Successful Strategies Implemented by the Texas Department of State Health Services to Increase its TB Budget Q and A Dr. John Hellerstedt Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD 12:55 1:10 Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center TX-DSHS-19-1309-A-002099 San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002100 From: Garcia,Imelda M (DSHS) Sent: Wednesday, June 26, 2019 1:51 PM EDT To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) CC: Marquez,Cynthia S (DSHS) ; Hahn,Evelyn (DSHS) Subject: RE: Information needed for ACET agenda Thanks Margie. I look forward to talking with you soon. Imelda M. Garcia, MPH Associate Commissioner Laboratory & Infectious Disease Services Division Phone: 512-776-7679 Email: ImeldaM.Garcia@dshs.texas.gov CONFIDENTIALITY NOTICE: This email and the information contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthorized individuals is prohibited. From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 12:49 PM To: Garcia,Imelda M (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: Information needed for ACET agenda Dear Ms. Garcia, Thank you for agreeing to present at the next ACET meeting on Tuesday, August 20, 2019. I’ll send out an email requesting for the PPT presentations from speakers and also an overview form to be completed by the speaker. The ACET Webinar is from 10:00am – 3:30pm (EDT). Please let me know if you have any questions. Thank you again, Margie From: Hellerstedt,John W (DSHS) Sent: Wednesday, June 26, 2019 11:59 AM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting Hi Margie, Imelda Garcia, DSHS’ Associate Commissioner for Laboratory and Infectious Disease is my primary designee. Thanks for the opportunity to present Texas’ initiative. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Wednesday, June 26, 2019 9:04 AM To: Hellerstedt,John W (DSHS) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Barbara Cole ; Dean, Hazel (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Identify presenter for upcoming ACET meeting TX-DSHS-19-1309-A-002101 Good morning Dr. Hellerstedt, I am following up on your response below to check back with you in 2 weeks. Have you identified a presenter for the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget”. Let me know if you have any questions. Thank you, Margie From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Thursday, June 13, 2019 1:23 PM To: Hellerstedt, John (CDC dshs.texas.gov) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Thank you Dr. Hellerstedt for responding to our request for the ACET meeting. Yes, I’ll follow-up in 2 weeks. Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Hellerstedt,John W (DSHS) Sent: Thursday, June 13, 2019 1:09 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Cc: Garcia,Ricky (DSHS) ; Garcia,Imelda M (DSHS) ; Sims,Jennifer (DSHS) ; Shuford,Jennifer (DSHS) ; Hendrickson,Rachael (DSHS) ; Geter,Carolyn (DSHS) Subject: RE: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Howdy Ms. Scott-Cseh, I have a conflict on that date and time. I will work to find a designee. Please check back in two weeks. For your reference, Carolyn Geter is my new Executive Assistant. Please include her in all correspondence with me. John John Hellerstedt, MD Commissioner Texas Department of State Health Services 512.776.7363 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) [mailto:zkr7@cdc.gov] Sent: Thursday, June 13, 2019 6:22 AM To: Hellerstedt,John W (DSHS) Cc: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Winkelbauer,Katharine (DSHS) Subject: ACTION REQUESTED: Available to present to ACET on August 20, 2019 Good Morning Dr. Hellerstedt, Hope all is well. Will you be able to provide a presentation on the “overview of successful strategies implemented by the Texas Department of State Health Services to increase its TB budget” on Tuesday, August 20, 2019 at 12:35pm and discussion from 12:55pm – 1:10pm (EDT)? Let me know if you have any questions. Tuesday, August 20, 2019 Roll Call 12:30 Dr. Hazel Dean 12:35 Dr. John Hellerstedt Overview of Successful Strategies Implemented by the TX-DSHS-19-1309-A-002102 12:55 1:10 Texas Department of State Health Services to Increase its TB Budget Q and A Overview of TB Prevention, Treatment, and Care of Minors in HHS Custody TBD Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Armitige,Lisa Y (DSHS Contractor) Sent: Wednesday, June 12, 2019 8:41 PM To: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: RE: ACTION REQUESTED: Review draft ACET agenda Hi, Margie, Looks good to me. I think Dr. Hellerstedt (liason for ACET from Texas DSHS) is the person who was to give the talk on Texas funding. Lisa Y Armitige, MD, PhD, FACP, FAAP, FIDSA Medical Consultant Heartland National TB Center San Antonio, Texas 210-531-4548 Associate Professor of Medicine/Pediatrics Division of Adult Infectious Diseases UT Health Northeast From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 3:13 PM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) (CDC/DDID/NCHHSTP/OD) ; Yanet Madera ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Subject: ACTION REQUESTED: Review draft ACET agenda WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Please see attached draft ACET agenda to review for comments/edits. Please send comments/edits NLT Friday, June 14th. Thank you. Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 From: Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) Sent: Tuesday, June 11, 2019 9:18 AM To: Dean, Hazel (CDC/DDID/NCHHSTP/OD) ; LoBue, Philip (CDC/DDID/NCHHSTP/DTE) ; Koski, Kathryn (CDC/DDID/NCHHSTP/DTE) ; Barbara Cole ; Cole, Barbara (CDC rivcocha.org) ; Horsburgh Jr, Robert (CDC bu.edu) ; Armitige,Lisa Y (DSHS Contractor) ; Tompkins, Lornel (CDC msn.com) <1drt@msn.com> Cc: Ross, Melanie R. (CDC/DDID/NCHHSTP/OD) ; Scott-Cseh, Margie (CDC/DDID/NCHHSTP/OD) ; Peck, Theresa (CDC/DDID/NCHHSTP/DTE) (CTR) ; Morgan, Avonette (Ava) TX-DSHS-19-1309-A-002103 (CDC/DDID/NCHHSTP/OD) ; Yanet Madera Subject: Friendly Reminder: Conference call today to discuss the ACET agenda Good Morning, The conference call to discuss the ACET agenda is scheduled today, Tuesday, June 11, 2019 from 2-3pm (ET). Dial-in numbers: 1-866-506-2712 and pass code: 365565. The next ACET meeting is on Tuesday, August 20, 2019. Attached is the draft agenda to guide our discussion and the summary of the Business Session which includes potential agenda items. Let me know if you have any questions. Thank you, Margie Margie Scott-Cseh Committee Management Specialist CDC/NCHHSTP/OPPP Tel: (404) 639-8317 Fax: (404) 639-8600 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002104 From: Centers for Disease Control and Prevention Sent: Thursday, June 27, 2019 2:10 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - June 27, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — JUNE 27, 2019 Ahead of Print Current Cover Monitoring Chikungunya with Big Data Podcasts Download the PDF of the podcast transcript (36KB) Dr. Joacim Rocklöv, a professor in the Department of Public Health and Clinical Medicine at Umeå University in Sweden, discusses using big data to monitor a 2017 outbreak of Chikungunya in Europe. Running time = 21:15 Contact EID Announcements CDC Read the associated article in the June 2019 issue of the EID Journal Using Big Data to Monitor the Introduction and Spread of Chikungunya, Europe, 2017 — J. Rocklöv et al. Browse all of EID's Podcast Content EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002105 From: Centers for Disease Control and Prevention Sent: Tuesday, July 02, 2019 9:49 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - July 2, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — July 2, 2019 Ahead of Print Current Cover Research Letter Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission Podcasts Lei Zhou, Qun Li, and Timothy M. Uyeki Abstract Contact EID Announcements CDC We estimated the incubation period and serial interval for human-to-human–transmitted avian influenza A(H7N9) virus infection using case-patient clusters from epidemics in China during 2013–2017. The median incubation period was 4 days and serial interval 9 days. China’s 10-day monitoring period for close contacts of case-patients should detect most secondary infections. Volume 25, Number 10 - October 2019 EID Stacks EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002106 From: Bartee, Brad Allen (CDC/OD/OCS) Sent: Wednesday, July 03, 2019 2:45 PM EDT To: Lucas,Shelley (DSHS) ; Rocha,Felipe (DSHS) ; Garcia,Imelda M (DSHS) Subject: CDC Director Agenda Attachment(s): "Texas-Arizona-California Agenda v.10.docx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi Shelley, Attached is our long agenda for all the sites were are visiting. Houston/Harris County did not send us an agenda, but I verified with them that the events and times on our agenda are accurate, based on our calls we had with them. Thank you for sending the updated agenda and the link for lunch. I will update ours with the new information that you sent. Thanks, Brad Brad A. Bartee Advance Team Office of the Chief of Staff Centers for Disease Control and Prevention (CDC) Office: 404-718-5097 Cell: 202-600-6537 Email: bbartee@cdc.gov Rm: 12107 TX-DSHS-19-1309-A-002107 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i~Tentative; [;.{!ffl•J~ Gift Exchange [l!!J -Remarks; Houston Monday, July 15th , 2019 0600 Transit to Airport (EDT) 0815 Departure on Delta 1638 to HOU (Hobby) (Duration: 2hrs/10mins) (EDT) 0925 (CDT) 0945 1030 - 1045 10451245 Arrival on Delta 1638 Transit to Texas southern University by Rental Vehicle Enterprise Confirmation#: 1605217546COUNT (Heather) Enterprise Confirm at ion#: 1605216803COUNT (Am and a) Aooroximatelv 9. 4 miles I 25-30 minutes Introductions Location: Texas Southern Universitv, 3100 Cleburne Street, Houston, TX 77004 Public Health Leader Engagement Event Location: TS u Campus, Public Affairs Building Auditorium. (Building 104)? Moderator: Thomas Giordano, Professor and Section Chief, Baylor College of Medicine Infectious Diseases Participants: . • • Stephen Williams, Director, Houston Health Department Umair Shah, Ex Dir, Local Health Authority of Harris County Janeana White, Medical Director for Disease Control and Clinical Prevention, Harris County • Michael Brannon, Administrator Disease control and Oinical Prevention, Harris County • • • Joann Schulte, Deputy Health Authority, Houston Health Department John Poole, Policy Co-Chair, End HIV Houston Steering Committee . . . Eric Boerwinkle , Dean, UT School of Public Health Sharon Hudson, TSU College of Science and Technology Marlene McNeese, Assistant Director, Disease Prevention and Control, Houston Health Department Carin Martin, Manager, Ryan White Grants Administration, Harris County Public Health 1 TX-DSHS-19-1309-A-002108 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i ~Tentative; [;.{!ffl•J~ Gift Exchanqe [l!!J -Remarks; William Campbell, HIV Prevention Manager, Houston Health Department Mike Blue, Prevention Co-Chair, End HIV Houston Steering Committee Patrick Martin, Criminal Justice Co-Chair, End HIV Houston Steering Committee Harrison Guy, Chair, Mayor's LGBTQ Advisory Board Crystal Townsend, Coordinator, End HIV Houston Steering Committee • Melody Barr, Deputy Assistant Director, Houston Housing and community Development Department • Shelley Lucas, Manager, HIV/STD Prevention and care services, Texas Department of State Health Services • Samira Ali, Assistant Professor, Graduate School of Social Work, University of Houston/Gilead Compass Initiative • Nancy Miertschin, Manager, HIV Services, Harris Health System • Steven Vargas, Access to care Co-Chair, End HIV Houston Steering committee • Bruce Turner, Chair, Houston Area Ryan White Planning Council • Af7?YLeonard, Prevention Co-Chair, End HIV Houston Steering Committee Obse,vers: Amber Harbolt and Tori Williams (Ryan White Planning Council); Illy Jaffer, Scott Packard, Amber David (Houston Health Department); Elizabeth Perez, King Hillier, Albert Cheng, Sherri Onyiengo, Dana Beckham, Eric Bakota (Harris County Public Health); Non-nan Mitchell (El Centro Community Health Center); Katy Caldwell (Legacy Community Health Services); Joe Fuentes (Avenue 360); Adriana Dibello (AAMA), Elia China (FLAS); Erica Brown (Harris County Judge's Office); Amber Weed (Precinct 1 Commissioner's Office); Pennv Shaw (Precinct 2 Commissioner's Office) • • • . . 12451345 1345 14001500 15001530 1530 Lunch Transit to Clinic bv Rental Vehicle Harris Health care Clinic Visit (likely 2 Groups) Location: Ben Taub Hospital, 1504 Taub Looo, Houston, TX 77030 Tentative Media Event Depart for Austin by Rental Vehicles Approximately 165 Miles / 2 hours and 40 minutes 1830 Arrival in Austin 2 TX-DSHS-19-1309-A-002109 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media; ;vellow Call; @i§§i ~Tentative; • - Gift Exchan e 18302100 Check in and Dinner on own RON Doubletree Suites by Hilton Austin Location: 303 W. 15rt1St., Austin, TX 78701 Conffrmation#:98016928 [l!!J -Remarks; 3 TX-DSHS-19-1309-A-002110 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media; ;vellow Call; @i§§i~Tentative; • - Gift Exchan e [l!!J -Remarks; Austin Tuesda , Jul 16th, 2019 0900 (CDT) -1 hr ATL 0930 -0935 Transit to Texas Department of State Health Seivices by Rental Vehicle Location: 1100 West 49 th Street, Moreton Building, Room 749, Austin, Texas 78756-3199 4 miles I 11 minutes Wei come by Dr. John Hellerstedt, Texas Department of State Health Seivices (DSHS) Participants for the Morning • Jennifer Sims, DSHS Deputy Commissioner • Kirk Cole • Ricky Garcia, DSHS Director, Center for External Relations • Imelda Garcia, DSHS Associate Commissioner, Lab & Infectious Diseases Division • Dr. Jenifer Shuford, DSHS Infectious Disease Medical Officer • Felipe Rocha, DSHS Section Director, TB/HIV/STD • Greg Beets, DSHS Manager, Health Communication and Community Engagement • Derek Johnson, DSHS Legislative Liaison, TB/HIV/STD Section • Shelley Lucas, DSHS Branch Manager, HIV/STD Prevention & care • Janina Vazquez, DSHS Manager, HIV Care Services • Jenny McFarf ane, DSHS Group Manager, HIV Prevention • Rachel Sanor, DSHS Group Manager, Texas HIV Medication Program Manager • Laura Potter, DSHS Manager, Texas HIV Medication Program Regional Manager • Sydney Minnerly, DSHS Manager , Public Health Follow Up • Dolores Alvarez, DSHS Group Manager, HIV Operations • DSHS Branch Manager, Epidemiology & Surveillance • Sylvia Odem, DSHS Group Manager, TB/HIV/STD Epidemiology & Surveillance 4 TX-DSHS-19-1309-A-002111 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; Media; ;vellow Call; @i§§i~Tentative; • - Gift Exchan e ~ • • • • • • • • • • • • • • [l!!J -Remarks; Margaret Vaaler, DSHS Group Manager, Epidemiology and supplemental Projects Justin Irving, DSHS Group Manager, Program Evaluation Aubrey Braglia, DSHS Manager, Data and Reporting Stephanie Hayden, Director, Austin Public Health Adrienne Sturrup, Assistant Director for Health Equity and Community Engagement, Austin Public Health Glenn Selfe, Austin Public Health Manager, HIV Resources Administration Unit Dr. Roberto Villareal, University Health Systems, Senior Vice President Leah Meraz, University Health Systems Senior Director, Ryan VVhite Programs Dr. Phillip Huang, Dallas County HHS Director/Health Authority Sonya Hughes, Dallas County Health and Human Services Assistant Director, Ryan VVhiteGrants Compliance Dr. Umair Shah, Harris County Public Health Executive Director Carin Martin, Harris county Public Health Program Manager, Ryan White Grant Administration Stephen Williams, Houston Health Department Director Marlene McNeese, Houston Health Department Assistant Director, Disease Prevention and Control Division • Ann Salyer-Caldwell, Tarrant County Public Health Deputy Director • Lisa Muttiah, Interim Grants Mana er, Tarrant Coun Public Health 0935 -0945 0945 - 0955 Ending the HIV Epidemic in Texas Presenters: • • Imelda Garcia, DSHS Associate Commissioner, Lab & Infectious Diseases Division Feli e Rocha, DSHS Section Director, TB/HIV/STD 5 TX-DSHS-19-1309-A-002112 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; 0955 -1025 ~ Media l.JYellow Call; @i§§i ~Tentative; [;.{!ffl•J~ Gift Exchanqe [l!!J -Remarks; • Shellev Lucas, DSHS Branch Manaaer, HIV/STD Prevention & care Local Jurisdiction overview Presenters: • Bexar County- Dr. Roberto Villareal, University Health Systems • Dallas county- Dr. Phillip Huang, Dallas county Health and Human • • • 1025 -1035 1035 -1045 1045 -1125 1125 -1130 1130 -1230 1230- 1300 1300 -1430 1500 1910 CDT 1935 MST 1935 RON Services Director/Health Authority Harris county- Dr. Umair Shah, Harris county Public Health Executive Director Houston- Stephen Williams, Houston Health Department Director Tarrant county-Ann Salyer-Caldwell, Tarrant county Public Health Deputy Director • Travis countv- Steohanie Havden, Austin Public Health Director Questions and Answers Break Roundtable Discussion Location: 1100 West 49m Street, Moreton Building, Room 749, Austin, Texas 78756-3199 Moderator: Participants: Same as Mornina Wrao Uo Lunch (Self Pav, Jason's Deli) Transit to Al DS services - Austin Tour of AIDS Services of Austin/Media Interview Location: 7215 Cameron Rd, Suite A, Austin, TX 78752 POC: Transit to Airport American Airlines Flight 2099 Departs Austin (Duration: 2hrs/25mins} American Airlines Fliaht 2099 Arrives in Phoenix Transit to Hotel Hampton STE Phoenix Downtown Location: 77 E. Polk St. Phoenix, AZ 85004 continnation #: 95135520 6 TX-DSHS-19-1309-A-002113 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i~Tentative; [;.{!ffl•J-~ Gift Exchange [l!!J -Remarks; Phoenix Wednesday, July 17th, 2019 0730 (MST) -3 Hrs Transit to Maricopa County Department of Public Health Clinic by Taxi or Uber (2.1 miles/ 6 m ins) from ATL 08000900 0900 0930 0930 0945 0945 1100 Maricopa county Department of Public Health Clinic/Rapid Start Program overview Location: 1645 E. Roosevelt St., Phoenix, AZ 85006 Participants: ADHS: Dr. Cara Christ, Jessica Rigler, Eugene Livar, Kristen Herrick MCDPH: Corinne Velasquez, Dr. Renuka Khurana, Jason Peters, Joyce Hines, Marcy Flanagan and/or Max Poner (tentative) Format: • Welcome remarks by MCDPH (approx. 5 min) • Introductions around the table (approx. 5 min) • Brief introductory remarks from Dr. Giroir and Dr. Redfield (5 min) • Overview of HIV Program and Rapid Start Initiative at MCDPH by MCDPH (approx. 15 min) • Clinic Tour by MCDPH (20 min) • Closinq remarks by MCDPH and CDC/HHS principal(s) (aoorox. 10 min) Transit to Arizona Department of Health Services (ADHS) (transponation provided by ADHS Representatives) Location: 150 N. 18m Ave, Phoenix, AZ 85007 Welcome with ADHS Director Location: Conference Room 500 Participants: Dr. Cara Christ, Don Herrington, Jessica Rigler, Sheila Sjolander, Colby Bower, Carta Berg, Chris Minnick Format: • Welcome and Introduction to the Depanment by Dr. Christ (7 minutes) • Introductions and Additional Remarks by Dr. Giroir and Dr. Redfield (7 minutes) HIV in Arizona - Roundtable Discussion Location: ADHS Headquarters, Conference Room 215 AIB 7 TX-DSHS-19-1309-A-002114 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; 1100 1115 1115 1200 ~ Media; ;vellow Call; @i§§i ~Tentative; • - Gift Exchan e [l!!J -Remarks; Moderator: Wayne Torma/a, ADHS Participants: ADHS: Dr. Cara Christ, Jessica Rigler, Carla Berg, Chris Minnick, Eugene Livar, Kristen Herrick, Lisa Villarroel, Rick DeStephens, John Sapero, Ricardo Fernandez Community Partners: City of Phoenix - Fast Track City, AZ HIV Statewide Advisory Group {SWAG), Ryan VVhitePart A Planning Council, Aunt Rita's Foundation, RipplePHX Format: • Welcome remarks by moderator (approx. 5 min) • Introductions around the table (approx. 5 min) • Brief introductory remarks from Dr. Giroir and Dr. Redfield {10 min) • Arizona HIV Programs Overview by ADHS {10 minutes) - John Sapero • Roundtable Discussion/Q&A (approx. 35 min) o Attendees will be encouraged to prepare questions in advance of the meeting along the following categories: § Clarification of the initiative § Successes in HIV prevention which could be held up as best practices § Challenges they want to raise for CDC/HHS' attention § Recommendations for CDC/HHS in implementing the initiative • Closing remarks from CDC/HHS principal (5 min) • Closin remarks b moderator rox. 5 min Break Media/Public Health Leader Roundtable Location: Conference Room 215 AIB Moderator: Chris Minnick, Director of Communications for ADHS Participants: • ADHS: Dr Cara Christ, Jessica Rigler, Sheila Sjolander , Colby Bower, Carla Berg, Chris Minnick • Arizona Local Health Officers Association Representati ves: [proposed] Leslie Horton, Marcy Flanagan, Diana Gomez • Media Representati ves: AZ Republic {Stephanie Innes), KJZZ (Kathy Ritchie), KTAR {Ashley Flood), AZ Family (Briana Whitney), NBC 12 {Celia Prince), Fox 10 John Davidson , ABC 15 Sonu Wassu , Univision Gerardo Hi inson 8 TX-DSHS-19-1309-A-002115 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i ~Tentative; [;.{!ffl•J~ Gift Exchange [l!!J -Remarks; Format : • • We/comeremarksby Dr. Christ (5 min) Roundtableintroducti ons (approx. 5 rrin) • Brief introductory remarks from Dr. Giroir and Dr. Redfield (5 min) • • Media Q&A (15 minutes) Post-eventphotoqranhs/interviews (15 rrinutes) 1200 1300 Lunch with ADHS Leadership/Arizona Success Stories Location: ADHS Headquarters, Conference Room 500 Pre-paid lunch ordered from sacks , Please order with Wendy Snyder by noon on 7/16/19 Location: ADHS Headquarters, Conference Room 500 Participants: ADHS: Dr. Cara Christ, Don Herrington, Jessica Rigler, Sheila Sjolander, Colby Bower, Carla Berg, Chris Minnick, Dr. Lisa Villarroel Format: • Lunch Distribution (5 minutes) • Introductions around the table (approx. 5 min) • Brief introductory remarks from Dr. Giroir and Dr. Redfield (5 min) • Roundtable Discussion of Arizona Success Stories (approx. 35 min) o Pain and Addiction Curriculum (Lisa Villarroel) o Empower Program {Sheila Sjolander) o Arizona Health Improvement Plan {Sheila Sjolander/Carla Berg) o Meet and Greet Program for TB/STD/HIV (Jessica Rigler) o Drinking Water Screening in Child Care Facilities {Colby Bower) • Closing remarks from CDC/HHS principal (5 min) 1300 1315 1315 1430 Break and Transition to State Public Health Lab Tribal Leaders Roundtable Location: ADHS Headquarters, Igloo Moderator: Wayne Torma/a, ADHS Participants: ADHS: Dr. Cara Christ, Jessica Rigler, Sheila Sjolander, Colby Bower, Michael Allison, Carla Berg, Chris Minnick, Eugene Livar Tribal Representatives: Invited members of Inter- Tribal Council of Arizona, Navajo Nation leadership Format: 9 TX-DSHS-19-1309-A-002116 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; • • • • 1430 1445 1445 1615 • • Break ~ Media; ;vellow Call; @i§§i ~Tentative; • - Gift Exchan e [l!!J -Remarks; Welcome remarks by moderator (approx. 5 min) Introductions around the table (approx. 5 min) Brief introductory remarks from Dr. Giroir and Dr. Redfield (10 min) Roundtable Discussion/Q&A (approx. 45 min) o Attendees will be encouraged to prepare questions in advance of the meeting along the following categories: § Ending the HIV Epidemic {Successes, Challenges, Recommendations) § Opioids § Rocky Mountain spotted fever § Others TBD Closing remarks from CDC/HHS principal (5 min) Closin remarks b moderator rox. 5 min Public Health Leader Roundtable Location: ADHS Headquarters, Igloo Moderator: Wayne Torma/a, ADHS Partid pants: • ADHS: Dr. Cara Christ, Jessica Rigler, Sheila Sjolander, Colby Bower, Carla Berg, Chris Minnick, Levada Coker • Arizona Local Health Officers Association Format: • Welcome remarks by moderator (approx. 5 min) • Introductions around the table (approx. 5 min) • Brief introductory remarks from Dr. Giroir and Dr. Redfield (10 min) • Roundtable Discussion/Q&A (approx. 45 min) o Potential items for discussion could include: § Ending the HIV Epidemic {Successes, Challenges, Recommendations) § STD § o ioids 10 TX-DSHS-19-1309-A-002117 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i ~Tentative; [;.{!ffl•J~ Gift Exchanqe [l!!J -Remarks; § § Immunizations Diabetes • Closing remarks from CDC/HHS principal (5 min) Closing remarks by moderator (approx. 5 min) • Post-event ohotoaranhs (15 minutes) Concluding Comments with ADHS Director Dr. Christ • Concluding Statements by Dr. Christ (7 minutes) • concluding statements by Dr. Giroir and Dr. Redfield (7 minutes) Transit to Airport United Airlines Flight 5389 Departs PHX 7:18pm (MST) (1hr/40min) . 16151630 1630 1918 (MST) 2058 United Airlines Flight 5389 Arrives LAX 8:58pm (PDT) (PDT) 2030 RON: Transit to Hotel Doubletree by Hilton Los Angeles Location: 120 South Los Angeles Street, Los Angeles CA 90012 Confirmation #: 95398208 11 TX-DSHS-19-1309-A-002118 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; Media l.JYellow Call; @i§§i~Tentative; [;.{!ffl•J~ Gift Exchange ~ [l!!J -Remarks; Los Angeles Thursday, July 18 th, 2019 0730 (PDT) -3 Hours from Atlanta 0800 0845 Transit to LA County Department of Public Health or California Endowment Center 313 N. Figueroa Street, Los Angeles, CA 90012 (.9 mile/ 5 minutes) Breakfast Location: TBD Participants: • • 08450900 09000915 0915 1130 Assistant Secretary for Health Admiral Brett Giroir and Team CDC Director Robert Redfield and Team • CDC Division of HIV/AIDS Prevention Director Eugene Mccray and Team • Los Anqeles Countv Department of Public Health Leadership Check-In Welcoming and Opening Remarks Location: TBD Participants: • Los Angeles County Department of Public Health Director Dr. Barbara Ferrer • Assistant Secretary for Health Admiral Brett Giroir • Director of the CDC Dr. Robert Redfield Roundtable with Public Health Leaders from across Southern CA Location : California Endowment Center Moderator: TBD Participants: • Assistant secretary for Health Admiral Brett Giroir and Team • CDC Director Robert Redfield and Team • CDC Division of HIV/AIDS Prevention Director Eugene Mccray and Team • Public Health Leaders from southern California Counties • Los Angeles County Department of Public Health Leadership 12 TX-DSHS-19-1309-A-002119 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media; ;vellow Call; @i§§i ~Tentative; • - Gift Exchan e [l!!J -Remarks; Discussion Topics: (20-25 minutes per topic) • Synchronization with the EtHE plan through data, partnerships, and community engagement 11301200 12001300 • Strengthening CDC relationships with southern CA county LHDs • Innovative efforts across federal departments (i.e. CMS, SAMS HA, NIH, DOJ, HUD) to align programming and resources for populations at risk of multiple poor health outcomes: community members struggling with S UDs and high rates of infectious diseases; GLBTQ+ young people with high rates of emotional distress; Black women experiencing high rates of maternal and infant mortality; high morbidity and mortality rates for people who are homeless. • Using data to more effectively connect health outcomes to social determinants of health • Integrating primary care and public health: where are the opportunities Media and Press Availability Location : TBD Moderator: Partidpants: • Assistant Secretary for Health Admiral Brett Giroir and Team • CDC Director Robert Redfield and Team • CDC Division of HIV/AIDS Prevention Director Eugene Mccray and Team • Members of the county of Los Angeles Board of supervisors • Public Health Leaders from Southern California Counties • Los An eles Coun De artment of Public Health Leadershi Lunch with Los Angeles County HIV Leaders Location: TBD Participants: • Assistant Secretary for Health Admiral Brett Giroir and Team • CDC Director Robert Redfield and Team • CDC Division of HIV/AIDS Prevention Director Eugene Mccray and Team • Los Angeles county Department of Public Health Leadership • Executive Director, Los An eles Coun Commission on HIV 13 TX-DSHS-19-1309-A-002120 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; • • 13001400 14001600 ~ Media l.JYellow Call; @i§§i ~Tentative; [;.{!ffl•J~ Gift Exchanqe [l!!J -Remarks; Co-Chairs, Los Angeles county commission on HIV Community Co-Chairs, Los Anqeles County HIV/AIDS Strateav Transit to APLA Health - Gleicher/Chen Health Center Location: 3743 South La Brea Avenue, Los Angeles, CA 90016 Moderated Comm unity Discussion Location: Gleicher/Chen Health Center Moderator: TBD Discussion Topics and Participants: Tog/c 1: Linkgg_eand Re-Enggg_ement Program/HIV Surveillance (DPH SME: Sophia Rumanes) (Key County/Community Partners: Dr. Alice Stek {OHS MCAH), Dr. Revery Barnes {OHS OVMC), Northeast Valley Health Corporation MCC Team, Others TBD) Togic 2: PrEP Centers of Excellence/PrEP Navigators (DPH SME: Leo Moore, MD) (Key community Partners: Raul Quintero (JWCH); Yolanda Reyes {LGBT center), Dr. Tony Mills (MHF), Others TBD) Togic 3: Meth!Ogiate Use and HIV and S'iJ2.hilisRisk among lncreasingl',i_l@acted Populations (DPH SMEs: Dr. Becca Cohen (DHSP), Dr. John Connolly {SAPC)) (Key Community/Academic Partners: Dr. Cathy Reback (FRI), Dr. Steve Shoptaw (UCLA), Albert Senella (TTC), Others TBD) 1600- 1700 18301959 2000 RON Togic 4: Pa',i_for Performance for HIV Ambulatonc. Outgatient Medical (AOM1 Services and Pa',i_forPerformance for HIV Testing Services (HTS1 (DPH SME AOM: Dr. Becca Cohen, DPH SME HTS: TBD) Depart for Airport United Airlines Flight 481 Departs LAX 6:30pm Arrives SFO 7:59pm (1h/29m) Transit to Hotel in Oakland Courtyard by Marriott Location: 988 Broadway, Oakland CA 94607 Confirmation#: 96103186 14 TX-DSHS-19-1309-A-002121 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ Media l.JYellow Call; @i§§i~Tentative; [;.{!ffl•J~ Gift Exchange [l!!J -Remarks; Oakland/San Francisco Friday, July 19th , 2019 0830 (PDT) -3 Hours from Atlanta 0900 -0930 0930 -1045 1045- 1100 1100 -1130 1130 -1230 1230 -1330 1330 -1400 1400 -1430 1430 -1500 1500 -1700 1700 2245 Transit to Event in Oakland Introductions and Networking Location: HIV Stakeholder Roundtable w/Public Health Partners and comm unity Advocates Location: Moderator: Participants: Photo Opportunity Meeting with Public Health Team from Alameda County Location: Participants: Transit to San Francisco Lunch with San Francisco County Public Health Team Media Engagement Event Location: Moderator: Participants: I ntrod ucti o ns Location: Moderator : Participants: Panel with San Francisco and Alameda County Representatives providing short updates on Getting to Zero Initiative Location: Moderator: Participants: Open Discussion and Dialogue Participants: Transit to Airport Delta Flight 1446 Departs SFO 15 TX-DSHS-19-1309-A-002122 CDC Director Travel Multi-State Trip ADM Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, Director, CDC Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS (TX, LA) Dr. Jonathon Mermin, Director NCHHSTP (TX, AZ) Eugene McCray, Director DHAP (CA) Janet Cleveland, Deputy Director for Prevention Programs, DHAP (CA) Loretta Lepore, Health Communications Officer LCDR Nicole Carr, Aide de Camp to the Assistant Secretary for Health Heather Dennehy, Special Assistant to the Director @if~ -Travel; ~ 0626 0645 Media; ;vellow Call; @i§§i ~Tentative; • • - Gift Exchan e [l!!J -Remarks; Delta Fli ht 1446 Arrives A TL Transit to Residence 16 TX-DSHS-19-1309-A-002123 From: Centers for Disease Control and Prevention Sent: Monday, July 08, 2019 9:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - July 8, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — July 8, 2019 Ahead of Print Current Cover Research Letter Worldwide Reduction in MERS Cases and Deaths since 2016 Podcasts Christl A. Donnelly, Mamun R. Malik, Amgad Elkholy, Simon Cauchemez, and Maria D. Van Kerkhove Abstract Contact EID Announcements Since 2012, Middle East respiratory syndrome (MERS) coronavirus has infected 2,442 persons worldwide. Case-based data analysis suggests that since 2016, as many as 1,465 cases and 293–520 deaths might have been averted. Efforts to reduce the global MERS threat are working, but countries must maintain vigilance to prevent further infections. Volume 25, Number 9 - September 2019 CDC EID Stacks EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002124 From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Sent: Monday, July 08, 2019 3:25 PM EDT To: Garcia,Imelda M (DSHS) CC: Aldridge,Tiffany (DSHS) Subject: AFM-Rapid Awards List (RAL) WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, As the fiscal year draws to a close each September, CDC’s CIOs often find they have unanticipated available funds (lapse or “fall out”). The Rapid Awards List (RAL) provides a means for CIOs to obligate the funds that are identified during the fiscal year-end closeout process. In preparation for the upcoming Rapid Awards List (RAL)/end-of-year ELC funding cycle, it has been brought to the ELC’s attention that there are additional funds that might become available. This financial assistance is being provided to a select group of recipients for work in enhanced surveillance for Acute Flaccid Myelitis (AFM). The AFM program at CDC anticipates an emerging issue that would benefit from: (1) communications around AFM surveillance; (2) surveillance data collection; and (3) surveillance data analysis to help understand burden of disease and inform future surveillance efforts. Your jurisdiction has been selected as one of the targeted recipients based on various factors (e.g., case counts, capacity, etc.). While, at this time, there are no guarantees of funding, the anticipated amount would be in the $400K-$500K range. ELC would like to know if you have any question or concerns around receiving this AFM funding? De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-002125 From: Lucas,Shelley (DSHS) Sent: Monday, July 08, 2019 4:10 PM EDT To: Chacon,John (HHSC) ; Walden,Kathie (DSHS) ; Bartee, Brad Allen (CDC/OD/OCS) ; Scales, Scott L. (CDC/OD/OCS) CC: Rocha,Felipe (DSHS) ; Marx,Cassandra (HHSC) ; Garcia,Imelda M (DSHS) Subject: Facilitation for CDC EtE meeting in Austin Attachment(s): "Ending the HIV Epidemic in Texas 7-8-19.docx" Hi John, I’m happy to hear that you will be facilitating our meeting. Please see attached for the latest agenda. As we discussed, Dr. Hellerstedt and DSHS are hosting a meeting on July 16 th from 9:30-11:30 at Moreton with Dr. Redfield, the CDC Director, and a designee for ADM Giror, Assistant Secretary for Health, to discuss Ending the HIV Epidemic efforts in Texas. We have invited the administrators of City of Houston, Harris, Bexar, Tarrant, Dallas, and Travis county health departments to join us. It will be a large group of people, approximately 40-50 with 15-20 people at the table for a group discussion. CDC has suggested, and we concur, that bringing in a facilitator would help. We want to ensure that everyone has an opportunity to share. I have copied Kathie Walden, who is heading up the meeting room logistics on our end, as well as Scott Scales and Brad Bartee, who are handling the CDC logistics. There is a scheduled planning call for Thursday at 1pm, and I will forward the invite to you. I will leave it up to you and Brad/Scott to determine if you need a separate or additional call. Thanks, Shelley Shelley Lucas, MPH Manager, HIV/STD Prevention and Care Branch Texas Department of State Health Services P.O. Box 149347 (MC1873) Austin, Texas 78714-9347 Office: (512) 533-3109 Fax: (512) 533-3172 I support Achieving Together: A Community Plan to End the HIV Epidemic in Texas TX-DSHS-19-1309-A-002126 TEXAS TexasDepartmentofStateHealthServices Healthand Human Services John Hellerstedt, M.D. Commissioner Ending the HIV Epidemic in Texas: A Discussion with CDC Director Redfield Time: July 16, 2019 9:30-11:30 PM Location: Moreton Building Rm 749, Austin, TX Purpose: · Provide overview of ETE initiative for Texas state and local public health leaders · Discuss how ETE can address on-going challenges related to HIV prevention and treatment in Texas and in the five target counties Participants · · · · · · · · · · · · · · · · · · · Designee for Admiral Brett Giroir, Assistant Secretary for Health Dr. Robert Redfield, CDC Director Amanda Campbell, CDC Deputy Chief of Staff Dr. Jose Montero, Director CSTLTS Dr. Jonathon Mermin, Director NCHHSTP Loretta Lepore, Strategic Advisor for Communications Heather Dennehy, Special Assistant to the Director TBD, Aide de Camp to ADM Giroir Dr. John Hellerstedt, DSHS Commissioner Jennifer Sims, DSHS Deputy Commissioner Kirk Cole, DSHS Senior Advisor Ricky Garcia, DSHS Director, Center for External Relations Imelda Garcia, DSHS Associate Commissioner, Laboratory and Infectious Diseases Division Dr. Jenifer Shuford, DSHS Infectious Disease Medical Officer Felipe Rocha, DSHS Section Director, TB/HIV/STD Shelley Lucas, DSHS Branch Manager, HIV/STD Prevention & Care Janina Vazquez, DSHS Manager, HIV Care Services Jenny McFarlane, DSHS Group Manager, HIV Prevention Rachel Sanor, DSHS Group Manager, Texas HIV Medication Program Manager P.O. Box 149347 • Austin, Texas 78714-9347 • Phone: 888-963-7111 • TTY: 800-735-2989 • dshs.texas.gov TX-DSHS-19-1309-A-002127 2 · · · · · · · · · · · · · · · · · Sydney Minnerly, DSHS Manager, Public Health Follow Up Sylvia Odem, DSHS Group Manager, TB/HIV/STD Epidemiology & Surveillance Margaret Vaaler, DSHS Group Manager, Epidemiology and Supplemental Projects Justin Irving, DSHS Group Manager, Program Evaluation Stephanie Hayden, Director, Austin Public Health Adrienne Sturrup, Assistant Director for Health Equity and Community Engagement, Austin Public Health Glenn Selfe, Austin Public Health Manager, HIV Resources Administration Unit Dr. Roberto Villareal, University Health Systems, Senior Vice President Leah Meraz, University Health Systems Senior Director, Ryan White Programs Dr. Phillip Huang, Dallas County Health and Human Services Director/Health Authority Sonya Hughes, Dallas County Health and Human Services Assistant Director, Ryan White Grants Compliance Dr. Umair Shah, Harris County Public Health Executive Director Carin Martin, Harris County Public Health Program Manager, Ryan White Grant Administration Stephen Williams, Houston Health Department Director Marlene McNeese, Houston Health Department Assistant Director, Disease Prevention and Control Division Ann Salyer-Caldwell, Tarrant County Public Health Deputy Director Lisa Muttiah, Interim Grants Manager, Tarrant County Public Health Agenda I. Welcome (5 minutes) Dr. John Hellerstedt, Commissioner, Texas Department of State Health Services II. Ending the HIV Epidemic Initiative Overview (10 minutes) Dr. Robert R. Redfield, Director, U.S. Centers for Disease Control and Prevention TX-DSHS-19-1309-A-002128 3 III. Ending the HIV Epidemic in Texas (10 minutes) Dr. John Hellerstedt, Commissioner, Texas Department of State Health Services IV. Roundtable Discussion (60 minutes) Each jurisdiction should be prepared to share: · 2-3 successes/success stories as it pertains to HIV from your organization or county/city. · 2-3 challenges in addressing HIV in Texas as it pertains to your work or your organization. · How would you recommend Ending the Epidemic funds are spent in your county/city? This can relate to the work you or your organization does and/or Texas’s needs in general. Please state which of the 5 ‘pillars’ of the Ending the Epidemic framework each of your recommendations addresses. V. Question and Answers (from full group) (15 minutes) VI. Wrap-Up (5 minutes) 11:30- 1:00PM Lunch break (pre-order/to be delivered onsite) 1:00-2:30PM Tour of AIDS Services of Austin/media interview TX-DSHS-19-1309-A-002129 From: Centers for Disease Control and Prevention Sent: Tuesday, July 09, 2019 8:32 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - July 9, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — July 9, 2019 Ahead of Print Current Cover Dispatch Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir Podcasts Vasiliy P. Mishin, Mira C. Patel, Anton Chesnokov, Juan De La Cruz, Ha T. Nguyen, Lori Lollis, Erin Hodges et al. Abstract Contact EID Announcements Baloxavir showed broad-spectrum in vitro replication inhibition of 4 types of influenza viruses (90% effective concentration range 1.2–98.3 nmol/L); susceptibility pattern was influenza A ˃ B ˃ C ˃ D. This drug also inhibited influenza A viruses of avian and swine origin, including viruses that have pandemic potential and those resistant to neuraminidase inhibitors. Volume 25, Number 10 - October 2019 CDC EID Stacks EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002130 From: Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) Sent: Wednesday, July 24, 2019 11:45 PM EDT To: Banicki,Allison (DSHS) ; Dutton,RJ (DSHS) CC: Phippard, Alba (CDC/DDID/NCEZID/DGMQ) Subject: Re: Healthcare assoc. infections will do. ill let you know next steps. k Get Outlook for iOS From: Banicki,Allison (DSHS) Sent: Wednesday, July 24, 2019 11:04:25 AM To: Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Dutton,RJ (DSHS) Cc: Phippard, Alba (CDC/DDID/NCEZID/DGMQ) Subject: RE: Healthcare assoc. infections Hi Kathy, I would definitely recommend the state HAI program: https://www.dshs.texas.gov/idcu/health/infection_control/hai/ I would also recommend asking Dr. Jennifer Shuford, as she is the infectious disease physician for DSHS and has taken an interest in border issues. Allison Allison Abell Banicki, PhD Epidemiologist Office of Border Public Health Texas Department of State Health Services Business: (512) 776-6705 Fax: (512) 776-7262 Email: allison.banicki@dshs.texas.gov Mailing Address: MC 1962 P.O. Box 149347 Austin, Texas 78714-9347 J _.,.._ I • ·. TEXAS ,.,.._ Tn.uDtjwrll11on11ISlllt! 1181t~ :s....i..,. From: Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) [mailto:kzm5@cdc.gov] Sent: Tuesday, July 23, 2019 8:19 PM To: Banicki,Allison (DSHS) ; Dutton,RJ (DSHS) Cc: Phippard, Alba (CDC/DDID/NCEZID/DGMQ) Subject: Healthcare assoc. infections WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Hi – We’ve been working with CDC’s DHQP (Div of Healthcare Quality Promotion) on a resistant pseudomonas cluster in Tijuana. On a call today, they mentioned other clusters/cases along the border that look related to care in Mexico facilities, though not to the TJ cluster. They asked if we had border partners who would be interested in engaging on this topic. We were thinking of having a call for DHQP to review what they are seeing and develop some “next steps” with interested partners. Who would you suggest from TX? State HAI program, Border Health Office, BIDS, and/or ?? We’ll be asking other border states as well. Thanks in advance. Kathy Kathleen Moser, MD Medical Officer, US-Mexico Unit – San Diego Office Division of Global Migration and Quarantine National Center for Emerging & Zoonotic Infectious Diseases TX-DSHS-19-1309-A-002131 Centers for Disease Control and Prevention Desk: 619-692-5628 Fax: 619-692-8821 Telework (Fri) 619-455-5383 *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002132 From: Aldridge,Tiffany (DSHS) Sent: Friday, July 26, 2019 6:31 PM EDT To: Zion, Karen (CDC/OCOO/OFR/OGS) CC: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) ; McHard,Elaine Q (DSHS) ; Cathey,Karen (DSHS) Subject: RE: Texas No-Cost Extension Attachment(s): "6NU50CK000378 Texas Zika Supplement NCE and Redirection.pdf","Submission Confirmation - Zika NCE and Redirection.pdf" Hi Karen, Attached is the Redirection and NCE for Texas Zika Supplement funds. Please let me know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Zion, Karen (CDC/OCOO/OFR/OGS) [mailto:wvf8@cdc.gov] Sent: Thursday, June 13, 2019 9:00 AM To: Aldridge,Tiffany (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension Hi Tiffany, I wanted to let you know that I will be out of the office next week. If you submit the NCE next week, please email my back-up, Ms. Freda Johnson @ wve2@cdc.gov and let her know that you have submitted. Thanks, Karen. From: Aldridge,Tiffany (DSHS) Sent: Tuesday, June 11, 2019 9:05 AM To: Zion, Karen (CDC/OCOO/OFR/OGS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension Good Morning Karen, We were going to send that once the NCE was approved in REDCap by De’Lisa and Nga. I spoke with De’Lisa and she said they will work on it quickly. Please let me know if we could go ahead and submit into GrantSolutions. Thanks, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 TX-DSHS-19-1309-A-002133 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Zion, Karen (CDC/OCOO/OFR/OGS) [mailto:wvf8@cdc.gov] Sent: Tuesday, June 11, 2019 7:58 AM To: Aldridge,Tiffany (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: RE: Texas No-Cost Extension WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Morning, I looked at the RedCap attachment. OGS requires a cover letter signed by the Authorized Business Official and a budget narrative/justification. You will need to create a cover letter and budget. Please submit all documents to GrantSolutions and choose “No Cost Extension” as the amendment type. Thank you, Karen. From: Aldridge,Tiffany (DSHS) Sent: Monday, June 10, 2019 5:13 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Zion, Karen (CDC/OCOO/OFR/OGS) ; Garza,Jodi (DSHS) ; Garcia,Imelda M (DSHS) ; Gamez,Monica (DSHS) ; Golden,Sharon (DSHS) ; Layfield,Anna (DSHS) Subject: Texas No-Cost Extension Hi De’Lisa, Attached is the PDF of the DRAFT ELC No-Cost Extension and the FFR for Texas. All items are in complete status until we hear back from CDC. Once approved, we will submit the final in GrantSolutions. Please let me know if you have any questions for me. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002134 TEXAS TexasDepartment ofStateHealth Services HealthandHuman Services JohnHellerstedt,M.D. Commissioner July 26, 2019 Karen Zion Grants Management Specialist Centers for Disease Control and Prevention Grants Services Office Infectious Disease Service Branch, Team I 2920 Brandywine Road, RM 2015 Atlanta, GA 30341 Reference : DSHS Doc.# Grant Numbers: 6NU50CK000378 Building and Strengthening Epidem iology, Laboratory , and Health Information Systems Capacity in State and Local Health Departments Budget Redirection and No-Cost Extension Dear Ms. Zion : The Texas Department of State Health Service s (DSHS) requests a redirect ion and no-cost extension through the project period to end July 31, 2020. Texas is request ing a No-Cost Extension to expend approximately $2,290,599.75 through July 31, 2020. The no-cost extension and redirection of the funds will allow DSHS to expand and increase the Zika Media Campaign (new name is Mosquito Borne Diseases Campaign) to better reach youth and older adults In Texas. The fund s will cont inue three Local Health Department cont racts to build susta inable laboratory and epidemiology capacity , vector control, and allow for laboratory testing and surveillance test ing activities . Addit ionally, the Laboratory is requesting addit ional supplies and cont inued tempo rary staff to support Zika testing for the state of Texas. Please see the supporting detail in Table 1, Zlka Media Campaign, page 2. Upon completion of Project Year 5, DSHS plans to request an extension with any rema ining unobligated funds as a redirection to assist with Zika activities through July 31, 2020. P.O.Box 149347 • Austin,Texas78714-9347 • Phone:888-96,3-7111 • TTY:800-735-2889 • www.dshs.texas.gov TX-DSHS-19-1309-A-002135 Zion, Karen April 20, 2018 Page 2 Table 1 - Zika Media Campaign Zika Supplemental Ml, M2 and 2017 Zika Combined ($7,017,459 +$1,324,801= $18,654,908 COSTCATEGORY Personnel ORIGINAL AWARDED BUDGET $263,029 REQUESTED REDIRECTION NEW REVISED BUDGET 78,669 341,698 + $10,312,648 JUSTIFICATION Funds from the equipment category have been redirected to support activities related to Mosquito Borne Diseases. Fringe 94,501 30,629 125,130 Funds from equipment category have been redirected to support activities related to Mosquito Borne Diseases. Travel 35,983 12,244 48 ,227 Funds from equipment category have been redirected to support activities related to Mosquito Borne Diseases. 363,900 (184 ,900) 179,000 Savings from this category have been redirected to Personnel, Fringe, Travel and Supplies to support Laboratory, Epidemiology and Media Campaign activities during the no cost extension period. 783,308 104,515 887,823 Funds from equipment and the other category have been redirected to support activities related to Mosquito Borne Diseases. Contractual 7,856,784 3,375,440 11,232,224 . Funds from the other category have been redirected to support activities related to Mosquito Borne Diseases . Other 9,099,983 (3,503,992) 5,595,991 18,497,488 (87,395) 18,410 ,093 157,420 87,395 244,815 0 18,654,908 Equipment Supplies Total Direct Costs Indirect Costs Total Award 18,654,908 Savings from this category have been redirected to Personnel, Fringe, Travel , Supplies and Contractual to support Laboratory, Epidemiology and Media Campaign activities during the no cost extension period. Savings from the other category have been redirected to the Indirect Cost Category . TX-DSHS-19-1309-A-002136 Zion, Karen April 20, 2018 Page 3 To support this request, please find attached the Zika supplemental redirection, SF 424A, detailed budget justifications, FFR, and indirect cost rate agreement. If you have any questions regarding this request, please feel free to contact me, Imelda Garcia, at (512) 776-7679 or via email: Ime JdaM.Garcia@dshs.texas .gov . Associate Commissioner Laboratory and Infectious Disease Services Division cc: Business Official Amanda Hudson Budget Director De'Lisa Simpson, CDC Project Officer Angelica O'Connor, CDC Project Officer TX-DSHS-19-1309-A-002137 Texas Department of State Health Services (DSHS) Zlka Response No-Cost Extens ion and Redirection CK14-1401PPHF17, Epidemiology and Laboratory Capacity for Infectious Diseases Budget Request Period: 08101/2018-07/31/2020 A. Personnel Position 1. Microbiologist II $84,549 "of Time 100% Annual Salary Annual Longevity S.nefft Replacement Months Total 12 $43,983 Pav{BRPJ $41,823 $2,160 $0 Hancock, Joseph (H41000/00008703) Position Description: Performs and maintains all aspects of mosquito testing program for West Nile Virus and other arboviruses. 2. Microbiologist II 100% $40,086 $480 $0 12 $40,566 Day, Joanne (H41000/00008706) Position Description: Performs and maintains all aspects of mosquito testing program for West Nile Virus and other arbovlruses. Public Health and Prevention 3. Specialist II 50% $0 $0 $0 12 $0 New Position/H41DOD/Position# TBD Position Description: Under limited Supervisor of the Data Entry and Reporting Branch Manager this position will spend 50 percent of their time on Arboviral disease, and 50 percent of their time on ARLN, CRE activities. The position will enroll submitters for CRE testing, and will perform data entry on CRE submission to the DSHS Laboratory. Confers with local health agencies, private physicians, or individuals, about requirements to enroll as a submitter for the DSHS Laboratory. Participates in planning, creating and conducting training on Standard Operating Procedures for data entry and reporting to include training on enrolling providers, data entry of information into Laboratory Information Management System (LIMS), reporting and communicating results to submitters and health agencies. Serves as a resource in creating awareness of requirements for submitting samples to the DSHS Laboratory including required paperwork, and submission forms. Distributes information on the public health laboratory and its menu of tests. Assists in collecting and preparing materials In response to public health information and report requests. May perform investigation functions, review standard operating procedures, and prepare summaries on submitter activities. May train others. Performs related work as assigned. B. Fringe Benefits Fringe benefits are applicable to direct salaries and treated as direct costs. Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% $30,962 1 of 10 TX-DSHS-19-1309-A-002138 C. $19,289 Travel 1. In-State $6,940 a. Travel description: Three Laboratory Services Section (LSS) staff and the State Medical Entomologist to attend the Texas Mosquito Control Association Meeting in Victoria, Texas October 17-18, 2018. Opportunity to gain knowledge and discuss current trends in arbovirus surveillance for Texas, including mosquito biology, ecology, trap use, surveillance, and virus testing. Additional opportunity to provide information regarding mosqu ito testing services provided by the state with current and potential submitters of the DSHS Arbovirus Surveillance Program. Requesting attendance for additional LSS staff to give presentations and to foster career growth opportunities. Mileage: 1 trips x 2 persons x 251 miles r/t@ $.545/mile Airfare: # persons @ $0.00 r/t Ground Transportation: 4 persons @ $45 Lodging: 2 nights @ $85/night x 4 persons x 1 trips Per Diem: 3 days @ $46/day x 4 persons x 1 trips Travel Fees: #persons@ $ x # trips Baggage Fees-determined by carrier:# persons @ $ $1,686 $274 $0 $180 $680 $552 $0 $0 b. Travel description: One LSS staff to attend the Westem Gulf Center of Excellence for Vector-borne Diseases 3rd Annual Conference (Location and Date TBD) Discuss ongoing collaborations and training activities with local health departments and academic partners. One LSS staff to attend the South Texas Tropical Medicine & Vector Borne Disease Conference in South Padre Island, Texas in February 2019, in order to present on the DSHS Arbovirus surveillance program in Texas. Mileage: # trips x # persons x? miles r/t@ $.545/mile Airfare: # persons@ $? r/t Ground Transportation: # persons @ $? Lodging: 2 nights @ $85/night x 2 persons x 1 trip Per Diem: 3 days @ $46/day x 2 persons x 1 trip Travel Fees: #persons@ $12.00 x # trips Baggage Fees-determined by carrier:# persons@$? $616 $0 $0 $0 $340 $276 $0 $0 c. Travel description: State Medical Entomologist traveled once to each of the Public Health Regions to assist with any trainings or assistance in working with entities that receive the surveillance kits. $4,639 Mileage: 8 trips x 1 person x 363 miles per trip x .545/mile Airfare: 1 person @ $450.00 r/t Ground Transportation: 1 person @ $45.00 Lodging : 2 nights @ $85/night x 1 person x 8 trips Per Diem: 3 days @ $46/day x 1 person x 8 trips Travel Fees : 1 persons @ $12.00 x 1 trip Baggage Fees-determined by carrier. 1 person @ $85 $1,583 $450 $45 $1,360 $1,104 $12 $85 2of 10 TX-DSHS-19-1309-A-002139 2. Out-of-State $12,349 a. Travel description: One LSS staff and the State Medical Entomologist to attend the American Mosquito Control Association Meeting in Orlando, Florida (Feb 25-Mar 1, 2019). Opportunity to discuss current trends and protocols in arbovirus surveillance nationwide. Also, meet with colleagues from other state health departments and CDC to discuss high throughput mosquito testing programs and mutual challenges we all face regarding endemic and newly emerging arboviruses. Mileage: # trips x # persons x? miles r/t @ $.545/mile Airfare: 2 persons @ $400 r/t Ground Transportation: 2 persons@ $50 Lodging: 4 nights@ $169/night x 2 persons x 1 trip Per Diem: 5 days @ $64/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 2 trips Baggage Fees-determined by carrier: 2 persons @ $50 $3,040 $0 $800 $100 $1,352 $640 $48 $100 b. Travel description: One LSS staff to attend the Florida Advanced Mosquito Identification and Certification Course in 2019 for continued proficiency and skills needed for mosquito surveillance in Texas. This advanced coursework for mosquito identification is not offered in Texas. $1,741 Mileage: # trips x # persons x ? miles r/t @ $.545/mile Airfare: 1 persons @ $400 r/t Ground Transportation: 1 persons @ $50 $0 $400 $50 Lodging: 5 nights@ $169/night x 1 persons x 1 trips Per Diem: 6 days @ $64/day x 1 persons x 1 trips $845 $384 Travel Fees: 1 persons@ $12.00 x 1 trips Baggage Fees-determined by carrier:1 persons @ $50 $12 $50 c. Travel description: One LSS staff to attend the American Society for Tropical Medicine and Hygiene Annual Conference in New Orleans, Louisiana October 28-November 1. Opportunity to gain knowledge and discuss current trends in emerging arboviral diseases and protocols for arbovirus surveillance, specifically regarding diagnostic techniques for arboviruses of concern in Texas. Mileage: # trips x # persons x ? miles r/t @ $.545/mile Airfare: 1 persons @ $300 r/t Ground Transportation: 1 persons @ $50 Lodging: 4 nights @ $148/night x 1 persons x 1 trip Per Diem: 5 days @ $64/day x 1 persons x 1 trip Travel Fees: 1 persons @ $12.00 x 1 trip Baggage Fees-determined by carrier:1 persons @ $50 $1,324 $0 $300 $50 $592 $320 $12 $50 3 Qf 10 TX-DSHS-19-1309-A-002140 d. Travel description: One LSS staff, State Public Health Veterinarian and Medical Entomologist to attend National Arboviral ELC meeting if scheduled in 2019. Mileage: # trips x # persons x ? miles r/t @ $.545/mile Airfare: 3 persons @ $400 r/t Ground Transportation: 3 persons@ $50 Lodging: 2 nights @ $120/night x 3 persons x 1 trip Per Diem: 3 days@ $69/day x 3 persons x 1 trip Travel Fees: 3 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 3 persons @ $50 $2,877 $0 $1,200 $150 $720 $621 $36 $150 e. Travel description: State Medical Entomologist - Attend 48th Annual Society for Vector Ecology (SOVE) in Yosemite National Park, CA on October 8-11, 2018.Opportunity to discuss current trends and protocols in arbovirus surveillance internationally. Also, meet with colleagues from other Country's Ministries of Health to discuss emerging arboviruses and new control strategies. We can share challenges we all face regarding endemic and newly emerging arboviruses . $1,897 Mileage: 1 trips x 1 persons x 54 miles r/t @ $.545/mile Airfare: 1 person @ $500 r/t Ground Transportation: 1 persons @ $50.00 Lodging: 6 nights@ $123.00/night x 1 person x 1 trip Per Diem: 7 days @ $69.00/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $85 $29 $500 $50 $738 $483 $12 $85 f. Travel description: State Medical Entomologist - Attend 16th Annual Arbovirus Surveillance and mosquito control workshop in St. Augustine, Florida on March 19-21, 2019. This meeting provides an opportunity to meet with Florida State Entomologist to discuss emergency management strategies, mosquito prevention and control strategies, and other public health related information , Florida and Texas are both states that experience local transmission of important Aedes-viruses like dengue and Zika. Having the opportunity to discuss current trends and protocols in medical entomology is vital to responding. Florida is also the leader in their mosquito control districts evaluating novel control strategies and this meeting highlights these endeavors. $1,469 Mileage: 1 trip x 1 person x 52 miles r/t @ $.545/mile Airfare: 1 person @ $500 r/t Ground Transportation: 1 persons @ $50 Lodging: 4 nights@ $121/night x 1 person x 1 trip Per Diem: 5 days@ $69/day x 1 persons x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $50 $28 $500 $50 $484 $345 $12 $50 4of 10 TX-DSHS-19-1309-A-002141 0. Equipment $179,000 Item Requested Sprinter XL 240 IFA/ELISA. Instrumentation for the automation of Chikungunya, Dengue, St. Louis Encephalitis, and West Nile 1. Viruses. 2. Ultra Low Chest Freezer Kingfisher Automated 3. Extractor 4. Ultro Low Freezer Qty Unit Cost 1 1 100,000.00 1 50,000.00 1 17,000.00 12,000.00 $179,000 Amount 100,000.00 12,000.00 50,000.00 17,000.00 E. Supplies Item Requested 1. ChemBlo DPP ZIKA lgM 2. ChemBlo DPP ZIKA lgM 3. 6B6C-1 Affinity HRP Conj GOAT Affinity Purified 4. Antibody To Human lgM 5. TMB ELISA HRP Substrate 6. Flavl WNV Viral Ag 7. Flavi WNV Nonnal Ag 8. AgfTC Diluent 9. Sulfuric Acid 1.0N 10. lmmulon 2HB FLT 96 well 11. CHIKV lgM Kit 12. DENV Detect lgM Kit 13. DSX Samole Tip 14. DSX Reagent Tip 15. DSX Reaoent Tube 16. Deeo Well Dilution 17. Control Vials 18. Lockwell Frame 19. Shoe Covers 20. VWR Impervious Gown M 21. VWR lmoervious Gown U 22. VWR lmoervious Gown XL 23. Respirator Mask Pouch 24. N95 Disoosable Resoirator 25. CAT#89068-863FACE 26. Sleeve Protectors 27. 50 ml Conical Tube 28. Volumetric Pipette 5 ml 29. Volumetric Pipette 10 ml 30. VWR Reaaent Reservoir 31. Sarstedt PP 11x66 tubes 32. Screw Caps for 11x66 33. Sample Tube 4 ml 34. Screwcap w/ 0-ring 35. EP Tios 50-1250 ul 36. EP Tips 2-20 uL 37. EP Tips 15-300 uL 38. EP Tios 0.1-10 ul $225,541 Qty 3 $ Unit Cost 499.80 45.00 8 $ 625.00 3 $ 158.60 40 $ 2 6 6 3 6 12 20 20 5 5 10 2 3 3 6 4 4 4 5 $ $ $ $ $ $ 2 2 2 2 2 2 2 2 4 2 3 2 $ $ $ $ $ $ $ $ $ $ $ $ $ $ 4 $ 20 $ 4 $ $ $ $ $ $ $ $ $ $ $ $ 165.57 63.00 66.00 20.00 8.00 212.27 497.00 489.00 51.00 51.00 24.00 104.55 12.75 240.67 38.38 63.93 112.11 124.77 508.67 186.35 678.92 83.06 90.33 113.55 148.59 153.73 152.40 23.10 130.31 120.84 90.32 192.16 180.92 193.19 Amount 19,992.00 Seroloav $225,541 $83,176 135.00 5,000.00 475.80 331.14 378.00 396.00 60.00 48.00 2,547.24 9,940.00 9,780.00 255.00 255.00 240.00 209.10 38.25 722.01 230.28 255.72 448.44 499.08 2,543 .35 745.40 13,578.40 332.24 180.66 227.10 297.18 307.46 304.80 46.20 260.62 241.68 361.28 384.32 542.76 386.38 5or 10 TX-DSHS-19-1309-A-002142 EP Tips 2-100 ul 0.5 ml microcentrifuge tube 2.0 ml microcentrifuae tube Film Polyester Test Tube 16x150 Germicidal Wipes Sharps 1 auart Sharos 8 quart Biohazard bags 19x24 Dispatch Sprayer 49. Paper Towel 50. Zip Ties 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 4 2 2 6 3 100 200 50 2 40 10 5 $ $ $ $ $ $ $ $ $ $ $ $ 162.19 372.06 72.72 37.18 59.26 65.74 1.81 3.63 59.49 17.37 19.54 21.29 648.76 744.12 145.44 223.08 177.78 6,574.00 362.00 181.50 118.98 694.80 195.40 106.45 6 or10 TX-DSHS-19-1309-A-002143 51. Bleach 52. Rnase Awav CS/6 53. Med Coats 54. Small Coats 55. Bleach Sorav 56. DSP 57. lnvitmaen 58. Pate Seals 59. Wvoalls 60. I.S tubes 61. MPLC Kits 62. M996 Svs fluid 63. MPLCSeals 64. MP 96 1000 Uos 65 MP 96 Lvsls 66 MP 96 Proc. Cort 67 MP 96 Cutout 68 MP 96 Seal fofl 69 Eoo 10 uL tios (960) 70 50 ml Basin 71 Eoo 1000 uL tlos (960) 72 Crvoboxes 73 ART 200 14ok) 74 KimWioes Lg 75 Kim Wioes small 76 Ethanol 77 Water 78 Flask welaht holder (4 okl 79 Hv!'.lrometers 80 81 82 83 CDC Light Traps (Bioquip oart #2863BQ) BG Sentinel 2 Traps (Bioquip oart 2883BCl 12 Volt Batteries (Bioquip part 2863) CDC Gravid Traps (John W. Hock 1712) 6 Volt Batteries (John W. 84 Hock 1.30) Hanging dry ice dispenser 85 Bioauio oart 2811 l Aspirators (Clarke Mosquito 86 Control) D-cell Batteries for aspirators (Office Depot - Duracell pack 87 of 12) Shipping mosquitoes to 88 arbovirus laboratorv 10 7 3 3 4 10 20 9 9 26 6 26 3 9 9 9 4 2 21 3 15 1 4 1 $ $ $ $ $ $ $ 2.78 278.00 328.00 227.00 69.21 242.00 1,688.00 246.00 76.00 40.00 499.00 117.00 170.00 936.00 155.00 313.00 246.00 245.00 183.00 112.00 205.00 155.00 780.00 130.00 120.00 31.00 101.00 26.00 60.00 100 $ 90.95 9,095.00 100 $ 165.85 16,585.00 100 $ 112.85 11,285.00 100 $ 97.00 9,700.00 200 $ 29.00 5,800.00 100 $ 18.00 1,800.00 20 $ 160.00 3,200.00 10 $ 29.99 299.90 $ 667 .00 8,004.00 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 1 $ 9 4 2 7 12-months $ 27.80 1,946.00 984 .00 681.00 VI $76,596 276.84 2.420.00 33,760.00 2,214.00 684.00 1,040.00 2 994.00 3,042.00 510.00 8.424 .00 1,395.00 2,817.00 984.00 490.00 3,843.00 336.00 3,075.00 155.00 3,120.00 130.00 120.00 279.00 404.00 52.00 420.00 $65,769 - ,~ - 7of10 TX-DSHS-19-1309-A-002144 D F. T I~ Contractual Sub-recipient {category 4000) · 1. Project Title: Local Health Departments (LHDs)- Zika Surveillance A. Name of Contractor(s}: Twelve LHDs and two universities B. Method of Selection: Existing contracts C. D. F. $2,999.656 Period of Performance: 08/01/2018 to 07/31/2019 (Three contracts will remain and go through 07/31/2020) Scope of Work: Vendor {category 2001 or 2009) 1. Project Title : Harris County Vector Control (see attached) A. Name of Contractor(s): Harris County B. Method of Selection : Continuation of existing contract C. Period of Performance : 9/1/2018 to 7/31/2019 D. E. A. B. C. $2,999,656 Local transmission of the Zika Virus is a serious threat in Texas. As the threat emerges , DSHS anticipates supporting enhanced surveillance for an increasing number of counties, while at the same time increasing capacity for those counties already following DSHS guidelines for enhanced surveillance. The focus is on high risk areas , defined as those with previous history of local Zika and/or dengue transmission (Lower Rio Grande Valley), and large urban areas with high numbers of travelers to/from areas experiencing local Zika outbreaks. This request is limited to twelve of the seventeen contractors who have expended the majority of their original ELC award and now require additional funding to sustain surveillance efforts and ensure readiness to respond to evidence of local transmission within their respective jurisdictions (see attached list). The increase in funding for two of the twelve local health departments is to cover increased staffing costs. The remaining contractors will use the funding to address increased staffing costs as well as resource gaps for Zika vector surveillance including but not limited to mosquito traps, batteries, specimen shipping material, larviciding, and adulticiding insecticides . Method of Accountability: Monthly progress reports and workplans . Conference calls and daily emails. Budget Detail and Justification ! List of contractors attached, including proposed funding amounts. E. F. $3,105,574 $105,918 $90,100 Scope of Work: Contractor shall enhance surveillance activities for arboviruses Method of Accountability : Reports as required in contract. Measured by established performance measures . Budget Detail and Justification: see attached 1. Project Title: Temp Staffing Name of Contractor(s): Goodwill Staffing Method of Selection : Continuation of Existing Contract Period of Performance : 8/1/2019 to 7/31/2020 $15,818 8of 10 TX-DSHS-19-1309-A-002145 D. Scope of Work: Agency to assist OSHS in hiring temporary staff to support laboratory activities during mosquito season . 5 public health and prevention specialist I for Zika coordination between check-in, laboratory testing areas and epidemiologists; 2 customer service rep to assist with submitter enrollment, reporting and data entry; 4 staff for PCR testing of mosquitos and clinical specimens; and 1 Microbiologist II for mosquito identification . Additional funding will extend the contract until July 31, 2020 . ADDITIONAL FUNDS NEEDED TO COVER TEMP STAFF THAT WAS NOT ABLE TO BE FUNDED IN SUPPLEM ENTAL 787 FUND . E. F. Method of Accountability: Under supervision of Check-in , Data Entry and reporting, and Virology Managers Budget Detail and Justification: see scope of work for budget detail. $3,372,544 Other Item Requested General Office Supplies (paper, pens, staples, toner, etc.) Number of Months Estimated Cost per Month 12 $ 41.67 Amount Requested Number of Staff 2 $1,000 $1,000 9of 10 TX-DSHS-19-1309-A-002146 Item Requested Number Needed Registration fee for Texas Mosquito Control Association 1 Meeting 4 Registration fee for American Mosquito Control Association 2 Meeting 2 Registration fee for Florida Advanced Mosquito Identification and Certification 3 Course 1 Registration fee for American Unit Cost - Amount Raauestad $95.00 $380.00 $350.00 $700.00 $500.00 $500.00 1 $600.00 $600.00 4 $9,100.00 $36,400.00 2 $9,050.00 $18,100.00 1 $11,000.00 Registration fee for SOVE Attend International Society 8. of Vector Ecology Meeting 1 $300.00 9. Diseases in Nature (DIN) Conference - Conference registration fees. The James Steele Conference on Diseases in Nature Transmissible to Man (DIN) serves as a forum for the presentation of epidemiological Investigations, clinical case studies, basic and applied research, and other topics in zoonotic and environmentally-acquired infectious diseases, including arboviral diseases. The conference's goal is to increase knowledge and awareness of these diseases within the medical, veterinary, public health, and academic research communities- it is a true "One Health" educational event. The DIN conference is held annually and represents one of the few national-level One Health professional educational opportunities in the United States. DIN is co-sponsored by the Texas Department of State Health Services-Zoonosis Control Branch (ZCB) and the non-profit Texas Health Institute (THI) . First year of funding for $26,250, second year of funding is $27,314. $11,000.00 $3,371,544 Society for Tropical Medicine and Hygiene Annual 4 Conference 7500 Fast Ox Service Contracts used for Mosquito Surveillance 5. KingFisher Automated Extractors Service Contracts used for Mosquito 6. Surveillance 7. EasyMag Service Contract with Biomerieux ---- $300.00 53,564.00 10 of 10 TX-DSHS-19-1309-A-002147 Reduction in state-appropriated general revenue funds to support zoonotic disease activities, including support for DIN, and loss of ELC support for DIN In grant year four, necessitated a 16.7 percent increase in the conference registration fee in 2017, from $300 to $350. There was an associated 26.4 percent drop in attendance, from 254 attendees in 2016 to 187 attendees in 2017. The conference scheduled for May 2018 retains the $350 registration fee . Due to budget constraints, the poster session was cancelled, but was rein.stated due to a generous one-time donation from Texas A&M University College of Veterinary Medicine. DSHS is requesting $26,250 to support the registration fee for 75 speakers or attendees. This will assist in attracting speakers and facilitate attendance by epidemiologists, veterinarians, and other government employees for whom DIN is the only opportunity to attend a zoonosis-focused, One Health in-state conference. 10. 11. Support for Epidemiology response by Local Health Departments (LHDs) and Public Health Regions (PHRs) for possible local transmission of the Zika virus through the next Mosquito season, July 2019. Specifically, support is for Zika vector control and ongoing surveillance and testing throughout an outbreak response. Includes supplies needed for specimen collection and laboratory testing and vector control (ground/aerial) as appropriate for the situation in communities as needed for emergencies. In the event of a response to local transmission, PHRs and LHDs will receive support via the STAR system (attachment with specifics on the STAR process previously submitted with original Zika supplemental grant request). Prevention messaging and targeted surveillance to high risk Lower Rio Grande Valley (LRGV) and statewide messaging throughout the grant period, extending through July 31, 2020 . The Zika media initiative have been most effective in leveraging prevention messages in communities; especially, Laredo/Webb, Hidalgo and Cameron Counties. $50,000.00 $3,200,000.00 Total Direct Cost: Total Indirect Charges: $7,017,459 so Please see attached DSHS Indirect Cost attachment for calculation . Total Budget: AJlocated Difference $7,017,459 $7,017,459 so 11 of 10 TX-DSHS-19-1309-A-002148 0MB Approval No. 0348.()044 BUDGET INFORMATION - Non-Construction Programs Grant Program Function or Activity (a) Catalog of Federa l I Domestic Number (b) 1. Project M 1 - Zika Response No-Cost Extension and Redirection ( C) I New or Rev~sed Budget Federal (e) Non-Federal (d) Federal 93.323 I Estimated uno~ligated Funds Non-Federal (f) Total (g) $0 $0 $7,017,459 $0 $7,017.459 $0 $0 $7,017,459 $0 $7,017,459 2. 3. 4. 5. TOTALS 6. Object Class Categori es GRANTPROGRAM, FUNCTIONOR ACTIVITY (2) 1(3) 1(4) (1) Total (5) a. Personnel $84,549 $84 ,549 b . Frin£!e Benefits $30,962 $30 ,962 c. Travel $19,289 $19 ,289 d. Equipme~t $179,000 $179 ,000 e. Supplies $225,541 $225 ,541 $3,105,574 $3,105,574 $0 $0 h. Other $3 ,372,544 $3 ,372,544 i. Total Direci Charges (sum of 6a - 6h) $7 ,017,459 f. Contractual -9_ . Construct ion j. IndirectCharge k. TOTALS (sum of 6i and 6j) 7. Program Income $0 $0 $0 $7 ,017,459 so $0 $7,017.459 $0 $0 $0 $7,017.459 $0 $0 $0 $0 $0 TX-DSHS-19-1309-A-002149 Standard Fann 424A (7-97) Prescribed by 0MB CirctJlar A-102 (b) Applicant (a) Grant Program (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. $0 $0 $0 $0 $7,017,459 $1,754,365 $1,754,365 $1,754,365 $1,754,364 $0 $0 $0 $0 $0 ,~o $1,754,365 $1,754,365 12. TOTALS (sum oflines 8-11) 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) 4 SECTION E - BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT (a) Grant Program orond (b) First INDING PERIODS (YEARS) (d) Third (e) Fourth 16. 17. 18. 19. 20. Totals (sum aflines 16-19) $0 $0 $0 $0 $7,017,459 122. Indirect Changes: $0 21 . Direct Charges: 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs . Fixed rate 9/1/2016 - 8/31/2017 and Provisional rate 9/1/2017 - 8/31/2019 for Health Programs- 13.5%; Laboratory Services- 26%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002150 Zika Response No-Cost Extension and Redirection Budget Request Period: 0B/01/2018-07/31/2020 HEAL TH PROGRAMS Fixed rate 9/1/2018- 8/31/2017 @18.1% Provisional rate 9/1/2017 - 8/31/2019@ 18.1% #of Direct Charges Total contracts Personnel $0 Fringe $0 Travel -- Supplies (Less than $5,000; unless an exception item) Contractual (Sub-recipient In excess of $25,000) IDCRate at 18.1% $0 $0 $0 $0 $11,863 $0 $0 $0 $0 $65,769 $65,769 $0 = $11,863 Equipment (Greater than $5,000; unless an exception Item) Applicable Amount charged IDC ~ $3,105,574 15 $375,000 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 $3105 574 15 Sub-total Contractual Other $3,328,494 Total • Health Programs $6,511,700 - ·-- -: - LABORATORY SERVICES Fixed rate 9/1/2016 • 8/31/2017 @ 33.9% Provlslonal rate 9/1/2017 - 8/31/2019@ 33.9% 15 y = "' Direct #of Charges Total contracts Personnel Fringe $30,962 Travel $7,424 - - so·· Equipment (Greater than $5,000; unless an exception Item) Supplies (less than $5,000; unless an exception Item) ,-- $0 - Applicable IDC Rate Amount at33.9% charged IDC _,_ $84,549 $0 $3,781,126 - - so 375 000 $3,328,494 ~· ~- $159,772 $84,549 $0 $30,962 $0 $7,424 $0 $0 $0 $159,772 $0 Contractual (sub-contracts In excess of $25,000} $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 Sub-total Contractual $0 Other 0 $0 - $67,235 Total - Laboratory Services - - ~ ~-. $67,235 $349,942 ~ TOTAL INDIRECT COST - $0 0 $349,942 $8,861,642 $0 $0 = - 15 $4,131,088 $0 The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2016-8/31/2017 and Provisional rate 9/1/2017 - 8/31/2019 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002151 Texas Department of State Health Services ELC Category M1 Epl/Lab and Vector Control and M2 Zlka Pregnancy Registry No-Cost Extension and Redirection CK14-1401PPHF17, Epidemiology and Laboratory Capacity for Infectious Diseases Budget Request Period: 01/01/2017 - 07/31/2020 A. Personnel Position Program Specialist VI/ELC Grant 1. Coordinator $257,149 "of Annual Salary Time 50% $65,428 Benefit Annual Longevity $1,440 Replacement Months Total PB BRP $0 12 $63,541 Aldridge, Tiffany (H20000/8996) Position Description: Works under limited direction of the Laboratory and Infectious Disease Services (LIDS) Associate Commissioner with extensive latitude for exercising lnltlative and Independent judgment. Works across the LIDS and other DSHS Divisions to produce grant appllcatlons, progress reports, and participates In requests for proposals that obtain federal funding and make state and federal funding available to the Infectious Disease Control Programs. Initiates Internal LIDS program activities to evaluate grants, budget and program expenditure data, as well as progress on programmatic objectives, to ensure optimum program Implementation. Coordinates with the Contract Management Section to plan, develop, and Implement programmatic work related to the Infectious Disease Prevention Section (IDPS) contracts, memoranda or understanding and request for funding. Coordinates across the IDPS on programmatic activities. Provides leadership In determining program priorities, building local capacity for IDPS services and funding local and public health regions Infectious disease activities. 2. Epidemiologist II 100% $51,508 $1,200 $0 12 $101,035 Arshadmansab, Sepher (H21400/00085197) Position Description: Under limited supervision by the Zoonosis Control Branch (ZCB) Manager and with considerable latitude for the use of Initiative and independent judgment, performs advanced epidemiologlc work and provides advanced consultative services and technical assistance to health service regions (HSR} and local health departments (LHDs) for surveillance and reporting of zoonotic and vector-borne diseases such as Zika, West Nile virus, dengue, and chikungunya. Provides guidance and coordinates protocol development for reporting Infectious agents and diseases, and for epidemiology and surveillance practices/procedures among ZCB staff, programs, and HSRs/LHDs to ensure federal/state requirements are met. Plans, develops, and Implements program training protocols, data entry user guides, and related materials for HSR and LHD Infectious disease programs. Provides advanced technical training and technical assistance on NEOSS Base System (NBS) operations to zoonosis staff statewide. Recommends appropriate changes In programs/processes to maintain surveillance and reporting compliance. Works to resolve NBS data reporting and surveillance issues, and recommends program improvement. Analyzes and produces zoonotic and vector-borne disease reports for distribution and presentation. Employee actively participates and/or serves In a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. 3. Program Specialist IV 100% $49,527 $0 $0 12 $92,574 Owens, Kamesha (H21400/00085198) Position Description: Under limited supervision by the ZCB Manager and with moderate latitude for the use of initiative and independent judgment, Performs highly complex consultative services and technical assistance work. Position will support ZCB Epidemiologists in a wide range of vector-borne disease surveillance activities with emphasis on arboviral diseases. Work involves planning, developing, and implementing major agency program(s) and providing consultative services and technical assistance to program staff, governmental agencies, community organizations, or the general public, May train, lead, and/or prioritize the work of others. Employee actively participates and/or serves in a supporting role to meet the agency's obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. TX DSHS • Zika Supplement Budget Narrative Page 1 of 10 TX-DSHS-19-1309-A-002152 B. Fringe Benefits $94,168 Fringe benefits are applicable to direct salaries and treated as direct costs . Current benefit rate Is 36.62% and are categorized in the following manner : Social Security/Medicare- 7 .65% Retirement- 10.00% Insurance- 18.97% C. Travel $10,456 1. In-State a. Travel description: Travel to perform 4 Zika related presentations to county commissioners and providers to educate them on Zika related activities and response during mosquito outbreak season. Travelers include three Region 8 Epidemiologists. $5,536 $860 Airfare: 0 persons @ $0 r/t x O trips Ground Transportation : 1 person @ $44 x 4 trips Lodging: 0 nights @ $85/night x Opersons x O trips Per Diem: 1 days @ $36/day x 4 persons x 4 trips Travel Fees: 3 persons @ $12 x 3 trips Baggage Fees-determined by carrier: 0 persons @ $50 x O trips $0 $176 $0 $576 $108 $0 b. Travel description: Travel to perform 50 site visits to Local Health Departments during project period. Travelers will Include one ( 1) DSHS program staff and one (1) contract management staff. REDIRECTION $0 Airfare: 2 persons @ $505 r/t x 1 trips Ground Transportation: 1 persons @ $49 x 48 trips Lodging: 1 nights @ $85/nlght x 2 p.ersons x 2 trips Per Diem: 1 days @ $36/day x 2 persons x 50 trips Travel Fees: 2 persons@ $12 x 50 trips $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trips $0 c. Travel description: Travel throughout the state for technical assistance to Local Health Departments and speaking at meetings and confemeces during the project period. REDIRECTION from site visits . Mileage: 4 trips x 4 persons x 215 miles r/t@$.58/mile Airfare; 2 persons @ $486 r/t x 1 trip Ground Transportation : 1 persons @ $49 x 1 trip Lodging: 1 nights @ $85/nlght x 4 persons x 2 trips Per Diem: 2 days @ $46/day x 4 persons x 2 trips Travel Fees: 2 persons@ $12 x 6 trips Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $4,676 $1,995 $972 $49 $680 $736 $144 $100 2 Out -of-State $4,920 a. ~ description: One round trip travel for Zoonosls Branch Manager to attended annual ELC Grantee Meeting in Atlanta, Georgia . Dates: April g • 12, 2018. $1,252 Airfare: 1 persons @ $481 .97 r/t x 1 trip Ground Transportation: 1 persons @ $50 x 1 trip TX DSHS - Zlka Supplement Budget Narrative $482 $50 Page 2 of 1D TX-DSHS-19-1309-A-002153 Lodging: 3 nights@ $148 x 1 person x 1 trip Per Diem: 4 days @ $69/day x 1 person x 1 trip Travel Fees: 1 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip TX DSHS • Zika Supplement Budget Narrative $444 $276 $0 $0 Page 3 of 10 TX-DSHS-19-1309-A-002154 b . Travel description: One round trip travel ror Zoonosis Branch Manager and a Epidemiologist Ill attended the annual ELC Granlee Meeting in Allanla, Georgia . Dates: April 10-13, 2017 . $2,414 Airfare : 2 persons @ $402 r/t x 1 trips Ground Transportation: 2 persons @ $40 x 1 trip Lodging: 3 nights@ $159 x 2 persons x 1 trip Per Diem: 4 days@ $69/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 0 persons @ $50 x O trips $804 $80 $954 $552 $24 $0 C. Travel description: One round trip travel for Zoonosis Branch Manager attended the FY19 Annual ELC Grantee Meeting in Atlanla, Georgia. Dates: April 1-4, 2019. Mileage: 1 trip x 1 person x 32 mHesr/t @ $.58/mile Airfare: 1 persons@ $475 r/t x 1 trip Ground Transportation: # persons @ $# x # trips Lodging : 3 nights@ $159 x 1 person x 1 trip Per Diem: 4 days @ $59/day x 1 person x 1 trip Travel Fees: 1 persons@ $16.00 x 1 trip Baggage Fees-determined by carrier : 1 person @ $50 x 1 trip D. Equipment E. Supplies $1,254 $0 $475 $0 $477 $236 $16 $50 so $327,622 Item Requested 1. OPP ZIKA lciMReaaents 2. OPP ZIKA lciMControls 3. DENVDetect lciMKit 4. DenguelgM PositiveControl 5. Dengue IOM NeQativeControl 6. CHIKV IQMKit 7. SameleTube 4 ml 8. ScreY.ac w/ O-rfna 9. 50 ml Conical Tube 10. Control Vials 11. 1.5 ml mictocentrifuoetube 12. EP Tics 2-20 ul 13. EPTlDS2-100 uL 14. Pipette tips 1250ul 15. tlPs 2501.11 16. uos101.11 17. EP Tics 50-1250ul 18. Sleeve Protectors 19. Nilrile Gloves all sizas 20. Latex Gloves all sizes 21. FaceShield Full 22. N95 Dlscosable Resclralor 23. Shoe Covers 24. Sleeve Prolectors 25. VWR ImperviousGownU 26. Sharps 1 Quart 27. Sharps8 Quart 28. Biohazarobaos 14x19 29 . Biohazac'dbaas 32 auart 30. Biohazardcontainer 31. DSX SamoteTip Tlp 32. OSX ~l 33. DSX ReaoentTube 34. OeeDWell Dilution TX DSHS • Zika Supplemenl Budget Narrative Qty 16 2 16 20 20 14 1 1 1 1 1 1 1 2 3 2 2 2 31 2 1 2 2 3 1 52 52 1 5 52 3 2 24 1 Unit Cost 490.00 45.00 504.00 53.00 53.00 497.00 130.31 120.84 90 .33 12.75 36.26 192,16 162.19 90.32 28.28 20.00 104.09 83.06 7.54 9.92 678.92 186.35 38.38 203.94 112.11 1.81 3.63 59.49 64.55 10.90 51.00 51.00 24.00 104.55 Amount $7,840 H41000 $90 H41000 $8,064 H41000 S1.060 H41000 S1.060 H41000 $6,958 H41000 S130 H41000 $121 H41000 $90 H41000 $13 H41000 S36 H41000 S192 H41000 $162 H41000 $181 H41000 $85 H41000 $40 H41000 $208 H41000 S166 H41000 $234 H41000 S20 H41000 S679 H41000 $373 H41000 H41000 $612 H41000 $112 H41000 S94 H41000 S189 H41000 S59 H41000 S323 H41000 $567 H41000 $153 H41000 $102 H41000 S576 H41000 S105 H41000 sn $327,622 LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology LAB-Serology Page 4 or 10 TX-DSHS-19-1309-A-002155 35. TMB ELISAHRP Substrate 36. 10ml alass oloets 37. 5ml alass r>1Mls 38. Plpette5ml 39. VolumetricPioette5 ml 40. LockwellFrame 41. 2HB lmmulonDlales 42. Culturetubes 12x75mm 43. Culture tubes 16x100mm 44 . Parafilm 45. FIim Polvester 48 . SulfurieAcid 1.0N 47. VWR ReaaentReservoir 48. 686C-1 Atrinltv H~,- \,Onl 49. uoat Affinity PurifiedAb loM 50. EL22-WNVanlKM!n 51. El325 - WNV tissue control 52. AG/TCdiluent 53. Paper Towel 54. 686C-1 Affinity HRP Conj 55. uoat Affinity PurifiedAb IOM 56. EL22•WNV an-n - WNV tissue control 57. ieL.325 58. AG/TC diluent 59. Nitrlle Gloves ansizes 60. i::aceShield Full 61. VWR ReaMnt Reservoir 62. YeHowTiDS,200 uL 63. 20 ultips 64. 96-well Mlcroliter,2205 65. VolumetricPinene5 ml 66. CultureTubes 12x75mm 67. Shares 1 auart 68. BlOllazardbag 69. 12-wellslides 70. Goat Serum 71. Tween-BO 72. FtTC-conluoate lnvltrogenPlatinumSS Ill One Step 73. qRT-PCR Eppendorf0.1-10 µLepTips Filtered 74. PipetteTips{Case of 960} 75. 76. Eppendorf.5-20 µL epTlp FIitered Pipette Tips (Case of 960) Eppendorf2-200 µL epTlp FIitered PipetteTips {Case of 960) Eppendorf50-1000µL epTip Filtered PipetteTips PCR {Case of 960) Eppendon20-300 µl oua1mer T.1.P.S Seal Maxfiltered tips (Case of 78. 960} 1-100µl SorensonMultlguardBarrier 79. PipetteTips (Case of 960) n. ThermoScientific 2160P Extended 80. length ART 200 µL (pack of 768) Applied BiosystemsMlcroAmp 81. Optical 8-Cap Strips {Box of 300) AppHedBiosystemsMlcroAmp 82. OpticalAdhesive Film (BoKof 100) Applied 5KlsystemsMlctoAmp Fast Optical 96-wellReactionPlates (Bo,i 83. of 20) Eppendorf1.5 ml Natural Safe-Lock 84 . MicrocenlrifugeTubes (Box of 500) lnvltrogenNuclease-Free Water (10 85. bottlesx 50 ml) TX OSHS• Zika Supplement Budget Namli ve 2 1 1 3 1 2 3 1 1 30 1 2 1 5 2 8 8 3 1 5 2 8 8 3 21 1 1 8 1 3 1 1 104 1 2 2 1 1 12 165.57 113.55 148.59 113.!i~ 113.55 240.67 227.00 35.89 47.74 19.75 37.18 8.00 153.73 625.00 158.60 63.00 33.00 20.00 19.54 625.00 158.60 63.00 33.00 20.00 7.54 678.92 153.73 8.10 20.00 61.89 113.55 35.89 1.81 64.55 52.85 115.00 26.60 187.85 1.876.00 S331 H41000 S114 H41000 $149 H41000 S341 H41000 $114 H41000 $481 H41000 $681 H41000 $36 H41000 $48 H41000 $593 H41000 $37 H41000 $16 H41000 S154 H41000 53.125 H41000 $317 H41000 $504 H41000 $264 H41000 $60 H41000 520 H41000 $3,125 H41000 $317 H41000 $504 H41000 $264 H41000 S60 H41000 $158 H41000 $679 H41000 $154 H41000 $65 H41000 $20 H41000 $166 H41000 $114 H41000 $36 H41000 $188 H41000 $65 H41000 $106 H41000 $230 H41000 $27 H41000 $188 H41000 LAS-Serology LAB-serology LAS-Serology LAB-Serology LAB-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAB-Serology LAB-Serology LAB-Serology LAS-Serology LAS-Serology LAB-Serology LAS-Serology LAB-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAS-Serology LAB-Serology LAS-Serology LAS-Serology 522.512 H41000 \B-Vlral Isolation 141.91 $5,676 H41000 \B-Viral Isolation 40 20 141.91 $2,838 H41000 \B-Vlral Isolation 20 210.00 $4,200 H41000 \B-Viral Isolation 30 141.50 $4,245 H41000 \8-Viral Isolation 6 126.84 $761 H41000 \B-Vlral Isolation 5 158.27 5791 H41000 \B-Viral Isolation 10 112.43 $1,124 H41000 \B-Vlral Isolation 5 111.00 5555 H41000 \B-Viral Isolation 4 209,10 $836 H41000 \B-Vlral Isolation 89.50 51.790 H41000 \8-Viral Isolation 20 40 3 39.66 109.00 S1.586 H41000 \B-Viral Isolation S327 H41000 \8-Viral Isolation Page 5 of 10 TX-DSHS-19-1309-A-002156 Nmbeny-\,1arkPro1ess1ona1 Nmtew ScienceKimwipes11.8 x 11.8 In ..,_..86.;;,: ',1>,:C.::aase:.:..:o:..f"'29_40 __ 1..._l ________ Kimberly-ClarkProfessionalKimtech Science Kimwipes8.4 x 4.4 ln (Case ----3 __ -+-___ 1_2_1_ .2_0.,..._ ___ S ___ 364----tH41000 \B-Viral Isolation 132.24 i-,:.87:...;. •+-o_f60....;.)_.,,.,....,...,,_,,..,,._.....,.~-+--....;;.3 __ +-----1-----S ... 39--t7 H41000 \B-Viral Isolation Kimberly-ClarkSmall SurgicalGown, 242 70 i-=88.;;,: •+.C_a_se_of,...34-=-...,...,,_.,....,,.,_-,-,---+---2-----+--- _ _· _ t- ___ S __ 48"""'""15 H41000 \B-Viral Isolation Kimberly-ClarkBasic Plus Labi-=8~9 ,+.C.,,.oa-,-t/B_l,_ue.,,.,,..s....,m,...a=-ll ----=---:--:--:,---:=:--+------2-----+---1-7_8_·2_4t___ S""3~56,H41000 \B-Viral Isolation Kimberly-ClarkBasic Lab-Coat/Blue, 1 15 _n_ . _ f- __ ...;S;;,;;3""54"""H41000 \B-Vlrallsolalion i-,::90:; ·~M,;;;ed=lu::.:m.:..-, ___ -----+----=2:.-_-+___ Kimberly-ClarkBasicPlus Lab_ 180 00 i-=9.;.;1 ''tli~.,,.°:--,~b":--i~""uey-e-,;·.,,,':,,,!r1cl'!le"",....Bas""1c'"'La..,,...b-~Co~at/~IBl""u-:--:e,, +------2-----+-----t----S-360--tH41000 \B-Virallsolalion 18000 i-=9=2 -.X~·-=la:::.r~oe---------+---2'----+--_ · -t- ___ S_360"'"""'1H41000 \B-Viral Isolation .48;.;;.+----'S_7_4--!1H41000\B-Viral Isolation i-,:9.;:3 •+.Rna __ se_A_wa_y_(6_x_47_5_m_l_) ----+---2'----+----3;;.;7..;;0.;.. i-=94 ..:: '+.B.,.,le_a_c_hn_·te=(C=-a_se,......,..of-=4.,...,bo-,-ttl_e..,.s).,..,,,._-+ __ ""' .1_at----S;;.;;22=a.i0 H41000 \B-Viral lsolallon 3'----+---7-3_ ,2 OIAampDSP viral RNA m'.nl Kit 219 6 i-,:.95:::;: ,.µC;::O;.;;ia~!l•e::;.;n.:..:.} ________ -+---5-----+------+---'$""1 .. .09_8--IH41000 \B-Viral Isolation i-,::96:::;; ·,1..E_lh_a_no_1_(M_o1_ec_u_1a_r_G_ra_d_e_) soo __m_L_+----=8-----+------"2""7"' ,50.a.t-----'S:;;:2=20--IH41000 \B-Viral Isolation Nunc Cryotubes1,8 ml StaffootVials w/ MarkingArea, RoundBottomVials i-,:.97:...;. ..,_(C_a_se_of,__1_800 ......l.,..... __ __,,.....,......,.-1-----1--+---1.;.:.,588a..a..;..a.a '8.a.91-----S ... 1,_58--t9 H41000 \B-Vlral Isolation MagNAPure LC Total NucleicAcid i-,:.98:: '+.l,;;.sol;..a..;.U.;.on_kl_ts _______ -+---'4-----+----4.;,,;;9-9"' .00.a.+---""'S""1..,,996--1H41000 \B-Viral Isolation i-: 99 :.;·-1,M..,.a_g..,.NA,...,....,P,....u_re....,L...,C,....C,,.a_rt_r1..,.dg_e,,.S_e,.,a,.,.ls_-+ __ ..;;3'----+----1""7""0.:..:;.0~01---...;S:aa5:..:.1.a.,t0 H41000 \B-Viral Isolation MagNAPure LC Sample Cartridges 1,.:1c.:00:::.: ,~12::0:.t.ll _________ -+---3'----+----1.:..:;2:..:.1.:.: .5=21-__ ...;S:aa36--15 H41000 \B-Viral Isolation 1,.:1c.:0..:.;1 •+.M-a_g_NA_Pu_re_L_C_TI,__p_S1a_na __ s,.,.(_200...,..)_+-_---"2'----+---'2_7_4,;,,;;.00;.;;.+----'S_548~H41000 \B-Viral Isolation MagNAPure LC ReactionTlps. Large l-'1-"02::-~<.,.960;.;.:.,) -,-,:-~-=-,-..,,...---=,---,-+---=2 __ +- __ 38.....,.1_.oo--i------=$_76--t2 H41000 \B-Viral Isolation MagNAPure LC MediumReagent l-'1"'03::·+;T.;;;.u,;;,;bs.,.2;;,;;0.,,;(..;150;,,;,;.l =...,..,,.,..,..----+--.;;;;.2 __ +- ___ 21_2_.oo--+------=S4_2---t4 H41000 \B-Vlral lsolatlon MagNAPure LC Tub Lids, 104. Smalt/Medium(300) 2 335.00 $670 H41000 \B-Viral Isolation i,;1:;0~5.ci;M;:,:.a.:.:;1Q::.:N..;;A;;,;P,::u.:..:;re::.:,96~s=vs ,le_m....,,n""'uld-,---+-----'c40=---+--~11""7"',oo,.,,.. __ --:$4,,.;a;7""1,:,,16 H41000 \B-Viral Isolation i,;1c.:,06,:;•~M,;;;a::,i1Cr.:;NA;:.:.;Pu,.::,;re~96;;;..,1;.:;000~T..:,;'l;c;DS;;,_ __ --+__ ..;9;.-_-+ ___ 9=-;36;.;,.:.;.90~ __ ...;$;.;8~ ,4;.;;32~H41000 \B-Viral Isolation l-'1""0""1."'M-'-a"'1a..,_NA;;;,,._P-u_re_96 ____ L_,__vsi_s ____ --+---'9'-----+------13_5_ .o_o,.___ s_1_.2_1-15 H41000 \B-Viral lsolatlon MagNAPure96Processing 108. Cartridges 9 275.40 $2,479 H41000 \B-Vlral lsolatlon i,;1:;09.;;_+.M""a-111..,.N""A..,,P.,.u-re--:96..,,..,0,..u..,.,tp,u.,.t----+-----,4=----+---,2=-46::-:i.60::::t--....... S~986=tH41000 \B-Viral lsolatlon 110. MaaNAPure 96 Seal Foll 2 244.80 $490 H41000 \B-Viral lsolatlon i-:,..:.1:::;:1.""M,;:a;;;a10e;.;N;:,:A~P,;;;u.:..:;re;.;S.::m~a;.;;ll;;;;;V~o,,;;lu~m-e---+--~,1,,,__-+----,2,..:1;a.,oa~.7~0t---$"'2"'3-,,1-;;96i:-IH41000 \B-Viral Isolation 112. MaaNAPure 96 Needle{41 2 279.90 S560 H41000 \B-Viral Isolation i.:,..:.13:::.:_ci.:.E;.::a;;;as~::..:rM::..:a..:.1a..:;S;;ll:....:lca:.=..:.,,48:::;::.tu:;be.=...l.,sl:.L...---4--..:;2:.,.__-+__ ..:90;,;,.;1"'.1c;.31----,$,.;1:.;,80:;2=-1H41000 \B-Viral Isolation l-.:1-f14;:.:·+;E.;a:;s~L:rM=::a~1a";L;Svs11s~buff=?::;.er~1~4i-xi1~L-:F.bo:=.:ttleF=s:L.fJ--~2;-_+---:7:cii0~7~.60* __ .,:S~1f..4~15i'IH41000 \B-Viral tsolatlon 115. EasVMagBuffer 114 x 1L bottles) 2 282.54 $565 H41000 \B-Viral Isolation i-:,..:.,e;.:_,.;E;::a:=s~t.;tM,;:.a:.01g'-=Boff.,:;;;e:;.;r...,;2:-!c.;.4..:.x.;.1;::.L.,;.bo;;.;;ttl,;;e""sf-1-+--..:;2-----+---""'1~94;-;-; _1~6t-----iS::388:-==tH41000\B-Viral lsolatlon 117. EasvMaaBuffer 314 x 1L bottles) 2 353.43 $707 H41000 \B-VirallsolaUon i.:1..:.18.:.:_,.;Ea;;:::.:s,"".u:;::a;;;a1a'-=o;::1s::.:m:;..:~,sa:.,ibl.:.e~s..:. 148=,,=.s::.:e::.:ts:;=l-+----=;2'----+--...;8;;:1:;2a,;.7""41----,S,.;1a,;.6,,;;2,;,t5 H41000 \B-Viral Isolation PerfeCTaMultlPlexqPCR SuperMlx, B.65 41 i.:1..:.19.;;,:•+Lo_w_R_O_X..;(:..200_x_50_m_L-')----+-----2-----+-----t----$""'8~3-;7 ._,1c.::20:::.:·+.a_1_Aa_m_p_DS_P_D_NA_B_lood __ M_ln_1 _KJ_t _-+-----"5'----+---1_1_0_.oo-+l-'1""2.:.:1."-H_u_m_a_n_G_e_no_m_1c_D_NA ________ 4___ i,;1:.:22:·+T_r1zm __ a_hyct_roch_1_o_r1d_e_so_1u_lio_n __ -+---'7---+---34- -+-___ ___ H41000 \B-Viral lsolatlon $_8_50.a.-tH41000 \B-Viral Isolation 2_B_3_.40-t----'s;...1 .... 1__ 34-1H41000\B-Viral Isolation .9-0f----S;;.;;2::...;44-tH41000 \B-Viral Isolation 1,.:1:.:23:::·,1..Pl....:pe_t Ba_s_ln_s _(ca_se_o_r _200_;_) ---+--...=.6--+---.:.:135=.90-+------"58=-!15 H41000 ECOmer 2 ThermoScientific,..CllpllpTU Pipette i-:1c.::24..:..:·+,Tl..,.:p_s.,,,(960,......,::-tlps ___ln-.ea::-ch-:-:-un_lt.;,) .,,,...-:-:--+---'50-----+---11_6_.5_9t------=S.a.5 .... ,B...,30 H41000 ECO!Tler2 MagMaxDeep well plates(50 plales I "1""2""5 •..,l.:.:.n.::;ea::cha;.;,,,,;;u;;,,;ni..,tl'--______ __.___ 10 ___ ....________368_.00....._ __ .,.S .... 3.,_660~H41000ECOmer 2 TX DSHS• Zika Supplement BudgetNarrative S155,645 Page 6 of 10 TX-DSHS-19-1309-A-002157 MagMax Standard plates (48 126. standard plates In each unH) MagMax Deep well tip combs (100 127. combs In each unit) Coming universal lld wtthcomer 128. notch {Coming 3099) caseof 50 Axw9nn1 5ml Snaplock MlcrocenlrifugeTubes-Case of 5 129. packs (pack= 250 tubes) SuperScrlpl IllPlatinum 1-Step qRT130. PCR kit (500 rxns) MtcroAmpll 96-Well Plate Barcode 131. ( 10 plate barcodes in each unit) MictoAmp4!1 Optlcat 8-cap strips (300 132. strips In each unill MagMax-96Viral RNA lsolallon Kil (5 133. x 96 preps)-automaled 134. While LabelingTape (19mm x 54.9m) 2-tTDpallOI (case or s 110rues x 135. 500mll 136. 100% ethanol (500 ml) Nuclease-free H20 (10 in each unit X 137. 50ml) 138. RnaseAway(6 In eachunit x 475 ml) cppendorf litter Upso.1-10 UI\IIOU In 139.. each IHllll Eppendorf!liter tips 2-200 ul (960 In 140. each unit) Eppendorffilter lips 20-300 ul (960 In 141. each unil) USA Scientific Inc 2ML MICRO TUBE 142. W/GASKET PK/100 143, 8Bs (6000In each unit) Mlcrocenlrifugetubes 1.5 ml (500 In 144. each unit) 1rrorn ciosure "'" coat~man,,., 1n 145. •"rh,inlt\ Front C10SU11t 1110 coat Meple g,ants. useFFR Artaervnentl ZIKAELCSUP 785 • ZJKAELCRSP787 80•739-1511 790 DSHS 32.0113643•"2 Pn:l!ecVGrant Penod 8 Fromrl.lonlh. ca-, 1--------' ZIKAELC To 1t.1on111 . 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DC20503 TX-DSHS-19-1309-A-002181 STATE AND LOCAL GOVERNMENTSRATE AGREEMENT EIN: 32-0113643 DATE:09 / 17/2018 ORGJl..NIZATION: Texas Department of State 1100 W. 49th Street Austin, TX 78756The ra:~s approv e d in t:h1s ag.:-ee·.,e:---.:.s•,\'lL. r-h Fed~ral Health Services are agn:ie, ,ent FILING REF.: The preceding agreement was dated Governrent, 06 / 15 / 2:Jl 7 :or t.:se on grants. co::::racts .irl':i othei:subjec: to the cand.tians in Section I!I. SECTION I : INDIRECT COST RATES P? : V. f!l1AL (?:{OVISi -..!·l.A.!..) PRSD. (?RE~ETERMIUED 2~!:='F.C'!'TVE PSRIOD RATE{~) LOCATI ON TYPE FROM IQ fIZSD 09/01/2017 08/31/2 FIXED 09 / 01/2017 08/31/2018 i?ROV. 09/01/2018 08/3~/2021 APPLI CABLE TO 18 . 10 On Site Health 3 3. 9 0 On Site Lab !.Jr.ogram 18 Use Pcogrclm sa111e rates and cor.ditions as those c1t -:d fo!- f 1.scal end1r.g P..ugus t y~ar 31 , 2018. Total direct cos:s exclLding capital expe~ditures (buildings, indi~idual ice~s of equipa:e:1t; alteratio::s and r-enovat:.ions :1, that: portico of each suba·,:ard in excess o~ 525,000, flow-thr ough ~unds and WIC ~ood cosLs. Pag e _ o f J GJE574 TX-DSHS-19-1309-A-002182 ORG~BIZATION: Texas AGREEMENT DA.TE: SECTION II: Department of State Health Services 9/17/2018 SPECIAL REMARKS TREATMENT OF FRINGEBENEFITS: Tne fringe benefits charged individually listed belm·1. are specifically as direct costs. identified to each employee anj are The directly claimed fringe benefits are '1REATMENT or PAIDABSENCES Vacation, r.oliday, sick leave pay and other paid absences are included in salaries and wages and are claimed on grants, contracts and other agreemen~s as part of the normal cost for salaries and wages. Separate claims are not ~ade for the cost of these paid absences. Equipm ~nt Def1n1tion Equipm e nt means an article of nonexpendable, tangible personal property having a use:ul life of more t~an on~ year and an acquisition ~ost of $5, COJ or more per unit. F:c ..; Rec i re:nert Wor~er s Com~~~sation Ur.employment :rlsurance rleal::h Insurun c e Post Retitement Heal:h Benefits "four next prop c:.sal based on actual ~as due in our office 02 128 1 2018 . c c sLs f o~ the Page 2 o: fiscal year ending 08/31/2017 3 TX-DSHS-19-1309-A-002183 ORGP..NIZJl..TION: Texas AGREEMENT DATE : SECTION III: !Jepa r tme n t of State Health Ser v ices 9/17/2018 GENERAL : .... r.:11:. ~-, 10 C.!'1!.! ACJ:·,.!~~~e~-:a:--e: -;u!:Jt:::: to dn) z~t:..J-:.:tr-y er cJd. 1.n:...s:.r~t1.•1,: l!n1td':.10as a:-d clr,ply ~:i a g!vt:r: y:ant, c--::t:-11-...t or oi:r.s:: '1.y-r~el"."~n::.o:i:y t.o t.h~ ex:e:1t. thu:. f.mds a:-e o·,a:.lub ..~ A:O:"!?ta:-:.·~t: of tl"'! t'clt~s :.."i ,;,;_bJo:: ...: .. .; :h'! ~:,!l::·JLr.g c n::h:-~::s t! 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Mayes-5 1,.. .,,.,..., .......... .......,,IUJ :4• 011 -:~ :0: 1"°'HO:-.I-U""'•N 'J for •J' , I I . ·, , ,I " .. , J • 'I , i6i-3::!61 Page.., o: 3 TX-DSHS-19-1309-A-002184 GrantSolutions Page 1 of 2 [TAldridge1] GrantSolutions-6.17.3 07/11/2019 Log Out O Grant Solutions. gov Account Management 'v Funding Opportunity Applications Grants 'v Reports 'v Online Data Collection Help/Support Amendment Status Confirmation Grants has marked the following application as submitted: * Please submit signed copies of forms if you have been instructed by your program or grant office. CDC Office of Financial Resources 2939 Brandywine Road Atlanta, GA 30341 Applicant Texas Department of State Health Services Grant Number NU50CK000378 Project Title 2014 STATE OF TEXAS APPLICATION FOR EPIDEMIOLOGY AND LABORATORY CAPACITY FOR INFECTIOUS DISEASES COOPERATIVE AGREEMENT FUNDING Action No Cost Extension Submitted Date 07/26/2019 06:26 PM Eastern Time Application Details Items Item Attachments Type Date Expected Date Received Upload N/A 07/26/2019 SF-424A Budget Information - Non-Construction Project Period Revision Application Upload 6NU50CK000378 Texas Zika Supplement NCE and Redirection Application Control Checklist GrantSolutions User Support (202) 401-5282 or (866) 577-0771 help@grantsolutions.gov TX-DSHS-19-1309-A-002185 https://www.grantsolutions.gov/gs/servlet/eacc.post.EACCSubmissionConfirmServlet 7/26/2019 GrantSolutions Page 2 of 2 TX-DSHS-19-1309-A-002186 https://www.grantsolutions.gov/gs/servlet/eacc.post.EACCSubmissionConfirmServlet 7/26/2019 From: Epidemiology and Laboratory Capacity for Infectious Diseases \(ELC\) \(CDC\) on behalf of Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (CDC) Sent: Tuesday, July 30, 2019 9:52 AM EDT To: Garcia,Imelda M (DSHS) Subject: Important Budget Updates & Other ELC News WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ELC's new NOFO has many new opportunities for our recipients. August 2019 Newsletter In This Issue... scroll down to read everything • • • • • • • A Note from Angelica and Jason Save the Dates: Upcoming Events of Interest to ELC Recipients Next Generation ELC: Changes in the 2019-2024 CoAg View FY 2019 ELC Awards Volunteers Needed: Evaluation Work Group & Focus Group IMPORTANT: Revised Budget Requirements Spotlight on ELC Folks Greetings ELCers and other friends, By now, everyone has received their initial CK19-1904 Notice of Award for Budget Period 1 (BP1) in addition to detailed budgets and reviews. As we usually do, our ELC Project Officers will soon begin scheduling post-award calls with each jurisdiction to answer questions and to walk through work plans in the context of your approved budgets. These calls are important for discussing your reviews, your concerns or anticipated challenges, and any questions you may have. In addition to the call with your ELC Project Officer, please be on the lookout for meeting invites from CDC Program Consultants in the various partner programs under ELC (e.g., Food/Water, HAI/AR, Vector-Borne). We are encouraging all of our internal ELC partners to utilize REDCap to facilitate and document post-award discussions so that we may all have clear work plan expectations as we move into BP1. As CK19-1904 begins, ELC must bring CK14-1401 (and all of its 1-time funding) to an end. Templates and instructions for CK14-1401 closeout reports are being finalized and will be distributed by September 5th. The format is similar to recent excel templates, and recipients are expected to report the final set of performance measure data, and provide brief narratives summarizing the activities completed during BP5 of CK14-1401. The closeout report will also give recipients an opportunity to illustrate the breadth of work completed over the project period and highlight the importance of your jurisdiction receiving ELC resources. Closeout reports will be due to ELC via REDCap by October 31st. Finally, we are preparing to solicit feedback about the 2019 ELC NOFO application process so we may identify additional opportunities for improvement. We hope you carve out some time to provide your unique perspective sharing what went well and what could be improved. Your input is critical to the success of our program! Angelica O'Connor, ELC Program Coordinator ​Jason Snow, ELC Program Manager 1. ELC Kickoff Webinar WHAT: Launch of Budget Period 1 (CK19-1904) & Close Out of Old Project Period (CK14-1401) WHEN: August 29, 2019, 3:00pm-4:30pm, ET WHERE: On-line webinar WHY: Join the ELC Team to kick-off Budget Period 1 under CK19-1904 and review the requirements to close out the old TX-DSHS-19-1309-A-002187 project period under CK14-1401. ELC staff will discuss the following: • • • • closeout report requirements, templates and submission details (Closeout reports are due October 31), ELC Monitoring Portal and how you will use the system to verify your work plans (project officers and program consultants may have already contacted you directly to schedule calls), an overview of the post-award process, in light of expanded authority, and details about the new requirement in Program A. Cross-Cutting Epi & Lab for a workforce and training assessment. Submit Webinar-related Questions Here 2. The 2020 ELC Annual Meeting WHEN: March 10-12, 2020 WHERE: CDC, Atlanta, GA WHY: Meet with ELC staff and other CDC Infectious Diseases Program staff to receive on-site programmatic and technical assistance. Also, meet with staff from the Office of Grants Services (OGS) to receive fiscal & budgetary technical assistance necessary for managing ELC funds. This will be a celebration of the ELC’s 25th anniversary of service to the US public health departments and our nations’ infectious disease-related infrastructure. Registration and hotel information will follow, but please mark your calendars now! Next Generation ELC: Changes in the 2019-2024 Notice of Funding Opportunity (NOFO) CDC has awarded nearly $209 million to its jurisdictions as part of a new, competitive five-year ELC Cooperative Agreement. The new cooperative agreement (CoAg) was developed with feedback from recipients and partners (e.g. APHL, ASTHO, CSTE, NACCHO), to enable public health program growth while maintaining critical flexibility. The new ELC CoAg places a stronger focus on four robust public health programs to enhance surveillance, response and control efforts; expand prevention and intervention activities; and increase communication and partnership engagement. In addition to the four large programs, the recipients will maintain the flexibility to undertake discrete infectious disease projects important to their specific population and jurisdictional public health needs. As anticipated, ELC application requests reflected significant need for financial assistance to address infectious diseases. Requests totaled more than $490 million for budget period 1 (August 1, 2019 through July 31, 2020); however, due to limited availability of funds, just under $209M was able to be awarded. • • • • Compared to FY18, Budget Period 5 under CK14-1401, FY19, Budget Period 1 under CK19-1904 funding levels reflect the end of the Zika and Ebola Supplemental funding to jurisdictions, as well as prior year carryover funding in many jurisdictions. Programs and Projects may have utilized a tiered structure of activities to allow for varying levels of capacity and regional approaches. This accounts for some of the variation in the resource distribution from the previous project period. To foster collaboration and integration, epidemiology and laboratory work plans have been combined for most programs and projects where possible; although, budget templates remained distinct. ELC did not have sufficient resources to support equipment or service contracts in year 1. However, ELC is prepared to provide additional support through end of year funding opportunities. If available, these funds would be awarded before the end of September 2019. View FY 2019 ELC Awards Volunteers Needed for Evaluation Stakeholder Work Group TX-DSHS-19-1309-A-002188 Seeking: 6-10 ELC recipients that we can contact when specific evaluation-related issues arise that would benefit from your input. Purpose: Solicit opinions, concerns and priorities of stakeholders to inform the development and use of performance measure data, and other related projects on an ad hoc basis. Example: ELC may contact members of this workgroup several times a year to review drafts of performance measures, questionnaires, or templates, or participate on conference calls to solicit more information on specific topics. If interested or would like more information, click orange button. Deadline: Monday, August 12, 2019. Attention ELC Recipients! • • • What are your thoughts about the new structure and organization of the FY 2019 NOFO guidance? How did the application process go for you? Did ELC provide sufficient assistance throughout the application process for you to successfully submit your FY 2019 ELC application? Seeking: Focus group of ELC recipient volunteers Purpose: To conduct a focus group and a few in-depth interviews with those who participated in the ELC application process this past spring. Example: If you or any of your team members who were involved in the ELC application process are interested in providing feedback (positive or negative), we want to hear! If interested or would like more information, click orange button. Deadline: Monday, August 12, 2019. Click Here to Volunteer​ Revised Budget Requirements Now that ELC Notice of Awards (NOAs) have been issued, several inquiries have come in regarding a requirement in the NOA. Per the Terms & Conditions in the NOAs, revised budgets are due to OGS by September 2, 2019. Reason: Many budgets submitted during the application process were missing required information for either contractual and/or travel categories. Please cross-check your approved contractual entries in the Master Budget against the CDC budget guidance. Contractual Costs Cooperative Agreement recipients must obtain written approval from CDC prior to establishing a third-party contract to perform program activities. Approval by CDC to utilize funds and initiate program activities through the services of a contractor requires the submission of the following information for each contract to CDC: 1. Name of Contractor: Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization. 2. Method of Selection: State whether the contract is sole source or competitive bid. If an organization is the sole source for the contract, include an explanation as to why this institution is the only one able to perform contract services. 3. Period of Performance: Specify the beginning and ending dates of the contract. 4. Scope of Work: Describe the specific services/tasks to be performed by the contractor and relate them to the accomplishment of program objectives. Deliverables should be clearly defined. 5. Method of Accountability: Describe how the progress and performance of the contractor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract. 6. Itemized Budget and Justification: Provide and itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and the indirect cost rate used. Copies of the actual contracts should not be sent to CDC, unless specifically requested. In the body of the budget request, a summary should be provided of the proposed contacts and amounts for each. Travel Costs TX-DSHS-19-1309-A-002189 Additionally, please cross-check your approved travel entries in the Master Budget with the CDC budget guidance to ensure that the necessary elements (e.g., name, title, purpose, etc.) are addressed. Submit to Grant Solutions All missing elements (contractual &/or travel) need to be provided in a revised budget. Once revised, please do the following: 1. 2. 3. 4. Go to GrantSolutions; Create an amendment; Select budget revision as the amendment type; and Upload your revised budget in GrantSolutions. If you have any questions about revising your budget or how to submit once completed, please contact your Grants Management Specialist in OGS for assistance. Spotlight on ELC Folks Earlier this year, Alvin Shultz (left), ELC's former Program Coordinator, received the Council of State and Territorial Epidemiologists (CSTE) Distinguished Partner Award from Sarah Park during their 2019 annual meeting. She is CSTE's Vice-President and ELC's Principal Investigator for Hawaii. This award recognizes individuals or organizational units who make significant contributions to CSTE and outstanding achievement in applied public health epidemiology. Congratulations Alvin! In June, De’Lisa Simpson completed in a 2-week epidemiology course at Emory University. Seen below (standing, far left) with her class-mates, who took an accelerated course designed for public health professionals seeking to broaden their understanding of applied epidemiology and bio statistics, public health surveillance, field investigations. De’Lisa is an ELC Project Officer for Alabama, Arkansas, City of Chicago, Florida, Georgia, City of Houston, Illinois, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and Texas. When De’Lisa joined ELC in 2012, she already had an established relationship with the staff and culture of ELC. Prior to her tenure with ELC, De’Lisa had over 15 years of grants management experience and worked as a Grants Management Specialist with the Procurement and Grants Office (PGO), which was the predecessor of the current Office of Grants Services (OGS). Possessing this unique background, she quickly became the grants management subject matter expert within ELC. De'Lisa lives in Lawrenceville, GA and enjoys running, spending time with her son Dillon and traveling. De’Lisa has a Master of Business Administration from the University of Phoenix and a bachelor’s degree in Business Management from Park University. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002190 From: Epidemiology and Laboratory Capacity for Infectious Diseases \(ELC\) \(CDC\) on behalf of Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (CDC) Sent: Wednesday, July 31, 2019 9:25 AM EDT To: Garcia,Imelda M (DSHS) Subject: Important Budget Updates & Other ELC News WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ELC's new NOFO has many new opportunities for our recipients. August 2019 Newsletter In This Issue... scroll down to read everything • • • • • • • A Note from Angelica and Jason Save the Dates: Upcoming Events of Interest to ELC Recipients Next Generation ELC: Changes in the 2019-2024 CoAg View FY 2019 ELC Awards Volunteers Needed: Evaluation Work Group & Focus Group IMPORTANT: Revised Budget Requirements Spotlight on ELC Folks Greetings ELCers and other friends, By now, everyone has received their initial CK19-1904 Notice of Award for Budget Period 1 (BP1) in addition to detailed budgets and reviews. As we usually do, our ELC Project Officers will soon begin scheduling post-award calls with each jurisdiction to answer questions and to walk through work plans in the context of your approved budgets. These calls are important for discussing your reviews, your concerns or anticipated challenges, and any questions you may have. In addition to the call with your ELC Project Officer, please be on the lookout for meeting invites from CDC Program Consultants in the various partner programs under ELC (e.g., Food/Water, HAI/AR, Vector-Borne). We are encouraging all of our internal ELC partners to utilize REDCap to facilitate and document post-award discussions so that we may all have clear work plan expectations as we move into BP1. As CK19-1904 begins, ELC must bring CK14-1401 (and all of its 1-time funding) to an end. Templates and instructions for CK14-1401 closeout reports are being finalized and will be distributed by September 5th. The format is similar to recent excel templates, and recipients are expected to report the final set of performance measure data, and provide brief narratives summarizing the activities completed during BP5 of CK14-1401. The closeout report will also give recipients an opportunity to illustrate the breadth of work completed over the project period and highlight the importance of your jurisdiction receiving ELC resources. Closeout reports will be due to ELC via REDCap by October 31st. Finally, we are preparing to solicit feedback about the 2019 ELC NOFO application process so we may identify additional opportunities for improvement. We hope you carve out some time to provide your unique perspective sharing what went well and what could be improved. Your input is critical to the success of our program! Angelica O'Connor, ELC Program Coordinator ​Jason Snow, ELC Program Manager 1. ELC Kickoff Webinar WHAT: Launch of Budget Period 1 (CK19-1904) & Close Out of Old Project Period (CK14-1401) WHEN: August 29, 2019, 3:00pm-4:30pm, ET WHERE: On-line webinar WHY: Join the ELC Team to kick-off Budget Period 1 under CK19-1904 and review the requirements to close out the old TX-DSHS-19-1309-A-002191 project period under CK14-1401. ELC staff will discuss the following: • • • • closeout report requirements, templates and submission details (Closeout reports are due October 31), ELC Monitoring Portal and how you will use the system to verify your work plans (project officers and program consultants may have already contacted you directly to schedule calls), an overview of the post-award process, in light of expanded authority, and details about the new requirement in Program A. Cross-Cutting Epi & Lab for a workforce and training assessment. Submit Webinar-related Questions Here 2. The 2020 ELC Annual Meeting WHEN: March 10-12, 2020 WHERE: CDC, Atlanta, GA WHY: Meet with ELC staff and other CDC Infectious Diseases Program staff to receive on-site programmatic and technical assistance. Also, meet with staff from the Office of Grants Services (OGS) to receive fiscal & budgetary technical assistance necessary for managing ELC funds. This will be a celebration of the ELC’s 25th anniversary of service to the US public health departments and our nations’ infectious disease-related infrastructure. Registration and hotel information will follow, but please mark your calendars now! Next Generation ELC: Changes in the 2019-2024 Notice of Funding Opportunity (NOFO) CDC has awarded nearly $209 million to its jurisdictions as part of a new, competitive five-year ELC Cooperative Agreement. The new cooperative agreement (CoAg) was developed with feedback from recipients and partners (e.g. APHL, ASTHO, CSTE, NACCHO), to enable public health program growth while maintaining critical flexibility. The new ELC CoAg places a stronger focus on four robust public health programs to enhance surveillance, response and control efforts; expand prevention and intervention activities; and increase communication and partnership engagement. In addition to the four large programs, the recipients will maintain the flexibility to undertake discrete infectious disease projects important to their specific population and jurisdictional public health needs. As anticipated, ELC application requests reflected significant need for financial assistance to address infectious diseases. Requests totaled more than $490 million for budget period 1 (August 1, 2019 through July 31, 2020); however, due to limited availability of funds, just under $209M was able to be awarded. • • • • Compared to FY18, Budget Period 5 under CK14-1401, FY19, Budget Period 1 under CK19-1904 funding levels reflect the end of the Zika and Ebola Supplemental funding to jurisdictions, as well as prior year carryover funding in many jurisdictions. Programs and Projects may have utilized a tiered structure of activities to allow for varying levels of capacity and regional approaches. This accounts for some of the variation in the resource distribution from the previous project period. To foster collaboration and integration, epidemiology and laboratory work plans have been combined for most programs and projects where possible; although, budget templates remained distinct. ELC did not have sufficient resources to support equipment or service contracts in year 1. However, ELC is prepared to provide additional support through end of year funding opportunities. If available, these funds would be awarded before the end of September 2019. View FY 2019 ELC Awards Volunteers Needed for Evaluation Stakeholder Work Group TX-DSHS-19-1309-A-002192 Seeking: 6-10 ELC recipients that we can contact when specific evaluation-related issues arise that would benefit from your input. Purpose: Solicit opinions, concerns and priorities of stakeholders to inform the development and use of performance measure data, and other related projects on an ad hoc basis. Example: ELC may contact members of this workgroup several times a year to review drafts of performance measures, questionnaires, or templates, or participate on conference calls to solicit more information on specific topics. If interested or would like more information, click orange button. Deadline: Monday, August 12, 2019. Attention ELC Recipients! • • • What are your thoughts about the new structure and organization of the FY 2019 NOFO guidance? How did the application process go for you? Did ELC provide sufficient assistance throughout the application process for you to successfully submit your FY 2019 ELC application? Seeking: Focus group of ELC recipient volunteers Purpose: To conduct a focus group and a few in-depth interviews with those who participated in the ELC application process this past spring. Example: If you or any of your team members who were involved in the ELC application process are interested in providing feedback (positive or negative), we want to hear! If interested or would like more information, click orange button. Deadline: Monday, August 12, 2019. Click Here to Volunteer​ Revised Budget Requirements Now that ELC Notice of Awards (NOAs) have been issued, several inquiries have come in regarding a requirement in the NOA. Per the Terms & Conditions in the NOAs, revised budgets are due to OGS by September 2, 2019. Reason: Many budgets submitted during the application process were missing required information for either contractual and/or travel categories. Please cross-check your approved contractual entries in the Master Budget against the CDC budget guidance. Contractual Costs Cooperative Agreement recipients must obtain written approval from CDC prior to establishing a third-party contract to perform program activities. Approval by CDC to utilize funds and initiate program activities through the services of a contractor requires the submission of the following information for each contract to CDC: 1. Name of Contractor: Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization. 2. Method of Selection: State whether the contract is sole source or competitive bid. If an organization is the sole source for the contract, include an explanation as to why this institution is the only one able to perform contract services. 3. Period of Performance: Specify the beginning and ending dates of the contract. 4. Scope of Work: Describe the specific services/tasks to be performed by the contractor and relate them to the accomplishment of program objectives. Deliverables should be clearly defined. 5. Method of Accountability: Describe how the progress and performance of the contractor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract. 6. Itemized Budget and Justification: Provide and itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and the indirect cost rate used. Copies of the actual contracts should not be sent to CDC, unless specifically requested. In the body of the budget request, a summary should be provided of the proposed contacts and amounts for each. Travel Costs TX-DSHS-19-1309-A-002193 Additionally, please cross-check your approved travel entries in the Master Budget with the CDC budget guidance to ensure that the necessary elements (e.g., name, title, purpose, etc.) are addressed. Submit to Grant Solutions All missing elements (contractual &/or travel) need to be provided in a revised budget. Once revised, please do the following: 1. 2. 3. 4. Go to GrantSolutions; Create an amendment; Select budget revision as the amendment type; and Upload your revised budget in GrantSolutions. If you have any questions about revising your budget or how to submit once completed, please contact your Grants Management Specialist in OGS for assistance. Spotlight on ELC Folks Earlier this year, Alvin Shultz (left), ELC's former Program Coordinator, received the Council of State and Territorial Epidemiologists (CSTE) Distinguished Partner Award from Sarah Park during their 2019 annual meeting. She is CSTE's Vice-President and ELC's Principal Investigator for Hawaii. This award recognizes individuals or organizational units who make significant contributions to CSTE and outstanding achievement in applied public health epidemiology. Congratulations Alvin! In June, De’Lisa Simpson completed in a 2-week epidemiology course at Emory University. Seen below (standing, far left) with her class-mates, who took an accelerated course designed for public health professionals seeking to broaden their understanding of applied epidemiology and bio statistics, public health surveillance, field investigations. De’Lisa is an ELC Project Officer for Alabama, Arkansas, City of Chicago, Florida, Georgia, City of Houston, Illinois, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and Texas. When De’Lisa joined ELC in 2012, she already had an established relationship with the staff and culture of ELC. Prior to her tenure with ELC, De’Lisa had over 15 years of grants management experience and worked as a Grants Management Specialist with the Procurement and Grants Office (PGO), which was the predecessor of the current Office of Grants Services (OGS). Possessing this unique background, she quickly became the grants management subject matter expert within ELC. De'Lisa lives in Lawrenceville, GA and enjoys running, spending time with her son Dillon and traveling. De’Lisa has a Master of Business Administration from the University of Phoenix and a bachelor’s degree in Business Management from Park University. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002194 From: Centers for Disease Control and Prevention Sent: Thursday, August 01, 2019 12:49 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - August 1, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — AUGUST 1, 2019 Ahead of Print Current Cover Research Progress on a Vaccine to Protect against Nipah Virus Disease in an Animal Model Podcasts Download the PDF of the podcast transcript (70KB) Dr. Thomas Geisbert, a professor in the Department of Microbiology and Immunology at the University of Texas Medical Branch, discusses a vaccine to protect against Nipah virus disease. Contact EID Running time = 23:36 Announcements CDC Read the associated article in the June 2019 issue of the EID Journal Use of Single-Injection Recombinant Vesicular Stomatitis Virus Vaccine to Protect Nonhuman Primates Against Lethal Nipah Virus Disease — C. E. Mire et al. Browse all of EID's Podcast Content EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002195 From: Centers for Disease Control and Prevention Sent: Thursday, August 01, 2019 1:07 PM EDT To: Garcia,Imelda M (DSHS) Subject: Health Depts. Successfully Combating Antibiotic Resistance, CDC Awards Millions WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Health Departments Successfully Combating AR, CDC Awards Millions Totaling $300+ million since 2016 for state and local health departments to fight antibiotic resistance (AR) Today, the Centers for Disease Control and Prevention (CDC) awarded $71 million across all 50 states, Puerto Rico and the U.S. Virgin Islands, and several local health departments to continue their successful work in healthcare, foodborne disease, and the community to detect and respond to antibiotic resistance, prevent the spread of germs, and contain new threats. AR is an urgent public health threat and a CDC priority. To date, previous awards—made possible by Congressional investments in CDC's AR Solutions Initiative—have improved the nation's domestic epidemiology and laboratory capacity, resulting in successes like: • Testing more than 130,000 specimens (samples) through the AR Lab Network, prompting more than 3,800 alerts for additional public health investigation. These tests have provided critical information to healthcare providers and health departments to help stop the spread of resistance threats like Candida auris and drug-resistant gonorrhea. • Assessing infection control in nearly 5,000 U.S. healthcare facilities to identify and provide recommendations that address gaps in infection control, like hand hygiene and Contact Precautions. Fighting Antibiotic Resistance • Whole genome sequencing more than 115,000 foodborne (e.g., Salmonella), tuberculosis, and gonorrhea isolates to rapidly identify changes in resistance and inform response to stop spread incommunities. Whole genome sequencing is a lab technique that provides genetic information. • Supporting 500+ local experts to identify and respond to AR threats whenever and wherever they emerge. As part of a new, competitive 5-year Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement, CDC continues to fund every U.S. state to combat AR. New this year, the AR Lab Network welcomes the Utah Department of Health Public Health Lab as the mountain regional lab, and will support local lab testing in Puerto Rico and four large cities: New York City, District of Columbia, Houston, and Los Angeles. Health departments are on the front lines of our national fight against AR. CDC applauds the heroic, critical work continuing at the state and local levels to protect people from this urgent threat. Learn more about how CDC is fighting AR: https://www.cdc.gov/ARinvestments. CDC awards $71 million to health depts. to continue the fight against #AntibioticResistance across healthcare, foodborne disease, & the community. #CDCfightsAR http://bit.ly/ARSolutionsInitiative Share on Twitter Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002196 From: Centers for Disease Control and Prevention Sent: Thursday, August 01, 2019 4:28 PM EDT To: Garcia,Imelda M (DSHS) Subject: Template test WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. CDC Travelers' Health ​Update Interested in the latest travel health recommendations? Check out the CDC Yellow Book, Health Information for International Travel, to answer your patients’, employees’, or your own travel health questions What is the Yellow Book? It is the U.S. government’s travel health guidelines, including pre-travel vaccine recommendations, destination-specific health advice, and easy-to-reference maps, tables, and charts. Resources include Pre-travel • How to conduct a pre-travel consultation • Travel-related disease information: Causes, global distribution, prevention measures • Vaccines: Updated vaccine requirements and recommendations • Clinical guidance: An in-depth look at the specific travel health needs of infants and children, pregnant travelers, and those with chronic medical conditions or weakened immune systems • Overviews of popular tourist destinations and itineraries • Recommendations for expatriates, travelers visiting friends and relatives overseas or participating in study abroad, travel for work, adventure travel. During-travel • Conditions: Including travelers’ diarrhea, altitude illness, jet lag, motion sickness, and respiratory infections. Post-travel • How to conduct a post-travel evaluation • Post-travel evaluation and management: Fever in the returned traveler, sexually transmitted infections, skin and soft tissue infections, persistent diarrhea, screening newly arrived immigrants and refugees. Want a copy of Yellow Book 2020? You can purchase the Yellow Book through Oxford University Press, other major online booksellers, at most major bookstores, or as an eBook. The entire content of the book is also available online at the CDC website. Travel Tip: Malaria Malaria occurs in Africa, Central and South America, parts of the Caribbean, Asia, Eastern Europe, and the South Pacific (malaria maps: Eastern Hemisphere and Western Hemisphere). Every year about 1700 cases of malaria occur among international travelers from the US. Travelers, protect yourself from malaria by preventing mosquito bites and talk to your doctor about taking prescription medicine. Clinician Updates TX-DSHS-19-1309-A-002197 Illness among US Resident Student Travelers after Return to the USA What to Know: The number of students from the US studying abroad each year has tripled during the last 2 decades. As study abroad programmes’ destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. The most common diagnosis category of returned travelers was gastrointestinal (45%). Acute diarrhea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute human immunodeficiency virus infection. More information. How to Counsel Your Patients: Make sure all of your patients are up-to-date on their routine vaccines. Ask your college age patients if they plan on studying abroad and use our destination tool to assess what vaccines, medications, and advice to provide them before their trip. Characteristics of the Last-Minute Traveler: Analysis of Vaccine Usage What to Know: Last-minute travelers (LMTs) present challenges for health care providers because they may have insufficient time for recommended vaccinations or pre-travel preparation. LMTs comprised 16% of all travelers. More LMTs also traveled for longer than 1 month and visited only urban areas. At least one travel vaccine was deferred by 18% of LMTs because of insufficient time before departure. Vaccines that required multiple vaccinations, such as Japanese encephalitis and rabies, were the most likely to be deferred because of time constraints. More information. How to Counsel Your Patients: Ask your patients about their travel. Interventions to improve the timing of pre-travel health consultations should be developed, particularly for business and visiting friends and relatives (VFR) travelers. Recently endorsed accelerated vaccine schedules for Japanese encephalitis and rabies may help some LMTs receive protection against these infections despite late presentation for pre-travel health care. The Rise in Travel-Associated Measles Infections What to Know: Any traveler not immune to measles is at risk of acquiring it in many destinations. In 2018, the World Health Organization (WHO) reported over 328,000 measles cases among 184 WHO member states, with the European Region reporting the most cases (25.6%). From January to March 2019, reported cases rose 300% in comparison to the same months in 2018. Low vaccination coverage for measles is presumed to be responsible for this recent increase. International travelers to measles-affected countries are at risk for infection and may contribute to disease importation. More information. How to Counsel Your Patients: Ask your patients about upcoming travel & make sure they have immunity to measles. Safe travels from CDC Travelers' Health! □□ This monthly e-Newsletter covers CDC Travelers' Health news and events. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002198 From: Epidemiology and Laboratory Capacity for Infectious Diseases \(ELC\) \(CDC\) on behalf of Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (CDC) Sent: Thursday, August 08, 2019 9:13 AM EDT To: Garcia,Imelda M (DSHS) Subject: PLEASE READ: Important dates from ELC WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. News Flash: Four Important Dates • August 12th: Deadline to Volunteer • August 26th: 2020 ELC Annual Meeting registration website launches • August 29th: ELC Kickoff Webinar • March 11-13, 2020 ELC Annual Meeting (dates change) Angelica O'Connor, ELC Program Coordinator ​Jason Snow, ELC Program Manager -■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■- Click Here to Volunteer​ Volunteers needed for Evaluation Work Group Seeking: 6-10 recipients to participate in an evaluation stakeholder work group. A core group of individuals that ELC can contact when specific evaluation-related issues arise that would benefit from recipient input. Purpose: Solicit opinions, concerns and priorities of stakeholders to inform the development and use of performance measure data, and other related projects on an ad hoc basis. If interested, click orange button. Deadline: Monday, August 12, 2019. Attention ELC Recipients! • • • What are your thoughts about the new structure and organization of the FY 2019 NOFO guidance? How did the application process go for you? Did ELC provide sufficient assistance throughout the application process for you to successfully submit your FY 2019 ELC application? Seeking: Focus group of ELC recipient volunteers Purpose: To conduct a focus group and a few in-depth interviews with those who participated in the ELC application process this past spring. If interested, click orange button. Deadline: Monday, August 12, 2019. -■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■- ELC Kickoff Webinar WHAT: Launch of Budget Period 1 (CK19-1904) & Close Out of Old Project Period (CK14-1401) TX-DSHS-19-1309-A-002199 WHEN: Thursday, August 29, 2019 WHERE: Webinar Information for participants:Dial-In Information: • • • 1-773-756-0169 or 1-800- 857-4945 URL: https://www.mymeetings.com/nc/join/ Conference Number: PWXW9408243 Participant Passcode: 3092790 Join directly at: https://www.mymeetings.com/nc/join.php?i=PWXW9408243&p=3092790&t=c 2020 ELC Annual Meeting On-line Registration Begins August 26, 2019 Registrations are limited to 5 people per jurisdiction and are by invitation for next year's meeting. ELC Governance Team members are encouraged to check spam/junk folders on August 26th if you do not see the ELC invite in your Inboxes. 2020 ELC Annual Meeting WHEN: March 11-13, 2020, 3 Full Days, Wednesday - Friday WHERE: CDC, Atlanta, GA Registration and hotel information will follow, but please mark your calendars now! Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002200 From: Epidemiology and Laboratory Capacity for Infectious Diseases \(ELC\) \(CDC\) on behalf of Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (CDC) Sent: Thursday, August 08, 2019 10:20 AM EDT To: Garcia,Imelda M (DSHS) Subject: Kickoff Webinar time WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ELC Kickoff Webinar including date & time Launch of Budget Period 1 (CK19-1904) & Close Out of Old Project Period (CK14-1401) WHEN: Thursday, August 29, 2019, 3:00pm - 4:30pm, ET WHERE: Webinar Information for participants:Dial-In Information: • • • 1-773-756-0169 or 1-800- 857-4945 URL: https://www.mymeetings.com/nc/join/ Conference Number: PWXW9408243 Participant Passcode: 3092790 Join directly at: https://www.mymeetings.com/nc/join.php?i=PWXW9408243&p=3092790&t=c Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002201 From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Sent: Thursday, August 08, 2019 2:42 PM EDT Subject: Requirements requested in the Notice of Award (NOA) Attachment(s): "Budget-Preparation-Guidance.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, There have been many questions regarding the requirement for responses to the technical reviews and revised budgets requested in the Notice of Awards (NOA). A response to the weaknesses and revised budgets must be submitted into GrantSolutions as a Grant Note by September 2, 2019 as outlined in the NOA. I recommend compiling one document with each specific program/project areas and upload one attachment. If you do not have any significant comments on certain sections, you may indicate the reviews are acknowledged and the recipient will work with CDC post award to address any concerns. Revised budgets are needed for the contractual element (approved & funded) ONLY where the 6 elements were missing when your budget template was submitted. This can also be submitted as one document in GrantSolutions as a Grant Note. I have attached our Office of Grant Services Budget Guidance for your convenience; the contractual elements are listed on page 6. If you need to revise your budget for any other reason (i.e. change to indirect, moving a position to a contract, etc.) please contact me directly. Feel free to contact me directly with any questions or concerns. De’Lisa De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-002202 Budget Preparation Guidelines Office of Financial Resources (OFR) Preparing a budget can be one of the most confusing aspects of applying fora CDC grant or cooperative agreement. This document provides guidance for the preparation of a budget request and examples to help with the process. Adherence to this guidance will facilitate timely review and approval of a budget request. Salaries and Wages For each requested position, provide the following information: 1) name of staff member occupying the position, if available; 2) annual salary; 3) percentage oftime budgeted for this program; 4) total months of salary budgeted; and 5) total salary requested. Also, provide a justification and describe the scope of responsibility for each position, relating it to the accomplishment of program objectives. Sample Budget Annual Salary Position Title Time Months and Name [l:)roject Coordinator ISu.sanTaylor $45,000 100% 12 month.s ~inance Admini.strator ~ohn John.son $28,500 50% 12 month.s !OutreachSupervi.sor 'Vacant*) $27,000 100% 12 month.s Amount Requested $45,000 $27,000 rTotalPersonnel Sample Justification The format may vary, but the description of responsibilities should be directly related to specific program objectives. Job Description: Project Coordinator-(Susan Taylor) This position directs the overall operation of the project including overseeing the implementation of project activities, coordination with other agencies, development of materials, provisions of service and training, collects, tabulates and interprets required data, program evaluation and staff performance evaluation. This individual is the responsible authority for ensuring reports and documentation are submitted to CDC. This position relates to all program objectives. Fringe Benefits Fringe benefits are usually applicable to direct salaries and wages. Provide information on the rate of fringe benefits used and the basis for their calculation. If a fringe benefit rate is not used, itemize how the fringe benefit amount is computed. Cen ters for Disease Co ntro I and Prevention Office of Financial Resources (0 FR) TX-DSHS-19-1309-A-002203 Sample Budget Fringe benefits computed by an established rate. Fringe Benefits Total $_______ 25% of Total salaries = Fringe Benefits If fringe benefits are not calculated using a percentage of salaries, itemize how the amount is determined for each salary and wage being requested. Project Coordinator Salary - $45,000 Fringe Benefit Percentage of Salary Amount Requested Retirement 5% $2,250 FICA 7.65% $3,443 Insurance N/A $2,000 Workers Compensation N/A $ Total Fringe $7,693 Consultant Costs This category should be used when hiring an individual to give professional advice or services (e.g., training, expert consultant, etc.) for a fee, but not as an employee of the grantee organization. Written approval must be obtained from CDC prior to establishing a written agreement for consultant services, and must be obtained annually in order to reestablish the written agreement. Approval to initiate or continue program activities through the services of a consultant requires submission of the following information to CDC for each consultant: 1. Name of Consultant: Identify the name of the consultant and describe his or her qualifications. 2. Organizational Affiliation (if applicable): Identify the organization affiliation of the consultant. 3. Nature of Services to Be Rendered: Describe the consultation that will be provided, including the specific tasks to be completed and specific deliverables. A copy of the actual consultant agreement should not be sent to CDC. 4. Relevance of Service to the Project: Describe how the consultant services relate to the accomplishment of specific program objectives. 5. Number of Days of Consultation (basis for fee): Specify the total number of days of consultation. 6. Expected Rate of Compensation: Specify the rate of compensation for the consultant (e.g., rate per hour, rate per day). Include a budget showing other costs (e.g., travel, per diem, supplies, and other related expenses) and list a subtotal. 7. Method of Accountability: Describe how the progress and performance of the consultant will be monitored. Identify who is responsible for supervising the consultant agreement. If the required information described above is not known at the time the application is submitted, the information may be submitted later as a revision to the budget. In the body of the budget request, a summary should be provided of the proposed consultants and amounts for each. TX-DSHS-19-1309-A-002204 Equipment Equipment is defined as tangible, non-expendable personal property (including exempt property) that has a useful life of more than one year AND an acquisition cost of $5,000 or more per unit. . However, in circumstances where your organization has a lower threshold, you may work with your CDC Grants Management Officer to establish a threshold that is consistent with your organization’s policy. All budget requests should individually list each item requested, and provide the following information: 1) number needed; 2) unit cost of each item; and 3) total amount requested. Also, provide a justification for the use of each item and relate it to specific program objectives. Maintenance or rental fees for equipment should be shown in the Other category. Sample Budget Item Requested Number Needed Unit Cost Amount Requested Computer Workstation 2 ea. $5,500 $11,000 Computer 1 ea. $6,000 $6,000 $17,000 Total Equipment Sample Justification The computer workstations will be used by the principal investigator and statistician to collect required data, perform data analysis, and generate reports. These computers will also support the daily operation of the project, routine correspondence, research, and electronic communication. Supplies Individually list each item requested, and provide the following information: 1) specify the type of item, as appropriate; 2) number needed; 3) unit cost of each item; and 4) total amount requested. If appropriate, General office supplies may be shown by an estimated amount per month times the number of months in the budget category. Also, provide a justification for the use of each item and relate it to specific program objectives. Sample Budget Item Requested Type Number Needed Unit Cost Amount Requested Computer Workstation (Specify type) 3 ea. $2,500 $7,500 Word Processing Supplies (Specify type) 1 ea. $400 $400 Educational Pamphlets N/A 3,000 copies $1 $3,000 General Office Supplies Pens, pencils, paper 12 months $20/month per person for 10 people $2,400 Total Supplies $19,900 TX-DSHS-19-1309-A-002205 Sample Justification Office supplies will be used by staff members to carry out daily activities of the program. The education pamphlets and videos will be purchased from Vendor X and used to illustrate and promote safe and healthy activities. Word Processing Software will be used to document program activities, process progress reports, Travel Dollars requested in the Travel category should be for recipient staff travel only. Travel for consultants should be shown in the Consultant category. Travel for other participants (e.g., advisory committees, review panel, etc.) should be itemized as specified below and placed on the Other category. For In-State Travel, provide a narrative justification describing the travel staff members will perform. List where travel will be undertaken, number of trips planned, who will be making the trips, and approximate dates. If mileage is to be paid, provide the number of miles and the cost per mile. If travel is by air, provide the estimated cost of airfare. If per diem/lodging is to be paid, indicate the number of days and amount of daily per diem, as well as the number of nights and estimated cost of lodging. Include the cost of ground transportation, when applicable. For Out-of-State Travel, provide a narrative justification including the same information requested above. Include CDC meetings, conferences, and workshops, if required by CDC. Itemize Out-of-State Travel in the format described above for In-State Travel. Sample Travel Budget Travel (In-State and Out-of-State) Total $_______ Sample In-State Travel Budget Travel (In-State): Total $____ Number of Trips Number of People Cost of Airfare Number of Total Miles Cost per Mile Amount Requested 1 2 N/A 500 mi. $0.27 $270 25 1 N/A 300 mi. $027 $2,025 $2,295 Total Per Diem or Lodging Number of People Number of Units Unit Cost Amount Requested Per Diem 2 2 days $37/day $148 Lodging 2 1 night $67/night $134 Total $282 Sample In-State Travel Justification The Project Coordinator and the Outreach Supervisor will travel to (location) to attend AIDS conference. The Project Coordinator will make an estimated 25 trips to local outreach sites to monitor program implementation. TX-DSHS-19-1309-A-002206 Sample Out-of-State Travel Budget Travel (Out of-State): Total $_______ Number of Trips Number of People Cost of Airfare 1 1 Number of Total Miles $500 Per Diem or Lodging N/A Cost per Mile Amount Requested N/A $500 Number of People Number of Units Per Diem 1 3 days $45/day $135 Lodging 1 1 night $88/night $88 Ground Transportation? Number of People Amount Requested Amount Requested 1 Yes Unit Cost $50 Sample Out-of-State Travel Justification The Project Coordinator will travel to CDC, in Atlanta, GA to attend the CDC conference. Other This category contains items not included in the previous budget categories. Individually list each item requested and provide appropriate justification related to the program objectives. Sample Budget Item Requested Number of Months Estimated Cost per Month Number of Staff Amount Requested Telephone $ $ Postage $ $ Equipment Rental $ N/A $ Internet Provider Service $ N/A $ $ Total Other Item Requested Printing Number Needed ___ documents Unit Cost $ Amount Requested $ Sample Justification For printing costs, identify the types and number of copies of documents to be printed (e.g., procedure manuals, annual reports, materials for media campaign). TX-DSHS-19-1309-A-002207 Contractual Costs Cooperative Agreement recipients must obtain written approval from CDC prior to establishing a third-party contract to perform program activities. Approval by CDC to utilize funds and initiate program activities through the services of a contractor requires the submission of the following information for each contract to CDC: 1. 2. 3. 4. 5. 6. Name of Contractor: Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization. Method of Selection: State whether the contract is sole source or competitive bid. If an organization is the sole source for the contract, include an explanation as to why this institution is the only one able to perform contract services. Period of Performance: Specify the beginning and ending dates of the contract. Scope of Work: Describe the specific services/tasks to be performed by the contractor and relate them to the accomplishment of program objectives. Deliverables should be clearly defined. Method of Accountability: Describe how the progress and performance of the contactor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract. Itemized Budget and Justification: Provide and itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and the indirect cost rate used. If the information described above is not known at the time the application is submitted, the information may be submitted later as a revision to the budget. Copies of the actual contracts should not be sent to CDC, unless specifically requested. In the body of the budget request, a summary should be provided of the proposed contacts and amounts for each. Direct Costs Show the direct costs by listing the totals of each category, including salaries and wages, fringe benefits, consultant costs, equipment, supplies, travel, other, and contractual costs. Provide the total direct costs within the budget. Indirect Costs To claim indirect costs, the applicant organization must have a current approved indirect cost rate agreement established with the cognizant federal agency. A copy of the most recent indirect cost rate agreement must be provided with the application. If the applicant organization does not have an approved indirect cost rate agreement, costs normally identified as indirect costs (overhead costs) can be budgeted and identified as direct costs TX-DSHS-19-1309-A-002208 From: Centers for Disease Control and Prevention Sent: Monday, August 12, 2019 9:10 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - August 12, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — AUGUST 12, 2019 Ahead of Print Current Cover Lyme Disease and Connected Landscapes, New York City Podcasts Download the PDF of the podcast transcript (74KB) Meredith VanAcker, a PhD candidate in the Department of Ecology, Evolution, and Environmental Biology at Columbia University, discusses how city parks impact your chances of getting Lyme disease. Running time = 26:23 Contact EID Announcements CDC Read the associated article in the June 2019 issue of the EID Journal Enhancement of Risk for Lyme Disease by Landscape Connectivity, New York, New York, USA — M. C. VanAcker et al. Browse all of EID's Podcast Content EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002209 From: Centers for Disease Control and Prevention Sent: Monday, August 12, 2019 4:20 PM EDT To: Garcia,Imelda M (DSHS) Subject: Mass Gatherings, Measles Travel Tip, JE Clinical Updates, and Yellow Book 2020. WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. CDC Travelers' Health ​Update Whether a mass gathering is planned years in advance like World Cup or happens more spontaneously like street celebrations, events that draw huge crowds can have unique risks to travelers, including increasing the spread of infectious diseases. Full article. What risks should I be worried about? • Poor hygienic standards • • • • Challenging security situations due to the large amount of people Exposure to harsh weather Diseases caused by bug bites (like malaria, dengue, Zika, chikungunya, and yellow fever) Increased risk of vaccine-preventable diseases: - Flu - Measles - Hepatitis What can I do to protect myself? Before your trip: Check your destination; talk to your doctor to get meds or vaccines before you travel. Enroll inSTEP to register their trip with the nearest US Embassy or Consulate. Pack a travel health kit tailored to your needs and destination. During your trip: Do not go to the gathering if you feel sick. Know where the emergency exits are located. Wash your hands often; be sun safe by applying sunscreen regularly; avoid bug bites; stay hydrated, and only drink sealed drinks and cooked or peeled food. After your trip: If you feel sick, call your doctor and tell them where you traveled. Travel Tip: Measles Do you need an MMR shot? It can be hard to know if you are up to date on your shots or have immunity. Use our MMR vaccine quiz to see if you need a shot before your next trip! TX-DSHS-19-1309-A-002210 Clinician Updates Clinical Update: Recommendations to Prevent Japanese Encephalitis (JE) in Travelers What to Know: JE virus spreads to travelers through mosquito bites and is a risk throughout most of Asia and parts of the western Pacific (see risk areas and transmission season). Although most travelers are at very low risk of infection, some may be at a greater risk because of their travel plans. Factors that increase a traveler’s risk of exposure include: • Travel in risk areas for prolonged periods • Travel during the JE transmission season • Spending time in rural areas • Participating in outdoor activities (such as hiking or camping) that increase the risk of exposure to the mosquitoes that spread JE • Staying in accommodations that lack air conditioning, window and door screens, or bed nets, thereby increasing the risk of exposure to infected mosquitoes Most people infected with the JE virus do not have symptoms or have only mild symptoms. However, a small percentage of people develop brain inflammation with headache, fever, seizures, and altered mental status. Illness with JE can be fatal or have serious long-term consequences. How to Counsel Your Patients: One JE vaccine (Ixiaro) is licensed in the United States to prevent infection in people aged 2 months or older. ACIP recommends Ixiaro for people moving to risk areas to live, longer-term (for example, 1 month or longer) travelers to risk areas, and frequent travelers to risk areas. Consider vaccination for shorter-term travelers (for example, less than 1 month) at increased risk of exposure to JE based on the risk factors listed above. Also consider vaccination for travelers not sure about their exact duration of travel, destinations, or activities. ACIP does not recommend vaccination for travelers with low-risk itineraries, such as shorter-term travel limited to urban areas or travel that occurs outside the JE transmission season. Ixiaro is given as a two-dose series, with doses spaced 28 days apart. Adults aged 18–65 years can get the second dose as early as 7 days after the first. Give the second dose at least 1 week before travel. Administer a booster dose at least 1 year after completion of the primary series to travelers who remain at risk for JE infection. All travelers should also take steps to prevent insect bites to prevent JE as well as other infections transmitted by insects. Yellow Book: JE. CDC Yellow Book 2020 Featured Chapter: The Pretravel Consultation What to Know: This chapter offers a full explanation of what to do to prepare travelers for the health concerns that might arise during their trip. The objectives of the pretravel consultation are to: 1. Perform an individual risk assessment. 2. Communicate to the traveler anticipated health risks. 3. Provide risk management measures, including immunizations, malaria prophylaxis, and other medications as indicated. For the full pretravel consultation resource and more, check out our Yellow Book 2020. TX-DSHS-19-1309-A-002211 Safe travels from CDC Travelers' Health! [l This monthly e-Newsletter covers CDC Travelers' Health news and events. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002212 From: Aldridge,Tiffany (DSHS) Sent: Wednesday, August 14, 2019 5:21 PM EDT To: CDC HAI AR (CDC) CC: Merengwa,Enyinnaya (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Garcia,lmelda M (DSHS) Subject: RE: Texas ELC HAI/AR Post-Award Call Good Afternoon, We would like to schedule the call for October 24, 2019 at 1 p.m. Eastern time. The group is requesting to add the following item to the agenda: Expectations for Performance Measure reporting, and Review of any additional reporting templates. Please add the ELC PI, Imelda Garcia, ImeldaM.Garcia@dshs.texas.gov and me to the invitation make sure all of the staff who need to be included are added to the meeting invitation. and I will Please let us know if this is still a good time and if you have any questions for me. Thanks, Tiffany Aldridge, CTCM Program S11ecialist Texas Department of State Ilea/th Services Infectious Disease Prevention Section MC30R2 Ph: (512) 776-6658 Cell: (5 I 2) 645-5030 Fax: (511) 776-7443 tiffan v.aldrid ge(iidshs.texas. gov From: Merengwa,Enyinnaya (DSHS) Sent: Wednesday, August 14, 2019 12:29 PM To: CDC HAI AR (CDC) Cc: Aldridge,Tiffa ny (DSHS) Subject: RE: Texas ELC HAI/AR Post-Award Call Hello Gregory, Good afternoon. Sure, my colleague Tiffany will work with you on the availability Thanks, Mexis. of the Texas team. Enyinnaya I\. Merengwa, MD, MPH, MHA, DrPHc N BPH I..'.Board Certified in Public Health Physician-Sc icnt ist!Mcdical l.'.pidem iologist Healthcare Safr.1yInvestigations Group Manager Emerging and Acute Infectious Disease Unit Texas Department of State Health Services Tov.·cr Building, Mail Code 1960 Austin, Texas 78714 Office:: (5 P\ 776-6878 Cc II: ( 5 P\ 634-6 558 Fax: (5 P\ 776-76 I 6 TEXAS IHealthian d Human Services asDepartment of State I Tex lflealt 1h Service-s COJ\ FIDEJ\TIALITY J\OTICE: This email and the in formation contained in it relate to cases or suspected cases of diseases or health conditions and is confidential pursuant to Tex. Health & Safety Code §81.046. Forwarding or otherwise distributing (either electronically or in print) to unauthori,:ed individuals is prohibited. From: CDC HAI AR (CDC) [mailto:HAIAR@cdc.gov ] Sent: Wednesday, August 14, 2019 8:44 AM TX-DSHS-19-1309-A-002213 To: Merengwa,Enyinnaya (DSHS) Cc: CDC HAI AR (CDC) Subject: RE: Texas ELC HAI/AR Post-Award Call WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good Morning Enyinnaya, I wanted to follow-up on my previous email regarding the scheduling of your Post-Award call. Are you available at any of these times for the call? Warm regards, Gregory J. Joseph, MPH Public Health Analyst Cadence Group Contractor CIMS Field Support Team HHS Regions 2, 6, USAPI’s Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Email – olm5@cdc.gov Phone – (404) 718-5225 Telework: Tuesday & Thursday From: CDC HAI AR (CDC) Sent: Friday, August 9, 2019 11:51 AM To: Enyinnaya (Mexis) Merengwa Cc: CDC HAI AR (CDC) Subject: Texas ELC HAI/AR Post-Award Call Dear Enyinnaya, DHQP is in the process of scheduling Year 1 ELC HAI/AR Post-Award calls for G1 (epi) activities. Below are the agenda items we would like to discuss along with some suggested days/times for the call. In order to make this process as efficient as possible, we would like to ensure the HAI Coordinator or equivalent is available for the call. Please plan to also have appropriate health department personnel on the call to address the topics listed below. Suggested personnel include, but are not limited to, the following: Principal Investigator & AR Expert or equivalent. In addition, please advise if you have any additional topics you would like to add to the agenda. Please contact us at HAIAR@cdc.gov if you have any questions. Suggested Dates & Times: Tuesday, October 22 (1PM EST) Tuesday, October 22 (3PM EST) Thursday, October 24 (1PM EST) Agenda: Review of BP1 Work Plan and Technical Review Review of BP1 Budget 0 Discussion of BP1 Spending and Activity Monitoring Other items (please advise if you have additional items to discuss) 0 0 Warm regards, Gregory J. Joseph, MPH Public Health Analyst Cadence Group Contractor CIMS Field Support Team HHS Regions 2, 6, USAPI’s Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention Email – olm5@cdc.gov Phone – (404) 718-5225 Telework: Tuesday & Thursday TX-DSHS-19-1309-A-002214 From: Electronic Data Exchange (CDC) Sent: Thursday, August 15, 2019 10:40 AM EDT To: Electronic Data Exchange (CDC) Subject: CDC Health Scientist - Informatics Position Announcement WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings All, The information below is in regards to a health scientist (informatics) opening at CDC for a position working with the ELC Health Information Systems team. The position is currently open for application and closes tomorrow night (8/16). Our apologies for the late notice, but there is still time to apply! Job Title: Health Scientist - Informatics Job Number: HHS-CDC-D3-19-10561576 Position Description: Division of Preparedness and Emerging Infections seeks public health informatician to assist with implementing infectious disease-related projects across the nation at the state and local level through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement (ELC). Specific duties include: Implement scientific policies and procedures on informatics practices and principles; Coordinate the sharing of health related in informational materials so that scientific advice and assistance is shared; Apply new method, approach, and technology to new and unusual situations and these methods have broad applications in the field; Collaborate and provide expert scientific advice to a variety of nation-wide and international organizations to synthesize, and implement informatics policies and directions for future development. Link: https://jobs.cdc.gov/job/fort-collins/health-scie%20scientist%20scientist-informatics/250/12808807 Regards, EDX Team CDC edx@cdc.gov TX-DSHS-19-1309-A-002215 From: Centers for Disease Control and Prevention Sent: Thursday, August 15, 2019 1:50 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - August 15, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — AUGUST 15, 2019 Ahead of Print Current Cover Emergence of MDR Campylobacter jejuni bacterium in U.K. Podcasts Download the PDF of the podcast transcript (101KB) Dr. Bruno Lopes, a postdoctoral research fellow at the University of Aberdeen, discusses an antimicrobial-resistant strain of Campylobacter jejuni in poultry. Running time = 26:22 Contact EID Announcements Read the associated article in the July 2019 issue of the EID Journal Nationwide Stepwise Emergence and Evolution of Multidrug-Resistant Campylobacter jejuni Sequence Type 5136, United Kingdom — B. S. Lopes et al. Browse all of EID's Podcast Content CDC EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002216 From: Centers for Disease Control and Prevention Sent: Friday, August 16, 2019 1:03 PM EDT To: Garcia,Imelda M (DSHS) Subject: People at High Risk for Flu Complications WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Influenza (Flu) 2018 - 2019 Flu Season August 16, 2019 Flu Vaccine Finder www.cdc.gov/flu older adult talking to doctor Study Shows Hospitalization Rates and Risk of Death from Flu Increase with Age While flu seasons can vary in severity, during most seasons, people 65 years and older bear the greatest burden of severe flu disease. A CDC co-authored study published in the journal Open Forum Infectious Diseases reports that people 85 years and older are much more likely to be hospitalized and die from flu than adults 65 to 74 years old. Learn More pregnant woman’s belly People at High Risk for Flu Complications ​Most people who get sick with flu will have mild illness, will not need medical care or antiviral drugs and will recover in less than two weeks. Some people, however, are more likely to get flu complications that can result in hospitalization and sometimes death. Flu also can make chronic health problems worse. Learn More Follow us on Twitter Follow a group of teens who help solve their friend's mystery illness in the graphic novel Operation Outbreak. Learn about variant #flu and real #diseasedetective work that happens during outbreaks. Available on @applebooks: https://go.usa.gov/xV36n Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002217 From: Centers for Disease Control and Prevention Sent: Tuesday, August 20, 2019 3:11 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - August 20, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Ahead of Print EXPEDITED AHEAD-OF-PRINT ARTICLES — August 20, 2019 Current Cover Podcasts Synopsis Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015 Maria D. Van Kerkhove, Sadoof Aswad, Abdullah Assiri, Ranawaka A.P.M Perera, Malik Peiris, Hassan E. El Bushra, and Abdulaziz A. BinSaeed Contact EID Announcements CDC EID Stacks Abstract To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers ≥1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low. Volume 25, Number 10 - October 2019 -------------------------------------------------------------- EID Podcasts Research Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections Nisreen M.A. Okba, V. Stalin Raj, Ivy Widjaja, Corine H. Geurts van Kessel, Erwin de Bruin, Felicity D. Chandler, et al. Abstract Middle East respiratory syndrome coronavirus (MERS-CoV) infections in humans can cause asymptomatic to fatal lower respiratory lung disease. Despite posing a probable risk for virus transmission, asymptomatic to mild infections can go unnoticed; a lack of seroconversion among some PCR-confirmed cases has been reported. We found that a MERS-CoV spike S1 protein–based ELISA, routinely used in surveillance studies, showed low sensitivity in detecting infections among PCR-confirmed patients with mild clinical symptoms and crossreactivity of human coronavirus OC43–positive serum samples. Using in-house S1 ELISA and protein microarray, we demonstrate that most PCR-confirmed MERS-CoV case-patients with mild infections seroconverted; nonetheless, some of these samples did not have detectable levels of virus-neutralizing antibodies. The use of a sensitive and specific serologic S1-based assay can be instrumental in the accurate estimation of MERS-CoV prevalence. Volume 25, Number 10 - October 2019 -------------------------------------------------------------- Research Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus Ruth Harvey, Giada MattiuzzoComments to Author , Mark Hassall, Andrea Sieberg, Marcel A. Müller, Christian Drosten, Peter Rigsby, Christopher J. Oxenford, and study participants Abstract Middle East respiratory syndrome coronavirus (MERS-CoV) was detected in humans in 2012. Since then, sporadic outbreaks with primary transmission through dromedary camels to humans and outbreaks in healthcare settings have shown that MERS-CoV continues to pose a threat to human health. Several serologic assays for MERS-CoV have been developed globally. We describe a collaborative study to investigate the comparability of serologic assays for MERS-CoV and assess any benefit associated with the introduction of a standard reference reagent for MERS-CoV serology. Our study findings indicate that, when possible, laboratories should use a testing algorithm including >2 tests to ensure correct diagnosis of MERS-CoV. We also demonstrate that the use of a reference reagent greatly improves the agreement between assays, enabling more consistent and therefore more meaningful comparisons between results. Volume 25, Number 10 - October 2019 -------------------------------------------------------------- Research Letter Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017–2018 Ahmed Hakawi, Erica Billig Rose, Holly M. Biggs, Xiaoyan Lu, Mutaz Mohammed, Osman Abdalla, Glen R. Abedi, et al. Abstract We characterized exposures and demographics of Middle East respiratory syndrome coronavirus cases reported to the Saudi Arabia Ministry of Health during July 1–October 31, 2017, and June 1–September 16, 2018. Molecular characterization of available specimens showed that lineage 5 predominated among circulating viruses during these periods. Volume 25, Number 11 - November 2019 Update your subscriber preferences for EID email notifications. TX-DSHS-19-1309-A-002218 Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002219 From: Centers for Disease Control and Prevention Sent: Wednesday, August 21, 2019 4:02 PM EDT To: Garcia,Imelda M (DSHS) Subject: Emerging Infectious Diseases Journal - Volume 25, Issue 9 - September 2019 Issue Now Online WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online TABLE OF CONTENTS Ahead of Print Current Cover Podcasts Synopsis Contact EID Announcements CDC Candida auris in Germany and Previous Exposure to Foreign Healthcare P. Nookeu et al. Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015 Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit G. Desoubeaux et al. Epidemiology of CarbapenemaseProducing Klebsiella pneumoniae in a Hospital, Portugal M. Aires-de-Sousa et al. EID Podcasts Research Letters Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum Medscape CME Activity Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions A. Ganesan et al. Research Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA V. J. Oakes et al. Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016 G. Oligbu et al. Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017 E. van Schalkwyk et al. Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018 P. Uprety et al. Medscape CME Activity Risk for Clostridiodes difficile Infection among Older Adults with Cancer M. Kamboj et al. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018 B. M. Berenger et al. Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand L. Ford et al. A. Hamprecht et al. M. Mateo et al. Disseminated Emergomycosis in a Person with HIV Infection, Uganda I. Rooms et al. Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients A. Bellanger et al. Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019 K. Okada et al. Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia S. P. Nowak et al. Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA L. Li et al. Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia C. L. Weitzman et al. Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease S. Jing et al. Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure J. C. Howard et al. Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013 K. C. Jackson et al. Bombali Virus in Mops condylurus Bats, Guinea L. S. Karan et al. Potential Fifth Clade of Candida auris, Iran, 2018 N. A. Chow et al. Worldwide Reduction in MERS Cases and Deaths since 2016 Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017 C. A. Donnelly et al. P. Chen et al. A. Kumar et al. Dispatches Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA R. Ginn et al. Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda A. I. Izimukwiye et al. Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance E. Tkadlec et al. Blastomycosis Misdiagnosed as Tuberculosis, India Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis S. M. Rudramurthy et al. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone P. K. Singh and A. Jain Etymologia Etymologia: Sporothrix schenckii F. P. Sellera and C. E. Larsson About the Cover TX-DSHS-19-1309-A-002220 Beatrix Potter, Author, Naturalist, E. Tkadlec et al. Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017 H. Li et al. Delays in Coccidioidomycosis Diagnosis and Associated Healthcare Utilization, Tucson, Arizona, USA F. M. Donovan et al. Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato Beatrix Potter, Author, Naturalist, Mycologist B. Breedlove Books and Media Infections of Leisure, Fifth Edition K. Fullerton Online Report Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers S. Barkati et al. E. S. Acheson et al. Use of Human Intestinal Enteroids to Detect Human Norovirus Infectivity M. Chan et al. Vaccine Effectiveness Against DS-1–like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015 K. C. Jere et al. Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002221 From: Centers for Disease Control and Prevention Sent: Wednesday, August 21, 2019 7:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest CME Articles - Emerging Infectious Diseases Journal - September 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online LATEST CME ARTICLES Ahead of Print Current Cover Podcasts Medscape CME Activity Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions Contact EID Announcements Medscape CME Activity Risk for Clostridiodes difficile Infection among Older Adults with Cancer M. Kamboj et al. A. Ganesan et al. CDC EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002222 From: Centers for Disease Control and Prevention Sent: Thursday, August 22, 2019 11:57 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - August 22, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — August 22, 2019 Ahead of Print Current Cover Dispatch Human-to-Human Transmission of Influenza A(H3N2) Virus with Reduced Susceptibility to Baloxavir, Japan, February 2019 Podcasts Emi Takashita, Masataka Ichikawa, Hiroko Morita, Rie Ogawa, Seiichiro Fujisaki, Masayuki Shirakura, Hideka Miura et al. Abstract Contact EID Announcements CDC EID Stacks In 2019, influenza A(H3N2) viruses carrying an I38T substitution in the polymerase acidic gene, which confers reduced susceptibility to baloxavir, were detected in Japan in an infant without baloxavir exposure and a baloxavir-treated sibling. These viruses’ whole-genome sequences were identical, indicating human-to-human transmission. Influenza virus isolates should be monitored for baloxavir susceptibility. Volume 25, Number 11 - November 2019 EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002223 From: Centers for Disease Control and Prevention Sent: Friday, August 23, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Malaria Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online MALARIA ARTICLES Ahead of Print Current Cover Podcasts Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia S. P. Nowak et al. Contact EID Announcements CDC EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002224 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, August 23, 2019 9:52 AM EDT CC: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) Subject: Important information about Budget Revisions and Technical Reviews WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings Recipients, This is a friendly reminder that Budget Revisions and Technical Reviews are both due by September 2, 2019. The budget revision will be submitted as an Amendment in GrantSolutions (please see instructions below); whereas, the Technical Reviews will be uploaded as a Grant Note in GrantSolutions. The budget revisions due by September 2, 2019, are not redirections, and only pertain to addressing any/all missing elements for approved & funded contracts and travel in the FY19/BP1 budgets. Details were provided in the last ELC Newsletter but also are below. Contractual Costs Travel Costs Cooperative Agreement recipients must obtain written approval from CDC prior to establishing a Additionally, please cross-check your approved travel third-party contract to perform program activities. Approval by CDC to utilize funds and initiate entries in the Master Budget with the CDC budget program activities through the services of a contractor requires the submission of the following guidance to ensure that the necessary elements (e.g., name, information for each contract to CDC: title, purpose, etc.) are addressed. Name of Contractor: Identify the name of the proposed contractor and indicate whether the contract is with an institution or organization. 1. Method of Selection: State whether the contract is sole source or competitive bid. If an 2. 3. 4. 5. organization is the sole source for the contract, include an explanation as to why this institution is the only one able to perform contract services. Period of Performance: Specify the beginning and ending dates of the contract. Scope of Work: Describe the specific services/tasks to be performed by the contractor and relate them to the accomplishment of program objectives. Deliverables should be clearly defined. Method of Accountability: Describe how the progress and performance of the contractor will be monitored during and on close of the contract period. Identify who will be responsible for supervising the contract. Itemized Budget and Justification: Provide and itemized budget with appropriate justification. If applicable, include any indirect cost paid under the contract and the indirect cost rate used. Copies of the actual contracts should not be sent to CDC, unless specifically requested. In the body of the budget request, a summary should be provided of the proposed contacts and amounts for each. Also, guidance was previously provided through a Grant Note issued by OGS through GrantSolutions. The details previously provided are: Per the Terms & Conditions in the recently issued Notice of Awards (NOAs), revised budgets are due to OGS by September 2, 2019. The reason behind this term is that many budgets submitted during the application process were missing required information for either contractual and/or travel categories. Please cross-check your approved contractual entries in the Master Budget against the CDC budget guidance attached to this note. Additionally, please cross-check your approved travel entries in the Master Budget with the CDC budget guidance to ensure that the necessary elements (e.g., name, title, purpose, etc.) are addressed. All missing elements (contractual &/or travel) need to be provided in a revised budget. Once revised, please do the following: (1) Go to GrantSolutions; (2) Create an amendment; (3) Select budget revision as the amendment type; and (4) Upload your revised budget in GrantSolutions. If you have any questions about revising your budget or how to submit once completed, please reach out to Karen Zion either via email wvf8@cdc.gov or by phone (770) 488-2729. Thank you, TX-DSHS-19-1309-A-002225 Karen Zion Grants Management Specialist (GMS) Thanks, ELC Team From: Centers for Disease Control and Prevention Sent: Saturday, August 24, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Rickettsia Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online RICKETTSIA ARTICLES Ahead of Print Current Cover Podcasts Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017 H. Li et al. Contact EID Announcements CDC EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002227 From: Centers for Disease Control and Prevention Sent: Sunday, August 25, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Parasites Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online PARASITES ARTICLES Ahead of Print Current Cover Podcasts Contact EID Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA Case of Plasmodium knowlesi Malaria in Poland Linked to Travel in Southeast Asia V. J. Oakes et al. S. P. Nowak et al. Announcements CDC EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002228 From: Centers for Disease Control and Prevention Sent: Sunday, August 25, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Tuberculosis and Other Mycobacteria Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online TUBERCULOSIS AND OTHER MYCOBACTERIA ARTICLES Ahead of Print Current Cover Podcasts Contact EID Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone P. Nookeu et al. P. K. Singh and A. Jain Announcements Blastomycosis Misdiagnosed as Tuberculosis, India CDC A. Kumar et al. EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002229 From: Centers for Disease Control and Prevention Sent: Monday, August 26, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Respiratory Infections Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online RESPIRATORY INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Contact EID Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone S. Jing et al. P. K. Singh and A. Jain Announcements Cluster of Nasal Rhinosporidiosis, Eastern Province, Rwanda CDC A. I. Izimukwiye et al. EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002230 From: Centers for Disease Control and Prevention Sent: Monday, August 26, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Vector-borne Infections Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online VECTOR-BORNE INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA Contact EID V. J. Oakes et al. Announcements Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013 CDC K. C. Jackson et al. Rodent Host Abundance and Climate Variability as Predictors of Tickborne Disease Risk 1 Year in Advance E. Tkadlec et al. Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017 H. Li et al. EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002231 From: Centers for Disease Control and Prevention Sent: Tuesday, August 27, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Zoonoses Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online ZOONOSES ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Theileria orientalis Ikeda Genotype in Cattle, Virginia, USA Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013 V. J. Oakes et al. K. C. Jackson et al. Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015 Infections of Leisure, Fifth Edition K. Fullerton M. Mateo et al. CDC Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand L. Ford et al. EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002232 From: Centers for Disease Control and Prevention Sent: Tuesday, August 27, 2019 2:31 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Expedited Articles - Emerging Infectious Diseases Journal - August 27, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal EXPEDITED AHEAD-OF-PRINT ARTICLES — August 27, 2019 Ahead of Print Current Cover Research Molecular and Clinical Comparison of Enterovirus D68 Outbreaks among Hospitalized Children, Ohio, USA, 2014 and 2018 Podcasts Huanyu Wang, Alejandro Diaz, Katherine Moyer, Maria Mele-Casas, Maria Fatima AraMontojo, Isabel Torrus, Karen McCoy, Asuncion Mejias, and Amy L. Leber Abstract Contact EID Announcements CDC EID Stacks Enterovirus D68 (EV-D68) causes respiratory tract infections and neurologic manifestations. We compared the clinical manifestations from 2 EV-D68 outbreaks in 2014 and 2018 and a low-activity period in 2016 among hospitalized children in central Ohio, USA, and used PCR and sequencing to enable phylogenetic comparisons. During both outbreak periods, infected children had respiratory manifestations that led to an increase in hospital admissions for asthma. The 2018 EV-D68 outbreak appeared to be milder in terms of respiratory illness, as shown by lower rates of pediatric intensive care unit admission. However, the frequency of severe neurologic manifestations was higher in 2018 than in 2014. During the same period in 2016, we noted neither an increase in EV-D68 nor a significant increase in asthma-related admissions. Phylogenetic analyses showed that EV-D68 isolates from 2018 clustered differently within clade B than did isolates from 2014 and are perhaps associated with a different EV-D68 subclade. Volume 25, Number 11 - November 2019 EID Podcasts Update your subscriber preferences for EID email notifications. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002233 From: Centers for Disease Control and Prevention Sent: Tuesday, August 27, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Antimicrobial Resistance Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online ANTIMICROBIAL RESISTANCE ARTICLES Ahead of Print Current Cover Podcasts Contact EID Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients Potential Fifth Clade of Candida auris, Iran, 2018 A. Bellanger et al. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018 Announcements Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017 CDC E. van Schalkwyk et al. Epidemiology of CarbapenemaseProducing Klebsiella pneumoniae in a Hospital, Portugal M. Aires-de-Sousa et al. N. A. Chow et al. B. M. Berenger et al. Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone P. K. Singh and A. Jain EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002234 From: Centers for Disease Control and Prevention Sent: Wednesday, August 28, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Viruses Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online VIRUSES ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Fatal Case of Lassa Fever, Bangolo District, Côte d’Ivoire, 2015 Bourbon Virus in Wild and Domestic Animals, Missouri, USA, 2012–2013 M. Mateo et al. K. C. Jackson et al. Disseminated Emergomycosis in a Person with HIV Infection, Uganda Association of Enterovirus D68 with Acute Flaccid Myelitis, Philadelphia, Pennsylvania, USA, 2009–2018 I. Rooms et al. CDC Dengue Virus Type 1 Infection in Traveler Returning from Tanzania to Japan, 2019 K. Okada et al. EID Podcasts P. Uprety et al. Bombali Virus in Mops condylurus Bats, Guinea Decision Tool for Herpes B Virus Antiviral Prophylaxis after Macaque-Related Injuries in Research Laboratory Workers L. S. Karan et al. S. Barkati et al. M. Chan et al. Household Transmission of Human Adenovirus Type 55 in Case of Fatal Acute Respiratory Disease Vaccine Effectiveness Against DS-1–like Rotavirus Strains in Infants with Acute Gastroenteritis, Malawi, 2013–2015 S. Jing et al. K. C. Jere et al. Use of Human Intestinal Enteroids to Detect Human Norovirus Infectivity Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002235 From: Centers for Disease Control and Prevention Sent: Thursday, August 29, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Bacteria Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online BACTERIA ARTICLES Ahead of Print Current Cover Podcasts Clinical Characteristics and Treatment Outcomes for Patients Infected with Mycobacterium haemophilum Contact EID P. Nookeu et al. Announcements CDC Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016 G. Oligbu et al. Whole-Genome Sequencing of Salmonella Mississippi and Typhimurium Definitive Type 160, Australia and New Zealand EID Podcasts Infections of Leisure, Fifth Edition K. Fullerton Medscape CME Activity Risk for Clostridiodes difficile Infection among Older Adults with Cancer M. Kamboj et al. Medscape CME Activity Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions A. Ganesan et al. L. Ford et al. Blastomycosis Misdiagnosed as Tuberculosis, India Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia A. Kumar et al. C. L. Weitzman et al. Epidemiology of CarbapenemaseProducing Klebsiella pneumoniae in a Hospital, Portugal M. Aires-de-Sousa et al. Genetic Characterization and Enhanced Surveillance of Ceftriaxone-Resistant Neisseria gonorrhoeae Strain, Alberta, Canada, 2018 B. M. Berenger et al. Rickettsia japonica Infections in Humans, Xinyang, China, 2014–2017 Limited Scope of Shorter Drug Regimen for MDR TB Caused by High Resistance to Fluoroquinolone H. Li et al. P. K. Singh and A. Jain Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002236 From: Centers for Disease Control and Prevention Sent: Thursday, August 29, 2019 9:49 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - August 29, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — AUGUST 29, 2019 Ahead of Print Current Cover Effect of pneumococcal conjugate vaccines on Pneumococcal Meningitis Podcasts Download the PDF of the podcast transcript (84KB) Dr. Shamez Ladhani, a pediatric infectious diseases specialist and clinical lead for vaccinepreventable diseases at Public Health England, discusses the effect of pneumococcal conjugate vaccines on reducing meningitis in the U.K. Contact EID Running time = 37:12 Announcements CDC Read the associated article in the September 2019 issue of the EID Journal Effect of Pneumococcal Conjugate Vaccines on Pneumococcal Meningitis, England and Wales, July 1, 2000–June 30, 2016 — G. Oligbu et al. Browse all of EID's Podcast Content EID Podcasts Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002237 From: Aldridge,Tiffany (DSHS) Sent: Thursday, August 29, 2019 3:01 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) Attachment(s): "ELC CK19-1904 Response To Technical Review and Budget Revision.pdf" Good Afternoon De’Lisa, The Texas Technical Review and Budget Revision has been submitted as a Grant Note into GrantSolutions.gov. Please let me know if you have any questions. Thank You, Tiffany Aldridge From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Wednesday, August 21, 2019 12:08 PM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) We cannot extend the date. I recommend completing the response and missing contractual information as requested by OGS. You can submit a redirection at any time. We are aware of the missing indirect from some of the programs and hope to fill those gaps during our rapid awards process. You can submit a redirection after those awards are released. De’Lisa From: Aldridge,Tiffany (DSHS) Sent: Wednesday, August 21, 2019 12:51 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) Hi De’Lisa, We are working to complete the ELC Budget Revisions and Technical Review responses as quickly as possible. Many projects were not fully funded in the Indirect Cost area so we are still working with agency programs to find funding to cover this cost. We would like to know if we could have a deadline extension until COB Monday, September 23, 2019 to submit the budget revisions and technical reviews. Please let me know if you have any questions for me. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Thursday, August 8, 2019 1:42 PM Subject: Requirements requested in the Notice of Award (NOA) Importance: High WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, There have been many questions regarding the requirement for responses to the technical reviews and revised budgets requested in the Notice of Awards (NOA). A response to the weaknesses and revised budgets must be submitted into GrantSolutions as a Grant Note by September 2, 2019 as outlined in the NOA. I recommend compiling one document with each specific program/project areas and upload TX-DSHS-19-1309-A-002238 one attachment. If you do not have any significant comments on certain sections, you may indicate the reviews are acknowledged and the recipient will work with CDC post award to address any concerns. Revised budgets are needed for the contractual element (approved & funded) ONLY where the 6 elements were missing when your budget template was submitted. This can also be submitted as one document in GrantSolutions as a Grant Note. I have attached our Office of Grant Services Budget Guidance for your convenience; the contractual elements are listed on page 6. If you need to revise your budget for any other reason (i.e. change to indirect, moving a position to a contract, etc.) please contact me directly. Feel free to contact me directly with any questions or concerns. De’Lisa De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002239 TEXAS Texas Department ofStateHealth Services HealthandHuman Services JohnHellerstedt,M.D. Commissioner August 29, 2019 DSHS Doc# DSHS Doc# Shirley Byrd Lead Grant Management Specialist Centers for Disease Control and Prevention Grant Services Office 2920 Brandywine Road, MS Atlanta, GA 30341 2190-01-AP-02 2217-01-AP-02 through Reference: Funding Announcement: CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC)Year 1 Technical Review Response and Budget Revisions Dear Ms. Byrd: Texas Department of State Health Services (DSHS) Epidemiology and Laboratory Capacity (ELC) Team is responding to the Center for Disease Control and Prevention (CDC) ELC Technical Reviews and has revised Budgets for the Budget Period 1 (BPl) activities. DSHS has updated the budgets to add contractual information as requested by CDC as well as updating travel locations and dates (those already made available) and personnel updates as approved by CDC. Many items on the Technical Review Response will require follow-up conversations with CDC Project Officers and Program Contacts. DSHS staff has already begun to reach out to CDC staff to schedule conference calls and CDC site visits. If you have any questions regarding this request or need additional information, please contact Imelda Garcia at (512) 776-7679, or via email at ImeldaM.Garcia@dshs .texas.gov. Sincerely, Imelda Gare· . , MPH Principal Investigator A"manda Hudson Budget Director Attachments cc: De'Lisa Simpson, CDC Project Officer Angelica O'Connor, CDC Project Officer P.O.Box149347 • Austin,Texas 78714-9347 • Phone: 888-963-7111• TTY:800-735-2989 • dshs.texas.gov TX-DSHS-19-1309-A-002240 ELC CK19-1904 Budget Period 1 Technical Review Responses Project A: CDC Comment I. Approach Strengths Weaknesses Additional CDC Comments II. Work Plan for 2019 Strengths Weaknesses: Strategy 1.C.A. DSHS Response The applicant will seek opportunities to cross-train ELC-funded positions across infectious disease areas and will report the number that are capable of and working across areas to CDC. No significant weaknesses noted. The applicant describes plans and capacity to collect data and report on the performance measures as listed in the 2019 guidance which includes strategies to utilize performance measure and evaluation data. N/A The milestones have completion dates that are reasonable and in-line with implementation plan. TX recognizes the need to implement GIS technology to enhance mosquitoborne surveillance and resistance testing to inform epi of potential "hot-spots" for human disease, identify new trap locations, and for vector control efforts. N/A This activity relies (completely) on the ability to hire a GIS Specialist who will be shared between the Arbovirus Lab and the Zoonosis Control Branch. As implementation of some GIS tools will provide key information in identifying clusters of (potential) disease based upon mosquito testing results, it is unclear why training and implementation of GIS tools cannot be at least initiated in lieu of hiring personnel. Are there any efforts to utilize GIS tools that may be currently used in routine surveillance that can Acknowledged, but unfunded. DSHS will work with CDC post award to address any concerns. N/A N/A N/A TX-DSHS-19-1309-A-002241 Additional CDC Comments III. IV. Budget (NOT SCORED) Strengths Weaknesses Additional Comments General Comments Regarding Content of Application be extended to vector testing? Also, while this is proposed as a joint effort between the Arbo Lab and Zoonosis Control Branch, the milestones and implementation plan focus on Arbo Lab functions. Approved for AMD Regional Training with WY PHL as regional training lead. The regional Training lead will reach out to your team to determine training dates. OAMD does not support Bionumerics only training- please check with PulseNet for Bionumerics training or other PulseNet related training. The DSHS Central Laboratory wishes to learn how other states improve communication with epidemiology programs and how they are implementing new technologies thru the ELC Peer-to-Peer training program. Grantees under consideration include New York, California, and Florida. No significant Weaknesses Noted. No significant Weaknesses Noted. The requested budget clearly and reasonably supports the proposed activities. Some activities were either partially funded or entirely ‘approved but unfunded’ based on the current unavailability of funds. Contact your ELC Project Officer to discuss how the approved budgets will impact your work plans. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. N/A N/A N/A The ELC will be developing a standardized workforce assessment tool Acknowledged. Texas will during the first quarter of the budget period. This tool will assist in meeting work with CDC post award the required activity ‘I. Strategy 1a: Enhance Workforce Capacity: Conduct to address any concerns. needs assessments to identify gaps and/or training needs in epidemiology and laboratory activities’. More details will be provided during the postaward call with the ELC Project Officer. TX-DSHS-19-1309-A-002242 Project B: I. Approach Strengths Weaknesses Additional Comments II. III. Work Plan for 2019: Core Required Activities Strengths Weaknesses Budget (NOT SCORED) Strengths Weaknesses Additional Comments The applicant has a dedicated ELC Program Manager who is N/A responsible for enhanced coordination of all activities and components for the ELC cooperative agreement. No significant weaknesses noted. N/A The applicant describes plans and capacity to collect data and report N/A on the performance measures as listed in the 2019 guidance. No significant strengths noted. No significant weaknesses noted. N/A N/A No significant strengths noted. No significant weaknesses noted. The requested budget clearly and reasonably supports the proposed activities. Some activities were either partially funded or entirely ‘approved but unfunded’ based on the current unavailability of funds. Contact your ELC Project Officer to discuss how the approved budgets will impact your work plans. N/A N/A N/A The jurisdiction described the needs of the jurisdiction &/or population served. Strategic approach is provided which explains how they plan to achieve outcomes. N/A Project C: I. Approach N/A TX-DSHS-19-1309-A-002243 Strengths Applicant describes current infrastructure and how resources will be leveraged. N/A Supports ongoing Tarrant County HD syndromic surveillance activities, which supply data to region 2/3, state and NSSP. Recognizes severe deficiencies in operating environment, maintenance and staffing for surveillance system and seeks to address them to get on sound footing before taking on other activities. o Use of a contractor to administer and update surveillance system while rebuilding staff provides a short term solution to ensure an improved, stable and functional surveillance system. N/A N/A o Task force addresses operational issues with surveillance system. o Agency leadership is engaged in developing strategic approach. Addresses LIMS maintenance, functionality and capacity issues and loss of technical staff that put the system at risk. o For LIMS, identified challenges as the loss of experienced administrators, outdated/missing LOINC and SNOMED codes, insufficient infrastructure, and hardware needed for processing Next Generation Sequencing and Advanced Molecular Detection. Lab has implemented ETOR for a few conditions via the AIMS Hub. Plans outlined to improve ELR and ETOR, update LIMS, and increase ability to support AMD testing and manage large NGS files. Syndromic surveillance system provides high quality, real-time data for epidemiologists conducting surveillance and for public health partners. Identified the challenge for syndromic surveillance is data quality with the increased number of reporting facilities. N/A N/A N/A N/A TX-DSHS-19-1309-A-002244 Weaknesses No mention of Maven that is used for conditions that are not captured in NBS. Despite evident challenges in obtaining/retaining the technical staff needed to maintain the surveillance and lab information systems, there is no evidence that a solution other than hiring and training more staff has been considered. (E.g., hosted solution or long-term contracted administration.) These strategies may not be practical solutions due to state IT or contracting requirements, but it seems like options that should be considered. Additional Comments Requesting 6 new positions and 1 continuing position from ELC for support of surveillance system. Application notes in Justification that state funds have been requested for 3 FTE IT position for surveillance system and ELR support. Applicant Capacity section indicates that state legislature has been asked to fund up to 20 surveillance system support staff. Presumably this will include ELR, MMG implementation and eventually eCR. This suggests severe over-staffing. A system such as NBS, that does not require development at the jurisdiction level, should require much lighter staffing for maintenance and support. Even including capacity to manage messaging, this still seems like an overly large team. Consider NBS upgrade to 6.0. May be ambitious to implement Message Mapping Guides during this grant year while resolving infrastructure priorities, data migration to SQL and NBS upgrade. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002245 II. Work Plan for 2019 (Budget Does the applicant clearly describe the following components Period 1) outlined in the NOFO? Consider the following elements: Implementation Plan: Describes the process and steps that will be completed to carry out and complete this activity. Milestones: Are discrete, measurable points during the budget period that can assist in monitoring progress. N/A Strengths N/A ELR: o Specific facilities (5 health systems and 2 reference labs) proposed for onboarding. o Implementing rules to better handle parent child relationships to accommodate more complex testing when ingesting into surveillance system. Syndromic surveillance: o Tarrant Co plans training to increase use of the data. o Tarrant Co plans to add 10 new facilities (but no indication of which facilities or what type). o State syndromic surveillance governance will coordinate with regions doing SyS. eCR: Will continue work to prepare for eCR this year by authoring in RCKMS, compiling trigger codes and identifying potential partners. EDX between Jurisdictions: o Will explore routes to exchange ELR. (They may not be planning to fully utilize NBS capabilities.) Will exchange with 2 states and with two counties that do not use the state surveillance system. o Will improve the ability to ingest case reports from the 2 counties with their own surveillance systems. Maintain system: o Improvement plans for case-based surveillance system – move to SQL environment, upgrade to newer version of system, hire N/A N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002246 contractor to assist with system administration and support, hire and train staff. o Lab staff will be trained to better understand, use and support LIMS and to use and support the ARLN module. Improving systems: o Lab will add space to virtual server environment to improve performance. o Surveillance system will be moved to new environment and upgraded. Innovative enhancements: o Fields will be added to LIMS to meet CDC requirements; AIMS LIMSConnect will be implemented to facilitate ETOR exchange with AIMS. AMD support: Acquire expanded cloud-based storage space for WGS and NGS and LINUX server for WGS management and analytical applications. Weaknesses ELR: o Overall % ELR not provided. Values are provided for specific systems/disease groups and range from 47% to 96%. o Plan to monitor data quality but no plan for how findings will be addressed. o Creating CSV schema for LRN labs to send findings to HD will translate into HL7 for consumption into surveillance system, rather than having the labs send ELR in HL7 compliant format. Case Notifications: o Plan to implement GenV2, Hepatitis and FDD MMGs in year 1 may not be realistic if priority is on re-configuring the surveillance system and that won’t be completed until the end of the project year. N/A N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002247 o Only Arboviral 1.3 MMG has been implemented, and is currently not being used due to system issues. Plan to implement 5 additional MMGs in the first year of new grant cycle but that seems ambitious with the NBS upgrade and SQL migration occurring during the same time period. Syndromic surveillance: o Tarrant Co will monitor completeness and timeliness but no plan to address issues identified. Houston is referenced in the application but limited information is provided on how the state and Houston will work together to enhance SyS. No mention of use of syndromic data at state level. Tarrant Co currently sending data to NSSP. Plan indicates incorporating 10 new facilities, however the facilities aren’t identified. o A milestone indicates a list of facilities registered for syndromic surveillance – focus should not be on creation of the list but rather develop strategy for reaching out and working with facilities to onboard. Position identified for facility recruitment at state level, which would be important for expanding coverage in areas outside 2/3 and 5/6, but this activity isn’t in workplan. EDX for lab: o Indicate intent to improve ability to message to surveillance system and CDC, but it is not clear how strategies under consideration will accomplish this. Acknowledged. Texas will work with Tarrant County and CDC post award to address any concerns. o The approach requested (LIMSConnect) is the AIMS functionality requested by the AIMS vendor, APHL, and CDC. LIMSConnect is a web service function developed by iConnect, vendor for AIMS, designed to integrate data transfer between AIMS and LIMS. All AR Regional Labs are TX-DSHS-19-1309-A-002248 o ETOR proposal seems to rely on provider manual entry and retrieval from AIMS portal. Additional Comments III. Evaluation Plan Maintain system: o Contract for work to stabilize and upgrade surveillance system will go out for solicitation in December, so the system will remain at risk for an extended period. Strategy 1h b. Only Arboviral 1.3 MMG has been implemented. Plan to implement 5 additional MMGs in the first year of new grant cycle seems ambitious with the NBS upgrade and SQL migration occurring during the same time period. Did the applicant report on required measures? requested to adopt LIMSConnect. CDC would continue to receive HL7 messages of results; however, these messages would be generated by the AIMS portal. This enables a faster turnaround time for standing up new testing, as AIMS uses LIMSConnect to read and write directly with the PHL LIMS, and HL7 messages from PHLs would be standardized for CDC consumption. o Acknowledged. The AIMS vendor has not shared plans for integrating ELR receipt or transmission from submitters. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. N/A TX-DSHS-19-1309-A-002249 Strengths Weaknesses Additional Comments IV. Budget (NOT SCORED) Strengths Did the applicant discuss how their plan for collecting necessary data to report in subsequent progress reports as well as inform future activities? The evaluation plan describes the required measures and how they will collect data to report in future progress reports: o Syndromic surveillance: number of facilities sending HL7 messages to the health department and BioSense Platform using CDC’s critical data quality reports. o ELR: number of facilities and number of lab reports submitted will be tracked. o LIMS: number of analyses being reported via AIMS to CDC. o Project C: The Medical Research Specialist will monitor progress by tracking the established measures, identify gaps requiring additional SME collaboration and communication. Quarterly meetings with agency programs to better integrate and enhance HIS capacity. N/A Evaluation plan is sufficient. Practical plan to generate requested measures and to monitor progress. The proposed budget presents expenses that are allowable, realistic, accurate, and clearly relate to activities in the work plan. The required personnel, professional and technical services, and/or travel for the budget period are clearly and adequately explained. The justifications for expenditures are reasonable and clearly explained. Roles proposed for additional proposed staff seem appropriate, but it is surprising that the HD doesn’t already have people, or at least positions, for these activities. N/A N/A N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002250 Weaknesses Additional Comments V. General Comments Regarding Content of Application $200,000 for contract with LIMS vendor (Labware) for update to the AIMS Lab Web Portal seems excessive. $300,000 for contract to migrate surveillance system from Oracle to SQL seems excessive. (This is in addition to contract for administration of surveillance system.) Budgeted costs for trainings (under “Other” and “Travel”) seem excessive. Some of these trainings may not exist (e.g., NEDSS System Administration and Management Training.) Requesting 6 new positions. Acknowledged. This is an estimate from the LabWare LIMS vendor for creating this totally new (to the vendor) functionality. Acknowledged, but unfunded. Acknowledged, but unfunded. N/A Texas has had significant challenges in maintaining the health information systems that need to be addressed this year. Acknowledged. Texas will work with CDC post award to address any concerns. The applicant described a project that will evaluate enhanced surveillance collection methods following a training initiative. Applicant demonstrates understanding of the need to work closely with epidemiologists and laboratorians to identify which areas might benefit from impact analysis. The application lacks specific information for several key aspects of the proposal: o No specific information is provided about the specific program, intervention or activity to be evaluated. o No outcomes of interest are specified (e.g. infections averted, interventions averted, length of hospital stay, cost per case averted). N/A Project D: I. Approach Strengths Weaknesses N/A Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002251 Additional Comments II. Work Plan for 2019 Strengths Weaknesses Additional Comments III. Budget (NOT SCORED) Strengths Weaknesses Additional Comments IV. General Comments Regarding Content of Application While it is important to evaluate surveillance data and its use in the field, the funding is intended to conduct a specific analysis of cost-effectiveness and/or public health impact of a program or policy in place. It is not intended to fund existing program activities. Acknowledged. Texas will work with CDC post award to address any concerns. N/A Some of the key proposed activities have an unrealistic timeline (i.e. complete surveillance enhancement in May 2020 and complete evaluation activity 2 months later). Some proposed milestones do not fit within the scope of the core required activities (i.e., completing surveillance enhancements. N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. N/A N/A Budgets times for personnel and travel are reasonable for the scope of the project and clearly justified. These items are appropriate for those activities identified in the work plan. It is unclear why Qualtrics is needed in addition to Tableau, ArcGIS, and SAS for analyzing the data. More information in the justification would be helpful. In general, the requested budget for software is quite high. N/A N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002252 Project E: I. Approach Strengths Weaknesses Additional Comments N/A N/A N/A Approved but unfunded component. N/A N/A N/A N/A II. Work Plan for 2019 Strengths Weaknesses Additional Comments N/A N/A N/A Approved but unfunded component. N/A N/A N/A N/A III. Budget (NOT SCORED) Strengths Weaknesses Additional Comments N/A N/A N/A Approved but unfunded component. N/A N/A N/A N/A IV. General Comments Regarding Content of Application The requested budget and work plans are unscored and considered “approved but unfunded.” If and when an unexpected or emerging issue arises, potential funding through this component may be available. This funding is envisioned to provide additional laboratory, epidemiologic and/or health information systems surge capacity necessary for enhanced surveillance due to factors such as technology change and expanding disease boundaries, or surge and response efforts associated with new or emerging infections, including outbreak scenarios. N/A N/A Approved but unfunded component. Acknowledged. Texas will work with CDC post award if outbreak occurs. Strengths Weaknesses Additional Comments N/A N/A N/A Project F: TX-DSHS-19-1309-A-002253 I. Approach Strengths Weaknesses Additional Comments II. Tier 1: Work Plan for 2019 Strengths Applicant provided a comprehensive problem statement and a clear justification to address the specific gaps mentioned in the problem statement. Applicant provided justification for proposed activities, including how implementation would improve surveillance and outbreak investigations. Applicant described current processes, staff resources, and existing infrastructure. Applicant notes plans to collect and report performance measures, and plans to use these data for program improvement. Detailed justification for the need for increase capacity to investigate cases of cryptosporidiosis and cyclosporiasis. Applicant provided a clear description of their current capacity and plans to extend that capacity in the transition to WGS and increased use of CIDTs. Application could be strengthened by providing additional detail in evaluation plan as to how data will be collected for all performance measures listed in the guidance. N/A N/A N/A The applicant responded to all core required activities. Implementation plans included process and steps that will be completed to carry out proposed activities. Application highlights close collaboration and coordination between the Department of State Health Services and local and regional health departments. N/A N/A N/A N/A N/A N/A N/A Acknowledged. DSHS will address these comments via direct communication with the CDC foodborne program staff. N/A TX-DSHS-19-1309-A-002254 Weaknesses Additional Comments III. Tier 2 Cyclo: Work Plan for 2019 Strengths Weaknesses Additional Comments IV. Tier 2 CryptoNet: Work Plan for 2019 Strengths Weaknesses The work plan provided by applicant was detailed and clear; milestones appeared reasonable for the proposed activities. Application could be strengthened by providing additional detail on how case surveillance data are or will be integrated into existing systems to enable data transmission (Strategy 1a, Activity Ib). Application could be strengthened by further breaking down milestones to measurable steps that will assist in monitoring progress for activities proposed in the implementation plans. N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Unclear whether this refers to all of the milestones or a few of them. DSHS will address these concerns via direct communication with the CDC Foodborne program staff. N/A Texas’s application had a clear implementation plan to conduct the proper laboratory methods required for Cyclospora genotyping. Their milestones were succinct and clearly laid out for a successful collaboration. N/A Budget included requests for supplies that seem sufficient and appropriate for proposed work plan for Cyclospora typing. N/A N/A N/A The work plan provided by applicant was detailed and clear; milestones appeared reasonable for the proposed activities. Application clearly indicates next steps to grow CryptoNet surveillance effort and expand lab testing. N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002255 Additional Comments CryptoNet ELC funding has remained stable, and unfortunately bringing on additional states and funding Tier 2 CryptoNet activities is not possible at this time. All CryptoNet related funding is associated with Tier 1 activities. However, if Texas is interested in consulting with CDC about working toward adopting the cryptosporidiosis tab in the Foodborne and Diarrheal Diseases MMG (FDD MMG), submitting Cryptosporidium specimens to CDC for typing, or joining CDC monthly CryptoNet state-CDC calls, please contact Ariana Perez at 404.718.7378 or oss0@cdc.gov. N/A Tier 2 OutbreakNet Enhanced: Work Plan for 2019 Strengths N/A N/A N/A Weaknesses Additional Comments The applicant sufficiently addressed each Tier 2: OutbreakNet Enhanced activity. The work plan provided by applicant was detailed and clear; milestones appeared reasonable for the proposed activities. The applicant highlights strong ongoing collaboration with a CoE. N/A N/A II. Budget (NOT SCORED) Strengths Weaknesses Additional Comments N/A N/A N/A N/A N/A N/A N/A N/A III. General Comments Regarding Content of Application Funding received under Section F should be used to support comprehensive activities for the detection, investigation and response, reporting, and prevention of foodborne, enteric, N/A I. N/A N/A N/A N/A TX-DSHS-19-1309-A-002256 waterborne, and environmentally transmitted infections and outbreaks Funding for MiSeq service contracts were capped at up to $12,000 per CDC DFWED/Section F funded sequencer. Requests for CIDT, serotyping, and PFGE supplies were not able to be supported. If requested, funding was provided in F2 for travel both to InFORM (no more than $1500) and a WGS or BioNumerics training (no more than $1500). Additional travel funding was provided for PulseNet Area Labs. Please contact project specific points of contact if included in the Budget Mark-Up and/or in the Objective Review Form. If you are unsure who to contact, or if you have general questions, feedback, redirection requests, or concerns, please contact Gwen Biggerstaff (fke8@cdc.govivz9@cdc.gov) or Anna Newton (). N/A N/A N/A N/A Project G1: I. II. Approach Strengths N/A Weaknesses Additional Comments The applicant describes the importance of HAI/AR response and prevention efforts in their jurisdiction. The application includes a compelling account of how program staff will build on previous successes to advance HAI/AR goals through internal infrastructure and collaboration with partners. The applicant adequately describes their plan and ability to collect and submit measures required during Budget Period 1. No comments provided. No comments provided. Work Plan for 2019 N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002257 Strengths Weaknesses III. N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Additional Comments The applicant identifies settings for prevention-based onsite assessment during BP1, however does not identify a target number of assessments within their application. Budget (NOT SCORED) Strengths N/A The required personnel, professional and technical services, and/or travel for the budget period are clearly and adequately explained. N/A Approved budget includes Tier 2 funds. Please review the budget mark-up for details. Important instructions are noted in the CDC Program Notes column (column L) in the budget mark-up file. N/A N/A CDC Division of Healthcare Quality Promotion (DHQP) will provide additional feedback on proposed activities in conjunction with recipient post-award calls. Acknowledged. Texas will work with CDC post award to address any concerns. Weaknesses Additional Comments IV. The applicant provides a detailed work plan, including a summary of the program’s capacity and prior successes, which clearly describe how the applicant intends to make progress on core HAI/AR priorities, including: containment and response, lab-epi coordination, onsite assessments, and prevention efforts. The applicant proposes an innovative and promising Tier 2 Data Validation project. See budget markup for related award. See general comments regarding content of application (Section IV, below). General Comments Regarding Content of Application N/A Acknowledged. Texas will work with CDC post award to address any concerns. DHQP anticipates that Tier 2 recipients will be able to apply for continued Tier 2 funding in BP2 and BP3. Future funding will depend on performance. Additionally, as described in the NOFO, Tier 2 activities are expected to be time-limited, with 2- to 3-year TX-DSHS-19-1309-A-002258 periods. Recipients should not expect Tier 2 activities to continue beyond 3 years. Project G2: I. Approach Strengths Weaknesses N/A N/A Cites increased recruitment efforts (without description), but acknowledges low enrollment of healthcare facilities as submitting partners within the state and regionally, and that most isolates are coming from within the state. With respect to Candida testing, the applicant cites gaps in recruitment efforts and that Texas HAI epidemiologists have "focused their efforts on AR prevention and containment leaving little time for Candida for Candida recruitment". For a regional laboratory, this type of response and lack of prior initiative is unacceptable. In the justification, the applicant indicates they will hire and train more staff to meet demands of increased testing volumes, specifically citing from TX; however, in the previous section the applicant just cited low participation of submitting partners both for CRE/CRPA/CRAB and Candida testing. The laboratory's plans for addressing recruitment gaps includes developing communication and outreach plans and to hire 3 new staff: Lab-epi coordinator and 2 HAI epidemiologists for TX regions. Communication and outreach plans are indeed a good strategy; however, it is unclear why these plans would just now be implemented (at outset of year 4 of testing) - when this has been a recommended/requested strategy of regional labs since 2016. N/A N/A Acknowledged and not funded for submissions outside of Texas. Acknowledged, but unfunded. The number of submissions from each existing partner has increased, therefore the specimen volume is expected to increase. Acknowledged, but FTEs were unfunded. Although the plans were not formalized in previous years, communication and outreach was conducted in previous years. DSHS has plans to formalize more TX-DSHS-19-1309-A-002259 Also, the reference to (2) TX epidemiologists as a solution for regional outreach underscores the laboratory's state-centric focus. Approach (and budget) indicates substantial dedicated IT funds to build infrastructure for test ordering and data reporting through the AIMS portal. The applicant has implemented data reporting and ELR for all available programs (understood that ELR is pending for CRE/CRPA/CRAB and C. auris colonization), and developed their own electronic test order and resulting platform (unclear whether they will adopt the CDC-recommended version), thus it is unclear what additional capacity this costly, enhanced IT infrastructure will provide. II. Work Plan for 2019 Strengths Weaknesses N/A Plans to train and cross train staff to maintain adequate workforce. Good demonstration of providing surge capacity when needed. Highly competent in GC testing and consistently shipping isolates to CDC-LRRB on time. Plan to expand GC activities by 30% by hiring additional staff. Plan to increase isolate testing volume from 3,000 to 4,000-4,500 however, given details provided with workflow, this may be unfeasible. No information including regarding TARP portal system for CPO screening and no details provided about how this system aligns with or integrates with APHL LabWeb portal. comprehensive plans in the current fiscal year. Acknowledged, but additional clarification is needed. DSHS will work with CDC program staff to address this. Our approach is based on APHL and AIMS recommendations. N/A N/A N/A N/A N/A Acknowledged. The DSHS Laboratory will evaluate workflow to accommodate increased specimen volume. The DSHS Laboratory did not implement its own ETOR platform; it implemented the AIMS Lab Web Portal (simply called TARP (Texas ARLN TX-DSHS-19-1309-A-002260 Portal) to differentiate it from the DSHS Laboratory system that was built pre-ARLN). This was a misunderstanding of nomenclature. Still working on integrating reporting of GNX2F results through The DSHS Laboratory is still LIMS. working toward interfacing the instrument to LIMS which will not impact reporting of results through LIMS. Not clearly described whether the applicant has implemented ETOR Acknowledged. The DSHS functionality. Laboratory will clarify in the next application that we have implemented ETOR functionality. This approach described for describing an AR lab expert doesn't Acknowledged. The DSHS support streamlined operations and isn't aligned with the intent or Laboratory will identify one request of this required activity - to identify a single AR expert and point of contact for the AR POC as opposed to identifying multiple AR experts. The breadth of Laboratory. engagement is applauded, but the strategy lacks cohesion. Unclear why some milestones listed are already not in place as Acknowledged, however opposed to ongoing activities. additional clarification is needed. It is unclear which milestones are referenced here. There is no option for “ongoing” activities under the drop-down menu. Selecting an “achieved by date” is required. More details regarding lab/epi functions/coordination would have Acknowledged. DSHS strengthened application and details regarding initial initiative to currently has coordinated TX-DSHS-19-1309-A-002261 develop a plan to-date would be helpful (no ongoing plans or policies were described in work plan). Limited details provided regarding increasing Candida isolate submission. Unclear which method of C. auris colonization screening has been implemented. Specified timeline for implementing ExAST program seems unreasonable, additional details and explanation would be helpful. Planning to hire regional lab-epi and 2 Texas HAI coordinators to help with specimen recruitment and other duties. Unclear what these other duties would be and if that's specific to the coordinator role or the HAIC. Cited addressing gaps in Candida recruitment as a key activity. Justification/response suggests the applicant does not have a clear understanding of the functionality of reporting systems (APHL AIMS/LabWeb portal). efforts between lab and epi groups that include regular meetings, workgroups and sub workgroups for specific outbreaks, an email box to share data and results that is monitored regularly, and shared folders that store common documents. DSHS will work towards documenting these activities and functions for the next application. Acknowledged, but unfunded. Candida colonization by culture has been implemented. Acknowledged, but unfunded. Acknowledged, but unfunded. DSHS Laboratory requests clarification of this statement. The DSHS Laboratory implemented the AIMS Lab Web Portal, which is used for TX-DSHS-19-1309-A-002262 Additional Comments electronic ordering and reporting for Carbapenemase Resistant Organism (CRO) Colonization testing. The AIMS Reporting Portal is used for electronic reporting only for CRE, CRPA, Candida, and other organisms. Describes AFST capacity, but that is not a tier 2 activity. Acknowledged. The DSHS Laboratory will not include tier 3 activities in tier 2 descriptions. Applicant lab indicates use of the LabWeb portal for ETOR of CPO Apologies for the confusion. colonization screenings, but then mentions TARP. This is confusing. TARP = ETOR of CPO colonization screening. CDC is not aware that there are plans in place to supplant the Our approach is based on current HL7 messaging specifications for already implemented test APHL and AIMS reporting. Applicant also states to use LabWeb portal for GC data - recommendations. unless the lab is undertaking this venture on their own, CDC is not currently supporting the development of ETOR functionality for GC testing. This would not be advised, as the CDC GC program relies on the current reporting structure to track testing and submissions back to labs. Attention to detail is lacking - it is unclear whether there are Acknowledged. Texas will copy/paste errors that created duplicate, incorrect content for work with CDC post award to multiple activities, or if there is truly a lack of understanding of the address any concerns. types of tests that are relevant to the individual tiers and/or organisms (e.g. AST is not a tier 1 activity, Candida AFST is not included in Tier 2), critical SOP information is missing for some activities (e.g., C. auris colonization), or workplans were provided/addressed under the wrong activity. For several TX-DSHS-19-1309-A-002263 activities, the applicant provides delayed implementation timelines for activities or deliverables that should already be in place. Of particular concern are TAT (the applicant does not indicate whether testing results are available within the prescribed 2 days, but cites planned procedures, including the dedicated efforts of 4 additional staff to ensure TATs are met - this raises questions of whether TATs are not being met currently) and procedures/plans for containment response and outreach for isolate submission. For these activities, particularly with the lab serving as a regional lab, it is extremely disappointing that 1) they are not already in place, and 2) implementation timelines for these basic policies/procedures are forecasted for as late as April 2020. For person responsible for milestones, would be helpful to have the person responsble listed, rather than the position, for easier crossreferencing to budget or understanding of staffing contributions atlarge. With respect to CRE/CRPA testing, the laboratory is testing high volumes, approaching capacity and offers the full suite of testing. However, it is disappointing to see the acknowledgement of low Candida testing volumes, the plan to do additional outreach to test more, but stating that the goal is not to test 1,000 isolates as requested by the NOFO guidance, but instead to incrementally work to that goal by the end of the 5-year cycle. Given that the nation is facing a serious emerging drug-resistant threat, and that neighboring regions are already battling outbreaks, the dismissal of the requested testing volume is unsatisfactory. Workplans for GC work were concise and clear - evident that the laboratory demonstrates continued skill and high performance in this testing area. III. Budget (NOT SCORED) TX-DSHS-19-1309-A-002264 Strengths Weaknesses N/A The budget lacks adequate justifications for requests. Supplies and consumables are lumped together with no rationale for testing volume or cost per testing activity. It is extremely difficult to determine how funds are allocated and used per test and the applicant provides no reference for testing volumes. The same FTE descriptions are provided for both microbiologists and molecular biologists, so it is unclear what the contribution of these staff are to the program. Excessive/unnecessary travel is requested. The applicant lists inappropriate items under mandatory costs, doubly listing service contracts under multiple tiers, and included a conference registration as a mandatory cost. Additional Comments Costs for regional lab-epi meeting are, in majority, should be covered by a separate cooperative agreement between CDC and APHL. CDC will not fund applicant’s request for core testing of regional activities under the HAI/AR Program (G2), Tier 3 of ELC NOFO. N/A Acknowledged, only partially funded. Additional clarification is needed. Which part of the budget does this reference? Acknowledged, the DSHS Laboratory will include the cost per sample in future applications. This is included in the DSHS budget template. Acknowledged. The Molecular Biologist III, Priti Patel was temporarily assigned to perform conventional testing to meet testing demands. Acknowledged, but unfunded. The DSHS Laboratory has multiple units of the same instruments on the same service contract that were listed in different tiers. We will provide specific details on the instruments (ex, serial numbers) to reduce confusion on the next application. Acknowledged, but unfunded. Acknowledged. Texas will work with CDC post award to TX-DSHS-19-1309-A-002265 Applicant has shown strong capacity for GC testing and CDC will address any concerns for fund these activities for this funding year and until transition to funded activities/positions. new regional lab for the Mountain Region. CDC will schedule a call within 30 days of award to discuss transition of core testing and communications to the new regional lab or an interim lab providing surge capacity during transition. CDC is providing continued funding for the HAI/AR Program (G2), Tier 1 and 2 activities to support state testing of CRE/CRPA and Candida ID. IV. General Comments Regarding Content of Application N/A N/A Large population, large geographical area, mobile/fluid border, prevalence of vectors. Endemic for WNV, Chagas, and rickettsial diseases. Highly mobile Texas-Mexico border populations increase risk of introduction of other diseases. Maintain core testing capacity for CHIK, DENV, and ZIKV using the CDC Trioplex Real-Time RT-PCR assay, and IgM testing for CHIK, DENV, ZIKV, WNV, SLE, and immunofluorescence assay (IFA) testing for IgG antibodies against Rickettsia rickettsia, Rickettsia typhi, and Ehrlichia chaffensis to enhance awareness of disease distribution, serve as diagnostic resource when epidemiologists need verification of commercial laboratory results, and detect possible transmission of emerging arboviruses. N/A Project H: I. Approach Strengths Problem Statement Justification N/A N/A TX-DSHS-19-1309-A-002266 Applicant Capacity Evaluation Plan Description of Collaboration Weaknesses Additional Comments ZIKV testing guidelines unique to Texas recommends Zika PCR testing three times during pregnancy for asymptomatic pregnant women residing in nine counties three times during pregnancy using PCR, as south Texas counties are at higher risk for local transmission, and Zika PCR and IgM for symptomatic individuals with no reported no travel or sexual exposure to someone who traveled to an area of active ZIKV transmission. Current capacity and testing activities achieved with ELC and ZIKA supplemental funds. Use ELC funds to reduce Disease in Nature Conference registration fee for all attendees to increase attendance. Arbovirus laboratory provides mosquito species identification, population counts, mosquito pool testing, and insecticide resistance testing. Capacity for molecular testing of mosquitoes for WNV, SLEV, EEEV, WEEV, DENV, ZIKV, CHIKV. Cell culture testing conducted on 15% of mosquito trap submissions to screen for new arboviral threats. Requesting support for new molecular biologist to support increased volume of mosquito testing. Highlighted Zika and Hurricane/Crisis investments – want to maintain and grow staffing in Lab, EPI, and Ecology. Submitted a background of reporting/completeness and accomplishments. Western Gulf COE, Partner Institutes, over 280 counties… N/A N/A Important state for arboviral diseases due to moderate burden on endemic arboviruses (WNV, SLEV, EEEV, LACV), large number of travel-associated disease cases, and risk of introduction and local transmission of exotic arboviruses. Grantee provided a very long N/A N/A N/A N/A N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002267 II. Work Plan for 2019 Strengths Tier 1 but comprehensive and thoughtful summary problem statement, justification, and evaluation plan. Nicely outlined the burden, current capacity, and role that ELC funding can take to fill that capacity, all in the context of supplemental Zika funds and the hurricane funding. It was nice to see mention of tickborne relapsing fever, as this has been an emerging issue in the state. Grantee provided a response to each activity in Tier 1. For a majority of the activities, the grantee provided an adequate narrative to capture the key processes that will be undertaken. For some activities, grantee was able to provide more information to the vector team on the processes to improve data quality and reporting to respective CDC systems as well. Relevant internal and external collaborators were also reported for activities in Tier 1. Suggestions to improve the narrative will be captured within the weaknesses section and within the additional comments sections below. For applicable activities in Tier 2 and 3, grantee responses were adequate unless otherwise indicated. Notable activities in the applicable tiers are captured below. N/A N/A N/A N/A Activity 1.4: Good overview of activities focused on data analysis N/A of arboviral diseases. Included plans to distribute weekly disease reports and annual disease summaries through email and posting on the agency website. Notify appropriate staff when they detect a significant event or trend that requires action. Activity 2.2: Great to see that support to local entities. N/A Epidemiologists provide state entomologist with spatial and temporal data on human and animal Vector-Borne disease cases to guide local jurisdictions on vector control to reduce human VectorBorne disease risk. TX-DSHS-19-1309-A-002268 Tier 2 Tier 3 Weaknesses Tier 1 Activity 3.1: Also included plans to validate Rickettsia 510K assay – great to see this included and is strongly supported. Activity 5.1: Clearly illustrated capacity in response by describe recent experience working with CDC during the Zika response. Staff will be involved in future outbreaks of vector-borne diseases including the timely dissemination of critical data. Activity 2.3: Outlines state capacity to provide support to local entities. Currently provides mosquito identification and counts to jurisdictions. Interested in providing vector surveillance kits to jurisdictions that are not conducting surveillance; will provide training on trap use and placement. Activity 1.9: TX clearly highlighted their capacity to lead and coordinate investigations involving multiple jurisdictions and agencies with examples of previous responses. Activity 5.3: Good outline of efforts by Arbo Lab and State Medical Entomologist to work with Regional/Local Health Departments and mosquito control entities to develop their own integrated vector surveillance and control plans. Activity 8.3: Zika outbreak is a good example of grantee’s ability to weigh evolving scientific knowledge and field experience to modify prevention and control messages and coordinate with local partners to reach target audiences with current information using a variety of communication methods. N/A Activity 1.1 - Does not address HL7 reporting. Does not address overall completeness of reporting. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Activity 1.2 - Does not address interactions with blood collection agencies or efforts to improve capture. Does not address overall completeness of reporting. N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002269 Activity 1.3 - Does not address interactions with hospitals or transplant providers to improve case identification and capture. Does not address overall completeness of reporting. Activity 2.2 - Does not address how other guidance is provided to local agencies but express need for two additional regional entomologists to help with this process. Activity 3.1 - Arbovirus Lab Core capacity described “current targets” ZIKA, DEN, CHIK (no mention of endemic viruses). Activity 6.1 - Does not directly address outreach and education of public. Tier 2 Tier 3 Activity 1.5 - Report diseases that are not nationally notifiable but are notifiable in Texas (murine typhus, louse-borne typhus, Chagas disease, leishmaniasis, and tick-borne relapsing fever. Does not address reporting of other arboviral diseases that are not notifiable nationally or in Texas. Activity 1.8 - Summarize previous experience during Zika response but not plans for further case investigations going forward. Activity 1.9 - Milestones are more consistent with Tier 1 capacity to identify viremic blood donors. Activity 8.3 - No specific proposed current or new activities to evaluate prevention messages. Activity 8.4 – Need more details for this activity. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. to to to to to to to to to TX-DSHS-19-1309-A-002270 Activity 8.5 - Videos are not really for public consumption, and technical audience guides are available via other resources. Additional Comments III. Budget (NOT SCORED) Strengths Weaknesses Additional Comments Comprehensive application – evaluation plan and approach were strong, milestones less so. Would like to have seen activities and milestones addressed better and more aligned with intent of activity. This was a strong Tier 2 proposal with emphasis on mosquito surveillance and testing and was limited in addressing of Tier 3 capacities. Texas has a high burden of R. typhi infections and this is an important issue in the region. We expected to see some activities relating to the understanding and control of R. typhi. Please consider for next year. Arbo lab tests mosquitos collected for WN/SLE/WEE ZIKA/DEN/CHIK, and EEE. Requesting additional personnel for testing and analysis. Funds for cell culture and molecular testing of 20,000 pools (highly supportive of this activity especially isolations). For future application, please refrain from only using the product description as justification in the budget template. We’d like to see TX improve their justification in the supply budget and provide a better overview of the requested items. This could be improved by avoiding adding individual items (going over the 65 available slots) and instead, by consolidating by similar activities or methods and provide overall budget for clarity. Should other funding become available, our team will work with your jurisdiction to identify appropriate activities. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. N/A Acknowledged. The Arbo Lab supply budget was mostly funded except for the primary reagents needed for testing, RNA extraction kits and qRTPCR enzyme kits. Based on the awarded funds, there will be a significant reduction in the mosquito testing services provided going forward. Acknowledged. Texas will work with CDC post award to TX-DSHS-19-1309-A-002271 address any available funding for unfunded activities. IV. General Comments Regarding Content of Application Thank you applying to Program H. Our aim is to strengthen and support your jurisdictions capacity for surveillance, diagnosis, and reporting of vector-borne diseases over the next five years. We know the application process this year was challenging and appreciate learning more about your jurisdiction’s goals and priorities for vector-borne diseases under the new Program H guidance. This year’s application cycle was very competitive with over $49,000,000 in jurisdiction funding requests. DVBD was able to provide over $16,300,000 in funding this year. Once ELC awards are made, DVBD will be contacting you to set up a kick off call between DVBD program and technical staff and your jurisdiction. In advance of this call, DVBD will be sending you a Milestone Checklist to complete. This document will clarify which milestones your jurisdiction plans to complete based on the funding amount you received. We encourage your jurisdiction to work closely with your Program H program consultant and ELC project officer to expedite requests for technical assistance. DVBD would like to maintain good communication with your VBD program to ensure your success in the coming year. Please reach out to our team (VBDELC@cdc.gov) to expedite requests for any redirections as necessary to support vector work in your jurisdiction. 2019 funding constraints included, but were not limited to the following: With limited exceptions, DVBD was unable to fund new positions. o With limited exceptions, DVBD was unable to fund positions created and funded with Zika supplemental funding and shifting to ELC Program H funding this year. Acknowledged. Texas will work with CDC post award to address any available funding for unfunded activities. Acknowledged. Texas will work with CDC post award to address any available funding for unfunded activities. Acknowledged. Texas will work with CDC post award to address any available funding for unfunded activities. Acknowledged. Texas will work with CDC post award to address any available funding for unfunded activities. TX-DSHS-19-1309-A-002272 o With limited exceptions, out of state travel support was limited to attending DVBD Vector Week and the Lyme and Other Tickborne Disease Meeting for High Incidence States. o We were unable to support new equipment or equipment service agreements in 2019. Project J: I. Approach Strengths Weaknesses Provided excellent background information for the three public health regions (PHR). Strong justification for need, use appropriate data to support approach. Included quantitative analysis of disease control gaps. Provided interesting data on current use of the binational variable and aims to scale its use. Used Support documentation to provide more detailed information. Evaluation plan could be better delineated. II. Work Plan for 2019 Strengths N/A N/A N/A Capacity to carry out the activities in the different regions is not well established, but a plan to achieve the capacity was clear and well defined. N/A Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Acknowledged. Texas will work with CDC post award address any concerns. Core activities were addressed and appropriate timelines in place. N/A A great deal of the application concerned vector surveillance, which is not a BIDS activity. Additional Comments N/A Provides different levels of details for each PHR; with PHR 9/10 most clear. to to to to TX-DSHS-19-1309-A-002273 Weaknesses Meet all requirements and criteria. Wide breadth of projects. Incorporates projects across the three border PHRs with different priorities based on their needs/epi. Large volume and milestones are not very specific or measurable in many instances. Lack of detail suggests slow scale up of binational variable in the PHRs. No mention of drug resistance as an important component of any activity. III. Budget (NOT SCORED) Some concern about the amount of new salary positions, which may be hard to acquire/hire in short timeframe. Strengths Weaknesses Reasonable focus on staffing and regional travel. Applicant requested staff (entomologist) and supplies to support vector testing and surveillance which BIDS is not able to support. BIDS staff reached out to the Division of Vector-Borne Diseases (DVBD) about the vector positions described in the application since those activities fall outside of BIDS scope. DVBD’s response was that with very limited exception, they are unable to fund new positions in any jurisdiction this year. Additional Comments IV. General Comments Regarding Content of Application BIDS staff reached out to the Division of Vector-Borne Diseases (DVBD) about the vector positions described in the application since those activities fall outside of BIDS scope. DVBD’s response was that with very limited exception, they are unable to fund new positions in any jurisdiction this year. N/A N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. N/A Acknowledged. Acknowledged. N/A TX-DSHS-19-1309-A-002274 Project K: I. Approach Strengths Weaknesses Additional Comments N/A N/A N/A The quality of the application is not scored. Please see the additional comments at the end of this document. N/A N/A N/A N/A II. Work Plan for 2019 Strengths Weaknesses Additional Comments N/A N/A N/A The application repeatedly indicates that BIDS (Section J of this cooperative agreement) staff would be engaged in these activities. The BIDS staff that DGMQ funds are not allowed to conduct work as outlined in this application. BIDS staff must be focused on the activities approved and funded by DGMQ under Section J of this cooperative agreement. N/A N/A N/A Acknowledged, but unfunded. III. Budget Strengths Weaknesses Additional Comments N/A N/A N/A N/A N/A N/A N/A N/A IV. General Comments Regarding Content of Application Strengths Weaknesses Additional Comments N/A N/A N/A N/A The scope of the program for training US Customs and Border Protection (CBP) partners in illness identification is conducted by CBP N/A N/A Acknowledged, but unfunded. TX-DSHS-19-1309-A-002275 both at their academy and after academy refresher training in coordination with CDC DGMQ Quarantine Stations. This is an inherently federal government activity and is part of a standing Memorandum of Understanding (MOU) between the CDC and the Department of Homeland Security (DHS). This activity would not be contracted out to a state government. Even if it were possible to contract to a state government, it is unclear how the applicant would carry out the proposed activities as they have not demonstrated any existing prior relationship with CBP to handle a program with these broad objectives. DGMQ BIDS programs are not allowed to use BIDS-funded staff to conduct any tuberculosis (TB) activities or programmatic work with port partners as is proposed in this application. None of these activities are approved and none are funded. Project L: I. Approach Strengths The applicant provides a thorough background to put into context N/A their request for funding for active prion surveillance. o Applicant provides background on CJD in TX. Very thorough justification for continued funding is presented. N/A The applicant thoroughly and completely describes current N/A resources, processes and steps planned to implement prion surveillance. Of note: o The Prion Disease Coordinator consults with the Texas Parks and Wildlife Dept (TPWD) on the epidemiology of CWD in Texas. CWD surveillance in deer is overseen by the TPWD, which has regulatory authority for free‐ranging white‐tailed deer and mule deer, and the Texas Animal Health Commission (TAHC) which TX-DSHS-19-1309-A-002276 Weaknesses Additional Comments II. Work Plan for 2019 Strengths Of note: Weaknesses has regulatory authority for alternative livestock (elk, red deer, sika deer and their hybrids), and the herd certification program for interstate movement. TPWD performs the majority of CWD testing within Texas and would be an excellent collaboration partner. The applicant describes the data systems already in place to be used for evaluation. The applicant has reliable and consistently collected data since 2005. The applicant does not clearly state that they will use evaluation data/information to identify gaps in surveillance and inform improvement. N/A The applicant did respond to all core required activities. Their implementation plans and description of milestones were adequate (except where noted in Weaknesses below). Quarterly review of death certificate data. Applicant specifically states that communication with public and others will use “layman’s terms”. Texas plans to work collaboratively with the TPWD and TX Veterinary Med Diagnostic Lab to remain informed about CWD surveillance. Generally, discussion of implementation plans is lacking detail. Mostly they have just restated the strategies. An absolute number of 10 or more referrals to NPDPSC for adequate documentation of referrals is not really a helpful indicator. Perhaps the % of possible cases referred to NPDPSC and an explanation of why referrals were made or why they were not would be a more useful measure of performance. N/A Acknowledged. Texas will work with CDC post award to address any concerns. N/A N/A N/A N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002277 It would be helpful to know why no facilities within the state have so far been identified to perform brain autopsy. Additional Comments III. Budget (NOT SCORED) Strengths Weaknesses Additional Comments IV. General Comments Regarding Content of Application N/A Acknowledged. Texas will work with CDC post award to address any concerns. N/A The proposed expenses are allowable, reasonable and relate to activities in the work plan. Personnel activities are clearly explained. The justifications for expenditures are reasonable and clearly explained. N/A 2019 Requested: $112,002 2019 Recommended $106,435 N/A N/A N/A Very thorough and articulate in every section. Applicant expertly described challenges faced by the program. N/A N/A N/A N/A N/A Well-described, appropriate and measurable milestones. The work plan relates to and supports what is presented in the Approach. N/A N/A N/A N/A N/A N/A N/A N/A N/A Project N: I. Approach Strengths Weaknesses Additional Comments II. Work Plan for 2019 Strengths Weaknesses Additional Comments N/A N/A N/A N/A TX-DSHS-19-1309-A-002278 III. IV. Budget Strengths N/A N/A Weaknesses Additional Comments N/A Proposed budget is well-explained, justifiable, and pertains to activities proposed in the work plan. N/A N/A General Comments Regarding Content of Application Some budget requests could not be funded for BP1 due to funding constraints. We encourage applying again in BP2 for the Chagas disease activities. Acknowledged. Applicant provides a clear and detailed description of the jurisdiction’s needs, system gaps, and the populations being served including the public health impact; employment of a strategic effort to address public health priorities; and the current infrastructure and resources for project implementation. None noted. N/A N/A N/A N/A Project O: I. Approach Strengths Weaknesses Additional Comments II. Work Plan for 2019 (Budget Period 1) Strengths Applicant provides a clear description of the strategic approach to achieve desired outcomes for the required strategies. Implementation plans are detailed and clear with discrete, measureable milestones appropriate for the planned activities with timelines reasonably aligned. N/A N/A N/A N/A TX-DSHS-19-1309-A-002279 Weaknesses Additional Comments III. Evaluation Plan Strengths Weaknesses Additional Comments IV. Budget (NOT SCORED) Strengths Weaknesses I. Approach – Meningococcal Disease – Tier 1 Strengths Application contains clear intent to coordinate VPD surveillance across epidemiology, laboratory, immunization, and health information partners within the jurisdiction. Work plans propose a number of collaborations that will enhance data collection, reporting, and use. None noted. N/A N/A Applicant provides a clear and detailed plan to collect data to report on the required performance measures, addressing the elements in the 2019 Continuation Guidance, and describing strategies to use performance measures and evaluations. None noted. N/A N/A The proposed budget present expenses that clearly relate to activities in the work plan and the required personnel are adequately explained. The justifications for expenditures are reasonable and clearly explained. None noted. N/A Texas is not proposing any new projects related to meningococcal disease but will continue to conduct the enhanced surveillance activities. A strategic approach is described to use the VPD coordinator currently in place to improve surveillance and ensure all key variables are collected. N/A N/A N/A N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002280 Weaknesses II. III. Work Plan for 2019 (Budget Period 1) Strengths Texas provides a reasonable implementation plan with appropriate and clear milestones and outputs. Specific plans are outline for educating local and regional health partners to ensure collection of meningococcal disease specific variables. Weaknesses None. Evaluation Plan Strengths Weaknesses I. None Approach – Varicella – Tier 1 Strengths Weaknesses N/A N/A N/A Texas provided a detailed plan to collect the meningococcal disease specific data elements according to CDC guidance and report on the performance measures listed in the 2019 guidance. Additionally, they provided specific information on how the performance measure feedback would be used to improve surveillance None. N/A The application includes a detailed description of the public health burden in the jurisdiction, providing specific measures like population, live births, vaccine exemptions, and populations vulnerable to VPDs like migrants. The strategic approach to achieving performance outcomes is clearly stated and feasible. A thorough description of their capacity facilitates assessment of the feasibility of their proposed strategic approach. None noted. N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002281 II. Work Plan for 2019 (Budget Period I) Strengths Varicella is a reportable disease in the jurisdiction, and the applicant does a good job of addressing how they will improve their existing program. The proposed work plan is clear and reasonable. Weaknesses Only one staff (Epidemiologist II) will be responsible for completing all of the ELC activities; this may not be feasible. Some milestones could be made more discrete/measurable, for example “evaluate and enhance existing processes.” III. I. Evaluation Plan Strengths Weaknesses Approach – Acute Flaccid Myelitis – Tier 1 Strengths Weaknesses N/A N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. The applicant reports on all required measures for varicella. The application could be improved by stating specifically what the timeline and expectations are for the project (vs. stating that they will be established). N/A Acknowledged. Texas will work with CDC post award to address any concerns. The application includes a detailed description of the public health burden in the jurisdiction, including a description of AFM cases and public health resources used to respond to AFM cases. The strategic approach to achieving performance outcomes is clearly stated and feasible. A thorough description of their capacity facilitates assessment of the feasibility of their proposed strategic approach. None noted. N/A N/A N/A N/A TX-DSHS-19-1309-A-002282 II. III. Work Plan for 2019 (Budget Period 1) Strengths The proposed work plan is detailed and clear and addresses all of the components for the AFM activities. Weaknesses Only one staff (Epidemiologist II) will be responsible for completing all of the ELC activities; this may not be feasible given the size of their jurisdiction. Some milestones could be made more discrete/measurable, for example “evaluate and enhance existing processes”. Evaluation Plan Strengths Weaknesses Varicella – Tier 2 Reviewer Comments Regarding Tier 2 Varicella Activities Mumps – Tier 2 Reviewer Comments Regarding Tier 2 Mumps Activities N/A Acknowledged. Texas will work with CDC post award to address any concerns. Acknowledged. Texas will work with CDC post award to address any concerns. The applicant reports on all required measures. The application could be improved by stating specifically what the timeline and expectations are (vs. stating that they will be established). N/A Acknowledged. Texas will work with CDC post award to address any concerns. While all of the components of the varicella tier 2 activities are met, the applicant could provide more detail on what they define as a “baseline” for key variables. A strength of the application is that they specify a measureable milestone for data completeness (90%). Acknowledged. Texas will work with CDC post award to address any concerns. The application states verbatim the components for the mumps tier 2 activity in their implementation plan. The application would benefit from providing specific details in the milestones about how the jurisdiction will accomplish the goals. A strength of the application is that they plan to contact clinicians to request submission of lab specimens to ensure testing for mumps cases. Acknowledged. Texas will work with CDC post award to address any concerns. TX-DSHS-19-1309-A-002283 However, they could include more strategic ways to communicate with partners to achieve this activity, versus relying on individual notification. Acute Flaccid Myelitis – Tier 2 Reviewer Comments Regarding Tier 2 Acute Flaccid Myelitis Activities Invasive Pneumococcal Disease – Tier 2 Reviewer Comments Regarding Tier 2 Invasive Pneumococcal Disease Activities All components of the AFM tier 2 activities are included. The Acknowledged. Texas will application could be improved by providing more detail on how the work with CDC post award to jurisdiction will improve its current procedures (examples of how address any concerns. they can reduce the interval between onset and collection) and communicate with partners (i.e. what communication tools/mechanisms are already available). The applicant proposes establishing a workgroup with pediatric neurologists and parents of AFM patients to ensure long-term follow-up data are collected for the confirmed and probable AFM cases. The work plan provided by applicant was detailed and clear; N/A milestones appeared reasonable for the proposed activities. Continued work obtaining IPD isolates for serotyping is valuable to understand current strains circulating. Ensuring complete reporting of key data elements is also very helpful. Project P: I. Approach Strengths TX provided key information around the needs of jurisdiction with a particular focus on building and training a multidisciplinary investigative team. The applicant described plans and ability to collect data and report on measures and evaluation data. N/A N/A TX-DSHS-19-1309-A-002284 Weaknesses Additional Comments II. Work Plan for 2019 Strengths Weaknesses Additional Comments III. Budget (NOT SCORED) Strengths N/A N/A N/A N/A Applicant responded to all core required activities and will develop an evaluation tool to analyze effectiveness out outbreak response protocol. The work plan provided by applicant was detailed and clear; milestones appear reasonable for the proposed activities. N/A N/A N/A The proposed budget for required personnel, professional and technical services are clearly and adequately explained. N/A Weaknesses Additional Comments IV. General Comments Regarding Content of Application N/A N/A N/A N/A N/A Thank you for your application. We look forward to working with you! Acknowledged. Texas will work with CDC post award to address any concerns. Full funds are not available to support all program activities. If the scope of activities needs to be adjusted based upon funds available, please contact CDC Legionella program (Laura Cooley, LCooley@cdc.gov and Candis Hunter Chunter@cdc.gov) before starting work to discuss modifications. Note: funding is not guaranteed to be continued after this year TX-DSHS-19-1309-A-002285 Project Q: I. Approach Strengths Problem Statement Justification Applicant Capacity Evaluation Plan Weaknesses Additional Comments II. Work Plan for 2019 Texas Department of State Health Services (TDSHS) has a N/A voluntary surveillance system including both epidemiology and laboratory components that provide useful data to the national surveillance system. TDSHS described the importance of an Influenza Surveillance system at their state. Along with mentioning the state needs, TDSHS also provided a clear understanding of the challenges that are being faced. TDSHS provided core information around the needs of their jurisdiction. Applicant also went above and beyond to give context to the gaps and needs of their jurisdiction as well as gave quantitative evidence. Also shed some insight on the issues they face with voluntary surveillance practices. Applicant indicated the importance of activities and identified gaps that will be filled or alleviated by their proposed plans and improvements. TDSHS described current resources and processes and steps planned to implement activities. They also described their current staff and infrastructure. Applicant provides detailed evaluation plan including data sources as well as explicit information regarding gap identification. None identified. N/A N/A The Texas Department of State Health Services has a comprehensive and well-defined work plan in place that clearly describes the purposes of surveillance pertaining to outbreak surveillance, public health action driven by surveillance, coordination and communication across jurisdictions and with the CDC, and laboratory capacity and coordination. N/A N/A N/A N/A N/A N/A TX-DSHS-19-1309-A-002286 Strengths Weaknesses Additional Comments The Applicant responded to all of the required core activities and N/A the implementation plan describes the steps and processes that will be carried out. Milestones are discrete and measurable. None identified. N/A For the 2018-2019 season, Texas met their ILI regular reporting N/A provider goal of 110 providers by having 113 regularly reporting providers (103%). They also submitted their State and Territorial Epi report 100% of the time (33 weeks) and reported laboratory data for 30 of the 34 weeks tracked thus far from the state lab and 18 of the 34 weeks from the South Texas lab. They Reported 9 pediatric deaths. III. Budget (NOT SCORED) Strengths Weaknesses IV. General Comments Regarding Content of Application The proposed budget clearly delineated what was requested and provided justification for the requests. None identified. N/A N/A N/A Applicant demonstrated a high burden of gonorrhea in Dallas County where GISP site located. Applicant also demonstrated disparities by race/ ethnicity and by age. Dallas County demonstrated capacity to perform GISP by highlighting long history as a GISP site and a strong relationship between the Dallas County STD Clinic and Public Health Laboratory. N/A N/A Project T: I. Approach Strengths TX-DSHS-19-1309-A-002287 II. Weaknesses The evaluation plan described was vague. Additional Comments N/A Work Plan for 2019 Strengths Weaknesses Additional Comments III. Budget (NOT SCORED) Strengths Weaknesses Additional Comments Acknowledged. Texas will work with CDC post award to address any concerns. N/A Applicant completed all required sections for a GISP only application. Site demonstrated a plan to see and diagnose more than the required number of gonorrhea infections. Site already has in place the clinical and laboratory processes to participate in GISP. Site also has a process in place to assign GISP IDs and transmit data to the regional laboratory and CDC. N/A Site’s history as a prior GISP site supports the current work plan. N/A The requested funding amount appeared reasonable for the work required to successfully participate in GISP. The budget did not provide a breakdown of costs by categories. It was not clear how all of the funding would be allocated. N/A N/A N/A N/A One-hundred percent of the funding will go to the Dallas Laboratory (Lab). The Dallas Lab budget was included as a tab in the DSHS tab Budget Template that was submitted as supporting documentation and in Grants.gov. DSHS can provide this to CDC post award during discussions. N/A TX-DSHS-19-1309-A-002288 IV. General Comments Regarding Content of Application Application was overall complete and well organized. N/A Project W: I. Approach Strengths Problem Statement Applicant Capacity The applicant describes core information about the jurisdiction and N/A the importance of the proposed activities related to surveillance for congenital syphilis. The applicant provided the number of births in Texas in 2018 N/A (380,753) and fetal deaths (1,806) as well as the number of CS cases in 2018 (“at least 217, with over 300 cases still being reviewed for case determination”). The applicant described current resources, processes, capacity, N/A and steps planned to implement surveillance for congenital syphilis in Texas. “Fetal Infant Morbidity Review of Congenital Syphilis and perinatal HIV (FIMRSH) activities are ongoing in Houston and San Antonio.... Texas Department of State Health Services will contract with the University of Texas Southwestern Medical Center to hire a Jurisdictional Coordinator …who will lead the activities for this project. The Jurisdictional Coordinator will work closely with the DSHS Congenital Syphilis Epidemiologist, who will function as the project lead at DSHS. UTSWMC is uniquely qualified to provide technical assistance in conjunction with conducting surveillance activities throughout the state because of its expertise in disease surveillance activities through previous and current contract projects for more than five years…DSHS has discussed expanding FIMRSH activities to Dallas County due to the increasing number of cases in this geographic area,” (see “Applicant Capacity” section). TX-DSHS-19-1309-A-002289 The applicant reported other existing capacity such as the jurisdiction’s syphilis (including CS) reporting requirements and disease surveillance activities, as of 2015, “to require that all pregnant women in Texas be tested for syphilis at their first prenatal visit and again during the third trimester of their pregnancy. If testing is not performed during the third trimester, or cannot be verified, testing must be performed at delivery.” The applicant described steps planned to implement project W activities. For year 1, these include “perform[ing] a retrospective study of syphilis and CS cases for years 2014-2018 using state surveillance data in order to establish a baseline from which to build future project year activities. DSHS will use the newly released Maven-based TB/HIV/STD Integrated System (THISIS) to collect surveillance data, work with local and regional health departments reporting the burden of CS cases to extend follow up of babies born to mothers with evidence of infection, continue current Fetal Infant Morbidity Review of Congenital Syphilis and perinatal HIV (FIMRSH) activities in Houston and San Antonio to work with clinical experts and professional organizations to develop recommendations for enhanced follow up and targeted screening and evaluation, expand FIMRSH activities to Dallas, and continue to develop and disseminate clinical guidance for mothers, babies, and their providers,” (see “Justification” section). Specifically, the applicant states “DSHS will continue to use THISIS for data management, processing, tracking, and analyzing data for disease exposure events, testing, treatment, and follow-up. Local and regional health departments will continue to use THISIS for CS reporting. DSHS will follow the CDC case definition for CS cases, so that CS cases will be recorded with increased accuracy.” The applicant described major activities conducted using previous funding to support CS surveillance efforts such as earlier analyses N/A N/A N/A N/A TX-DSHS-19-1309-A-002290 that found 18% of women delivering an infant diagnosed with CS received no prenatal care and examination of barriers to receiving this care. These activities and funding are described further, “In December 2015, DSHS initiated a pilot FIMRSH project in the Houston area. The project involves performing extensive medical chart reviews and maternal interviews to identify barriers women face in receiving prenatal care. In October 2017, DSHS was awarded supplemental funding for enhanced CS response through Notice of Funding Opportunity CDC-RFA-PS14- 14020401SUPP17. Through this 15-month supplemental project, DSHS hired a CS Epidemiologist and a CS Coordinator, as well as expanded FIMRSH activities to San Antonio. The supplemental project ended December 31, 2018; however, DSHS continued the full time employee positions and activities as part of CDC-RFA-PS19-1901, Strengthening STD Control and Prevention for Health Departments.” Additionally, the applicant described other previous funded activities such as an evaluation of hospital policies and/or SDOs that address testing and treatment recommendations for the prevention of CS. Results indicated a need for provider education and hospital outreach efforts to ensure compliance with CDC recommendations for the prevention of CS. To address this, applicant will coordinate with partners to identify and offer training on syphilis and CS prevention, treatments, and reporting guidelines. Specifically, the applicant states, “DSHS will collaborate with local and regional health departments, maternal and child health programs, community planning groups, the Perinatal Task Force, FIMRSH, or other entities involved in prevention to identify hospitals and providers and offer training on syphilis and CS testing, treatment, and reporting guidelines.” N/A N/A TX-DSHS-19-1309-A-002291 Evaluation Plan (see “Evaluation Plan” section of application for quoted sections, below) Weaknesses The applicant notes that they have the ability to collect data and report on the performance measures: “DSHS has the capability to collect data and report on performance measures.” N/A The applicant provided some detail on performance measures: staff will “monitor the data to ensure reporting accurately follows the case definition,” “DSHS will evaluate the lab reporting process for women and infants by utilizing the lab reporting survey to identify any gaps,” and staff will “identify infants born to women diagnosed with syphilis for case ascertainment and CS reporting.” The applicant described how they plan to use these performance measurement data to “identify gaps, inform program improvement, and produce and distribute reports to provide data to community planning groups and other entities involved in CS prevention to improve prevention efforts.” The applicant could more explicitly describe program staff responsible for the evaluation. While in some instances the applicant notes that the CS Epidemiologist will perform a task, in others it simply states that this will fall to “DSHS” (e.g., “DSHS will work with the CDC-assigned Programmatic Team to ensure development of a complete Evaluation and Performance Measurement plan upon award.”) Though the applicant plans to use funding to hire a jurisdictional coordinator who will be located in Dallas, it is unclear from the application if activities will focus solely on the jurisdictions of Dallas, Houston, and San Antonio, which have a high burden of CS and where the review boards are located, or whether the activities will be state-wide. N/A N/A Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002292 The applicant’s performance measures could have been more measurable (e.g., included specific targets) in the evaluation plan. The applicant could have provided more detail on how project W activities complement those of “CDC-RFA-PS19-1901, Strengthening STD Control and Prevention for Health Departments.” In the applicant capacity section, the applicant says “In October 2017, DSHS was awarded supplemental funding for enhanced CS response through Notice of Funding Opportunity CDC-RFA-PS14-14020401SUPP17. Through this 15-month supplemental project, DSHS hired a CS Epidemiologist and a CS Coordinator, as well as expanded FIMRSH activities to San Antonio. The supplemental project ended December 31, 2018; however, DSHS continued the full time employee positions and activities as part of CDC-RFA-PS19-1901, Strengthening STD Control and Prevention for Health Departments.” The applicant is collaborating with the DSHS Center for Health Statistics and Vital Statistics to identify infants born to women diagnosed with syphilis for case ascertainment and CS reporting. It is unclear if this includes both live and stillborn infants. The applicant could have provided specific plans to reach women who are at risk of not receiving prenatal care to enhance the application. Additional Comments II. None. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. N/A Work Plan for 2019 TX-DSHS-19-1309-A-002293 Strengths Weaknesses The applicant has a work plan that aligns with each project W strategy and activity (see ‘Work Plan’ tab). These overall strategies and activities were consistent (i.e., the exact same) with those described in the project W description. o The applicant has demonstrated that they have an established framework of CS prevention in Houston and San Antonio upon which to build and inform expansion of activities into the Dallas area. Most of the applicant’s outcomes as described in the Work Plan “BP milestones” are appropriate and consistent with the project W goals (see ‘Work Plan’ tab). For example: I(a) to increase epidemiologic capacity by hiring a jurisdictional coordinator and III(b) to “evaluate follow-up clinical data for CS cases reported in 2014-2018 to assess if testing and treatment were performed at designated time points for eligible pregnant women and infants.” The work plan is detailed and specific and achievable, with milestones noting specific discrete tasks and appropriate timelines. o For example, for activity III (d) regarding the case definition, the applicant described plans to ensure that local and regional health departments are aware of the case definition and monitor the use of the case definition in the surveillance data. o Ten of the 18 activities have three to four milestones, and only two have one milestone listed. The strategies and activities planned for year one will establish a baseline to adequately inform future project year activities. For some activities, it is unclear if the applicant implementation plan aligns with the project W activity. For example: N/A N/A N/A N/A Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002294 For activity III (b), the project W activity relates to “collecting follow-up clinical data at designated time points”, which are presumably at 2, 6, 12, 18, and 24 months of age (per pg 270 of the project W description). The details provided in the work plan, however, seem to relate to clinical data on cases, rather than sufficient length of follow-up: “DSHS will work with UTSWMC and FIMRSH partners to evaluate follow-up clinical data for CS cases reported in 2014-2018 to assess if testing and treatment were performed at designated time points for eligible pregnant women and infants. DSHS will use evaluation results to identify barriers to follow-up and provider adherence to CDCrecommended testing and treatment guidelines.” Additionally, the applicant’s work plan does not specifically state that surveillance of infants with CS will continue up to at least 24 months in order to assess long term health outcomes. For activity VII (a), the project W activity relates to “actively participate in the Data Use Working Group to communicate the public health message to protect mothers and babies.” The work plan does not mention the “Data Use Working Group” but rather discusses the two to three local FIMRSH programs. o From the work plan II(a): “DSHS and UTSWMC will work with DSHS Birth Defects Epidemiology and Surveillance Branch to identify potential birth defects among infants diagnosed with congenital syphilis for years 2014-2018.” However, no further details were provided on this collaboration. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002295 Additional Comments o The applicant did not clearly note plans to submit data to CDC or describe why certain variables could not be submitted. The applicant could consider collaborations with national, state, and local professional organizations such as the American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Nurses Association, and Association of Clinical Nurse Midwives as appropriate to increase provider education and outreach of CDC recommended CS prevention and treatment. While the applicant plans to use funding to support some of the CS Epidemiologist’s time and to hire a jurisdictional coordinator, it isn’t clear in the application how the roles of these two epidemiologists will be distinct. For instance, even though the CS Epidemiologist is located at the DSHS, the jurisdictional epidemiologist is tasked with “evaluat[ing] the lab reporting process for women and infants by utilizing the lab reporting survey and evaluate the documentation of pregnancy status on labs,” which requires collaborating with the TB/HIV/STD surveillance group, presumably at DHSH (IV (b) in the work plan). In the application, the applicant describing being able to identify missed cases by linking to birth and fetal death data for 2018. This seemed to be a fruitful exercise, but it was only mentioned in IV(b) as “Conduct a match between vital statistics data and syphilis surveillance data to identify infants born exposed to syphilis for case ascertainment.” The applicant appears to plan to use their pre-existing surveillance system, THISIS, to conduct surveillance for CS. It was not readily apparent in the application as to whether the applicant plans to make any improvements to this surveillance system or whether this system is sufficiently equipped to capture follow-up date on Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002296 CS cases through 24 months of age (as is described in the ‘outcome measures’ section of the project W plan [pg 270]). III. Budget (NOT SCORED) Additional Comments Your application and budget submitted under Notice of Funding Opportunity CK19-1904 “Project W: Surveillance and Monitoring of Infants with Congenital Exposure to Emerging Infectious Diseases and Other Health Threats” was reviewed and recommended for approval, however, due to limited availability of programmatic funds, the approved activities could not be funded. This action in no way precludes consideration of any applications you may submit in the future. We appreciate the time and effort you spent on preparing the application. Your application may be held up to a maximum of twenty-four months from the date of this response, during which time unfunded applications may be considered for funding if additional money becomes available. IV. General Comments Regarding Content of Application Brief Summary of Application The applicant (Texas) is requesting $265,932 in year 1 to conduct surveillance for congenital syphilis (CS). Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002297 The applicant has the following: o 380,753 births in Texas in 2018. o Texas ranks in the top five reporting jurisdictions nationally in the number of CS cases in 2017, with a rate of 41.1 per 100,000 live births. Preliminary state data for 2018 show a rise in CS cases to at least 217, with over 300 cases still being reviewed for case determination. The areas of the state with the highest morbidity in 2017 include: Harris County (Houston) with 45 cases, Public Health Region 11 (serving a 19-county area in the Rio Grande Valley in South Texas) with 30 cases, Dallas County (Dallas) with 26 cases, and Bexar County (San Antonio) with 17 cases. o The applicant has identified an increase in congenital syphilis (CS) in its jurisdiction from 2013 to 2017. The applicant indicated the increase is due to an actual increase in cases and enhanced surveillance efforts. In March 2019, the Texas Department of State Health Services (DSHS) matched syphilis surveillance data with live birth and fetal death records to ensure complete ascertainment of infants and stillbirths born to women diagnosed with syphilis during pregnancy or at delivery. Using provisional 2018 birth and fetal death data, DSHS identified 323 infants and 9 fetal deaths not previously reported or investigated. The applicant noted that this indicates a gap in reporting for surveillance data and a missed opportunity to ensure that women receive adequate treatment during pregnancy. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. o The applicant has also identified a lack of adequate treatment to women diagnosed during pregnancy and those historically diagnosed with syphilis. A 2018 evaluation of hospital policies and/or standing delegation orders (SDOs) that address testing and treatment recommendations for the prevention of CS TX-DSHS-19-1309-A-002298 found, among hospitals with inpatient delivery services, a lack of policies/SDOs for syphilis screening at admission for delivery or when a woman delivers a stillborn. o A provider survey also showed that the need for provider education and outreach to hospitals to ensure compliance with Centers for Disease Control and Prevention (CDC) recommendations regarding the prevention of CS. DSHS will use Year 1 of this project to perform a retrospective study of syphilis and CS cases for years 2014-2018 using state surveillance data in order to establish a baseline from which to build future project year activities. DSHS will use the newly released Maven-based TB/HIV/STD Integrated System (THISIS) to collect surveillance data, work with local and regional health departments reporting the burden of CS cases to extend follow-up of babies born to mothers with evidence of infection. o o DSHS will continue current Fetal Infant Morbidity Review of Congenital Syphilis and perinatal HIV (FIMRSH) activities in Houston and San Antonio (which began to identify barriers women face in receiving prenatal care) to work with clinical experts and professional organizations to develop recommendations for enhanced follow-up and targeted screening and evaluation. ▪ With this established framework, the applicant seeks to expand FIMRSH activities to Dallas to enhance surveillance and epidemiology to inform prevention activities to address the increasing rates of syphilis and CS in Texas. ▪ This includes continuing to develop and disseminate clinical guidance for mothers, babies, and their providers. o The applicant plans to use the CDC case definition for CS. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002299 DSHS will contract with the University of Texas Southwestern Medical Center (UTSWMC) at Dallas to hire a Jurisdictional Coordinator to lead the activities for this project. The Jurisdictional Coordinator will work closely with the DSHS Congenital Syphilis Epidemiologist, who will function as the project lead at DSHS. UTSWMC is uniquely qualified to provide technical assistance in conjunction with conducting surveillance activities throughout the state because of its expertise in disease surveillance activities. The applicant plans to work with the CDC program team to develop an evaluation and management plan and notes that it has the ability to collect and report on performance measures. The applicant plans to use their disease surveillance system, THISIS, for processing, tracking, and analyzing data for disease exposure events, including testing, treatment, and follow-up. Recommendations for Improvement Per pg 265 of the project W NOFO: “All collaborating jurisdictions who request funding should confirm that they plan to submit all variables requested, with redaction only of variables that cannot be submitted due to specific state laws or regulations.” It was not clear if the applicant plans to submit data to CDC. Though the applicant plans to use funding to hire a jurisdictional coordinator that will be located in Dallas, it is unclear from the application if activities will focus solely on the jurisdictions of Dallas, Houston, and San Antonio, which have a high burden of CS and where the review boards are located, or whether the activities will be state-wide. It would have been helpful if the applicant explicitly stated this in their application. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. Acknowledged. Project unfunded. Texas will work with CDC post award to address any concerns if potential funding is available. TX-DSHS-19-1309-A-002300 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) ELC -CDC•REF-CK19-1904 Federal New or Revised Budget Non-Federal (d) ( C) 93 ,323 Federal (e) $0 Non•Federal (f) $4,843,839 Total (g) $0 $4,843,839 2. $0 3. $0 4. $0 5. TOTALS $0 $0 SECTION 6 . Object Class Categories a. Personnel B - BUDGET $4,843,839 $0 CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY (1) $4,843,839 (2 ) (3) Total (5) (4) $1 ,713 ,639 $1,713,639 b. Fringe Benefits $627 ,535 $627 ,535 c. Travel $193 ,653 $193,653 $5 ,582 $5,582 e. Supplies $740,020 $740,020 f. Contractual $540,163 $540,163 $0 $0 $109,781 $109,781 d , Equipment g. Construction h. Other i. Total Direct Charges (sum of 6a - 6h) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $3,930,373 $0 $0 $0 $913,466 $3,930,373 $913,466 $4,843,839 $0 $0 $0 $4,843,839 $0 $0 $0 $0 $0 Standard Form 424A (7-97) Prescribed by 0MB Circular A· 102 TX-DSHS-19-1309-A-002301 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. $0 10. $0 11. $0 12. TOTALS (sum oflines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $4,843,839 $1,210,960 $1,210,960 $1,210,960 $1,210,959 $0 $0 $0 $0 $0 $4,843,839 $1,210,960 $1,210,960 $1,210,960 $1,210,959 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) $0 $0 $0 $0 21. Direct Charges: $3,930,373 22. Indirect Changes: $913,466 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIG food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018- 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.,9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002302 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project A - CrossCutting Epidemiology and Laboratory Capacity (Laboratory) Federal Non-Federal (d) ( C) 93.323 New or Revised Budget Federal (e) Non-Federal (f) Total (g) $0 $0 $110,931 $0 $110,931 $0 $0 $110,931 $0 $110,931 2. 3. 4. 5. TOTALS SECTION 8 - BUDGET 6. Object Class Categories CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (4) (5) a. Personnel $46,905 $46,905 b. Fringe Benefits $17,177 $17,177 $4,451 $4,451 $0 $0 $12,153 $12,153 f. Contractual $0 $0 g. Construction $0 $0 $2,160 $2,160 c. Travel d. Equipment e. Supplies h. Other i. Total Direct Charges (sum of 6a - 6h) $82,846 j. Indirect Charge $28,085 k. TOTALS (sum of 6i and 6j) 7. Program Income $0 $0 $0 $82,846 $28,085 $110,931 $0 $0 $0 $0 $0 $0 $110,931 $0 $0 TX-DSHS-19-1309-A-002303 Standard Form 424A (7-97) Prescribed by 0MB Cirrular A-102 SECTION C • NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum oflines B-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $110,931 $27,733 $27,733 $27,733 $27,732 $0 $0 $0 $0 $0 $110,931 $27,733 $27,733 $27,733 $27,732 SECTION D • FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum of/ines 13 and 14) SECTION E • BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) $0 $0 $0 $0 21. Direct Charges: $82,B46 22. Indirect Changes: $28,085 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovalions); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Heallh Programs- 18.1%; laboratory Services- 33.9%. SF 424A (7·97) Page 2 TX-DSHS-19-1309-A-002304 Texas Department of State Health Services ELC Category A- Cross Cutting Epidemiology and Laboratory Capacity (Laboratory) CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: 811/19-7/31/20 A. Personnel $46,905 Position 1. Microbiologist Ill "of Time 100% Annual Salary $45,465 Benefit Annual Longevity Replacement PavfBRPJ $1,440 $0 Months Total 12 $46,905 Leavitt, John (H41000/8782) Position Description: Cross Cutting Laboratorian that can work across laboratory programs. Daily work includes antimicrobial susceptibility testing for CRE, CRPA, ESBL, CRAB and GC. Serves as primary liaison with epidemiology programs and assists with ARLN laboratory testing functions. 2. Microbiologist Ill 100% $0 $0 $0 12 $0 NEW (H41000/Position # TBD) Position Description: Performs specimen logistics activities to improve communication and coordination between specimen receiving, laboratory testing areas, laboratory reporting, and submitters for infectious disease, foodborne outbreak and other microbiology tests. Confers with medical providers to obtain required and accurate demographic information on potential invalid specimens. Collaborates with staff from other areas of the laboratory as appropriate to resolve issues with specimen submissions. Assists with Texas ARLN Portal (TARP) submissions to improve workflow in laboratory and assure that data is available for testing/reporting. Performs data extracts to identify submitters with unsatisfactory specimens to provide targeted education lo submitters and analyzes data to identify trends which need a more systematic approach. Performs extensive customer service duties and maintains frequent communication with external and internal customers. Participates/assists with updating website information for Microbiological Sciences Branch and ListServ notifications. Assists with the development of educational materials such as but not limited to presentations, tutorials, and FAQs. 3. Molecular Biologist Ill 100% $0 $0 $0 12 $0 NEW (H41OOOPosition# TBD) Position Description:This will be a split position in the Medical Virology Group between the Arbovirus Laboratory and the Viral Isolation Laboratory. Performs highly complex (senior-level) molecular biology work. Primary responsibilities include overseeing, training and conducting arbovirus testing on mosquito specimens and performing clinical diagnostic testing to detect vector-borne diseases, measles, mumps, influenza, MERS-CoV, and other respiratory virus pathogens. Coordinates and performs all aspects of arbovirus testing on mosquito specimens and clinical specimens, including nucleic acid extractions, real-time multiplex RT-PCR analyses and isolation of viruses, while using BSL2 and BSL3 practices. Reviews and interprets PCR results and determines and coordinates any additional work needed on the specimens and ensures that the specimens are processed appropriately. Enters and validates mosquito and arbovirus testing results in the laboratory information management system. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting requirements. Consults with medical personnel/epidemiologists regarding test application and interpretation. Participates in the preparation and supervision of validation studies. Prepares SOP documents. Coordinates daily tasks to expedite work.flow. May perform cross-training within the Medical Virology Group as needed, including the Rabies Laboratory, acting as a resource to assist in the evaluation of the Rabies LN34 real-lime real-time RT-PCR assay and training staff on molecular methods, including real-time RT-PCR. Geographic Information 4. Specialist I 100% $0 NEW (50%H41000/50%H21400/Position #TBD) so $0 12 so 1 oq TX-DSHS-19-1309-A-002305 Position Descriotion:This will be a split position between the Arbovirus Laboratory and the Zoonosis Control Branch. Primary responsibilities will include organizing and generating reports for mosquito surveillance and insecticide resistance testing data. Coordinates and assists with maintaining spatial databases of relevant information, documents procedures, validates data for accuracy and completeness, completes approved metadata forms, and produces maps of the resulting information. Coordinates and assists with generating maps and summary tables for distribution between epidemiology and laboratory staff, for MosquitoNET reporting, for responding to submitter requests, and for updating the DSHS website . Referred to as GIS Specialist in the Project A Approach tab and Workplan . Public Health Prevention 6. Specialist II 100% $0 $0 $0 12 $0 NEW (H42000/Position #TBD) Position Description: This position will spend their time on ARLN Carbapenem Resistant Organism (CRO) activities, including Texas ARLN Portal (TARP), AIMS and provide response to emerging outbreak events. Performs complex public health work. Under limited supervision of the Data Entry and Reporting Branch Manager will enroll submitters for CRO testing, and will perform data entry on CRO submission to the DSHS Laboratory. Act as a liaison between laboratory and epidemiology staff on errors and discrepancies. Confers with local health agencies, private physicians, or individuals about requirements to enroll as a submitter for the DSHS Laboratory. Participates in planning, creating and conducting training on Standard Operating Procedures (SOP) for data entry and reporting to include training on enrolling providers, data entry of information into Laboratory Information Management System (LIMS), reporting and communicating results to submitters and health agencies. Serves as a resource in creating awareness of requirements for submitting samples to the DSHS Laboratory including required paperwork and submission forms. Assists in validation of new tests. Distributes information on the public health laboratory and its menu of tests. Assists in collecting and preparing materials in response to public health information and report requests. May perform investigation functions, review standard operating procedures, and prepare summaries on submitter activities. May train others. Performs related work as assigned. 7. Microbiologist I 100% $0 $0 $0 12 $0 NEW (H42000/Posilion # TBD) . Position Description: This position will support laboratory testing activities across multiple projects including Arboviral disease, Bacteriological ARLN, CRO activities, including TARP, and provide response to emerging outbreak events.) Works under the moderate supervision of a Microbiologist IV with limited latitude for the use of initiative and independent judgment. Checks in Bacteriological, Serological and Virological specimens and samples; determines specimen acceptability; uses Laboratory Information Management System (LIMS) to accession and order tests requested; submits specimens to Centers for Disease Control and Prevention (CDC) and other laboratory sites; provides customer service; reports problems and assists team leader in investigating causes for errors/discrepancies; assists in training/mentoring employees; delivers/picks up shipments; performs other duties as assigned including COOP activation that may require an alternative shift pattern assignment and/or location. 2ofl TX-DSHS-19-1309-A-002306 8, FringeBenefits $17,177 Fringe benefits are applicable to direct salaries and treated as direct costs . Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% C. Travel $4,451 1. In-State $0 a. Travel description : Mileage: # trips x # persons x? miles r/t@ $.58/mile Airfare: # persons @ $? r/t $0 $0 $0 Ground Transportation: # persons @ $? Lodging : ? nights @ $85/night x # persons x # trips Per Diem: ? days @ $46/day x # persons x # trips Travel Fees: #persons@ $12.00 x # trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 b. Travel description : Mileage: # trips x # persons x? miles r/1@ $.58/mile Airfare : # persons @ $? r/t Ground Transportation: # persons @ $? Lodging: ? nights @ $85/night x # persons x # trips Per Diem: ? days @ $46/day x # persons x # trips Travel Fees: #persons@ $12.00 x # trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 $0 $0 $0 2. Out-of-State $4,451 a. Travel description: One microbiologist from the DSHS Rabies Laboratory will travel to the Laboratory Methods for Detecting Rabies Virus training workshop. This opportunity helps Laboratory staff gain in depth knowledge of rabies and hands on laboratory experience. Attendance is requested to enhance knowledge, collaborate with other rabies laboratories and learn new methodologies. Location and date TBD. Mileage: 1 trip x 1 person x 30 miles r/t@ $.58/mile Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $80 x 1 trip Lodging: 5 nights@ $178/night x 1 person x 1 trip Per Diem: 6 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 x ] J 3of TX-DSHS-19-1309-A-002307 J b. Travel description: One microbiologist from the DSHS Rabies Laboratory will travel to Rabies in the Americas conference. This opportunity will help Laboratory staff to gain in depth knowledge of rabies in North and South America. Attendance is requested to enhance knowledge and collaborate with other rabies laboratories. Location: Kansas City, MO. Dales: Oct 27-Nov 1, 2019 Mileage: 1 trip x 1 person x 30 miles r/1@ $.58/mile Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $80 x 1 trip Lodging: 6 nights @$169/night x 1 person x 1 trip Per Diem: 7 days @ $66/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person@ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 c. Travel description: One microbiologist from the DSHS Viral Isolation Laboratory will travel to the Clinical Virology Symposium. Opportunity to gain in depth knowledge of current and novel test methods and other relevant topics regarding viral diseases, endemic and emerging, including but not limited to influenza, measles, mumps, MERS CoV, and arboviruses. Attendance is requested to enhance knowledge and collaborate with other laboralorians and and peers in the field of Virology. Location and date TBD. Mileage: 1 trip x 1 person x 30 miles r/t @ $.58/mile Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $80 x 1 trip Lodging: 5 nights@ $150/night x 1 person x 1 trip Per Diem: 6 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 d. Travel description: Travel expenses for two molecular biologists to travel to the AMD Regional Whole Genome Sequencing (WGS) training/meeting. Final Location and date TBD. Mileage: 1 trip x 2 persons x 20 miles r/t@ $.58/mile Airfare: 2 person @ $ 590 rt x 1 trip Ground Transportation: 2 person @ $80 x 1 trip Lodging: 3 nights@ $160/night x 2 persons x 1 trip Per Diem: 4 days @ $65/day x 2 person x 1 trip Travel Fees: 2 persons@$12.00 x 1 trip Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $2,967 $23 $1,180 $160 $960 $520 $24 $100 e. Travel description: Travel expenses for two molecular biologist to travel to AMD training workshop held by CDC. Final Location and date TB□. Mileage: 1 trip x 2 persons x 20 miles r/t@ $.SB/mile Airfare: 2 persons @ $ 590 rt x 1 trip Ground Transportation: 2 persons@ $80 x 1 trip Lodging: 3 nighls@$160/nighl x 2 persons x 1 trip Per Diem: 4 days @ $65/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 2 persons @ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 4 ofl TX-DSHS-19-1309-A-002308 f. Travel description: Laboratory Director to attend the 2020 Four Comers and Central Plains Regional Consortium Meeting in March 2020 in Albuquerque, New Mexico. Mileage: 1 trip x 1 persons x 30 miles r/t @ $.58/mile Airfare: 1 person @ $ 400 rt x 1 trip Ground Transportation: 1 person @ $80 x 1 trip Lodging: 3 nights @ $170/night x 1 persons x 1 trip Per Diem: 4 days @ $46/day x 1 person x 1 trip Travel Fees: 1 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $1,484 $17 $631 $80 $510 $184 $12 $50 f. Travel description: Travel for one person to attend the Quality Manager exchange meeting to facilitate workgroup goals of creating a single quality management system. Location and Date are TB □. Mileage: 1 trip x 1 person x 30 miles r/1@ S.58/mile Airfare: 1 person @ $ 400 rt x 1 trip Ground Transportation: 1 person @ $80 x 1 trip Lodging: 4 nights@ $150/night x 1 person x 1 trip Per Diem: 5 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person@ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 J I t TX-DSHS-19-1309-A-002309 D. Equipment $D Item Requested Qty Unit Cost 1. [Item Name] - Descri~tion: Amount 0.00 $0 2. E. Supplies $12,153 Item Requested Replacement lamp for Qty Unit Cost Amount $12,153 Rabies DFA 1. microsoopeBB 119:C146 4 625.00 2.500.00 Supplies 2. Rabbit brain 3. Rabies Chemicon Reagent 2 2 164.00 328 .00 1,090.00 4. Rabies DFA Fuii Reaaent 5. Monoclonal Negative Control 2 1 6. Liaht dlaanoslics normal aoat laG 7. FJuorescein-oonjugated mouse lgG 8. Glycerol 9. Acetone 10. Combi Tios Sawzall Blades 545.00 1 1 431.13 107.42 76.00 157.00 862.26 107.42 76.00 0 1 57.00 60 .00 0.00 60.00 1 100.00 100.00 157.00 Necropsy Supplies 11. 1 50.95 50.95 (Rabies) 12. Scaloels 13. Saw Washers 13.00 3.50 91.00 7.00 14. Cast Cutter Blades 15. Replacement Module for Knife 7 2 1 1 87.50 103.00 87.50 103.00 16. Multiseot disinfectino reaoent 17. Disposable lab coat 12 2 10.83 170.00 129.96 340.00 18. Flea/tick sorav 19. Disposable sleeves 2 1 40.00 87 .00 20. Ointment tins MEM Vitamins 21. 1 20 .00 87 .00 58 .00 1 71.71 Cell Culture 71.71 (Rabies) 22. Streptomycin Sulfate 23. Penicillin G Sodium Salt 1 1 29.00 69.00 29.00 69.00 24. Minimum Essential Media 25. Filter unit 1 1 75.70 200 .00 75.70 200 .00 26. Polv L Lvsine 27. Methanol 1 1 45.30 35.00 45 .30 35.00 58 .00 Rabies LN34 PCR 28. AG Path Kit 29. 96 Well Plates 1 2 1,500.00 980 .00 1,500.00 Assay 1,960.00 30. Direct-zol RNA miniprep kit 31. PCRTubes 1 1 1,500.00 138.00 1,500.00 138.00 32. 1.5 ml Snap Cap Tubes 33. Barrier Tips 1 1 94.00 160.00 94 .00 160.00 F. Contractual $0 6ofl TX-DSHS-19-1309-A-002310 Sub-recipient(category 4000) $0 1. Project Title: A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work: (Enter SOW detail here] E. Method of Accountability : (Er,teraccounlib ility met!)od here) F. Budget Detail and Justification : Vendor (category 2001 or 2009) $0 1. Project Title: A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work: (Enter SOW detail here) E. Method of Accountability : [Enter accountibility method here] F. Budget Detail and Justification : 1 orJ TX-DSHS-19-1309-A-002311 G. Other 1, $2,160 Item Requested Estimated Cost per Month Number of Months Numberof Staff Amount Requested $0 1. 2. 3. lt.m Requested Number Needed 1. Annual Microscope Maintenance Contract (Rabies testing) 2. Training offered by UT on Bioinformatics. Registration $120/class (estimated unit cost) 3 Rabies in America Reaistration Fee 4 CVS Reaistration Fee 1 Unit Cost - Amount Reauested 0.00 0.00 18 120.00 2,160.00 1 1 $0.00 0.00 $0.00 0 .00 Total Direct Cost: Total IndirectCharges: Please see attached DSHS Indirect Cost attachment for calculation. Total Budget: $2,160 $82,846 $28,085 $110,931 s of I TX-DSHS-19-1309-A-002312 ELC Category A - Cross Cutting Epidemiology and Laboratory Capacity (Laboratory) Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018@ 1B.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Personnel Direct Charges Total #of contracts Applicable Amount charged IDC $0 Fringe $0 Travel $0 Equipment (Greater than $5,000; unless an exception Item) $0 Supplies (Less than $5,000; unless an exception Item) $0 Contractual (Sub-recipient In excess of $25,000) - ·-- JDC Rate at 1a.1-,,. $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 ~ 0 0 $0 $0 $0 $0 $0 Sub-total Contractual Other $0 Total - Health Programs $0 - = --- 0 = LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Direct Charges Total #of contracts Applicable Amount charged IDC IDC Rate at 33.9% Personnel $46,905 $46,905 $15,901 Fringe $17,177 $17,177 $5,823 Travel $4,451 $4,451 $1,509 $0 $0 $0 $12,153 $12,153 $4,120 Equipment (Greater than $5,000; unless an exception Item) Supplies (Less than $5,000; unless an exception Item) Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 $0 0 $0 $0 $2,160 $732 Sub-total Contractual Other $2,160 Total - Laboratory Services $82,846 0 $82,846 $28,085 $82,846 0 $82,846 $28,085 - -- - -TOTAL INDIRECT COST The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002313 0MB ApprovalNo. 0348-00.W BUDGET INFORMATION - Non-Construction Programs SECTION A - f3UOGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) Epidemiology and Laboratory Capacity (Epidemiology) Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $181,926 $0 $181,926 $0 $0 $181,926 $0 $181,926 2. 3. 4. 5. TOTALS SECTION B - BUDGET CATEGORIES 6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) a. Personnel $93,629 $93,629 b. Fringe Benefits $34,287 $34,287 c. Travel $10,362 $10,362 d. Equipment $0 $0 e. Supplies $0 $0 f. Contractual $0 $0 g. Construction $0 $0 $15,766 $15,766 h. Other i. Total Direct Charges (sum of 6a - 6h) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $154,044 $0 $0 $0 $27,882 $154,044 $27,882 $181,926 $0 $0 $0 $181,926 $0 $0 $0 $0 $0 Standard Form 424A (7-97) TX-DSHS-19-1309-A-002314 Prescribed by 0MB Circular A-102 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum oflines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $181,926 $45.481 $45,481 $45.481 $45,483 $0 $0 $0 $0 $0 $181,926 $45,481 $45.481 $45,481 $45,483 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum offines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) Fi (e) Fourth C 16. 17. 18. 19. 20. Totals (sum of lines 16-19) $0 $0 $0 $0 21. Direct Charges: $154,044 22. Indirect Changes: $27,882 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovalions); that portion of each subaward in excess of $25,000, flow-through funds and WIG food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018- 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002315 Texas Department of State Health Servlcas ELC Category A - Cross Cutting Epidemiologyand Laboratory Capacity (Epidemiology) CDC-RFA-CK19-1904,2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELCI Budget Requast Period: August 1, 2019 thru July 31, 2020 A. Personnel $93,629 Position "of Time Annual S.lary Senefft AnnualLons,ellffyReplacementPay Months Total BRP Public Health & Prevention 1. Specialist II 100% $37,401 $1,920 $0 12 $39,321 Albers, Wendy (H21000/8881) Posilion Description· Works as part of the foodbome investigation team, under the administrative supervision of the Emerging and Acute Infectious Disease Branch (EAIDB) Manager. Supports statewide diseasesurveillance activities. Participates in statewide outbreak lnvestigations/epidemiologic studies of Infectious diseases, creating and maintaining case or cluster fine fists in Excel. Responds to requests for statistical summary reports or other infectious disease information. Plans and organizes surveillance training workshops. Develops graphic presentalions of epidemiologic data. Performs data entry and reviews records submitted by local and regional heatth offices via the National Electronic Disease Surveillance System (NEDSS) Participates in routine data management and quality assurance activities. 2. Program Specialist IV 100% $52, 148 $2,160 $0 12 $54,308 Mauney. Andrew (H21000/8969) ~ Description: Works as part of the surveillance infrastructure team (SIT) under the administrative supervision of the EAIOB Data Manager. Works with limited supervision and considerable latitude. Provides expertise and complex consultative and technical assistance in data management, quality assurance. and analysis statistical analysis during epidemiological studies and survelllance projects. Participates In planning, developing, and implementing pol cies, guidelines, and action plans lo improve effectiveness and maximize the benefit of infectious disease data reporting. Collaborates within EAIDB and across the Infectious Disease Control Unit and Department on data capturing and reporting issues. Evaluates disease data gathering and reporting applications, identifies gaps in resources, develops actions plans for Improvement and initiates new procedures. Provides technical assistance and oversight for end-of-year data clean-up activities for the NEDSS. Serves as a liaison with the Centers for Disease Control and Prevention (CDC). regional and local health departments, laboratories and other disease data providers for Issues involving data reporting and management. Trains start members, otters guidance, and provides technical assistance. J Epidemiologist II 10~ $0 $0 $0 12 $0 NEW (H21000/Pos.bon # TBD) Posilion Description: Develops and implements a scalable epidemiology table top exerc,se in conjunction with other DSHS program areas and publ c health stakeholders; Oes:gns and distributes an annual survey to state public health partners (I.e. regional and local health departments to assess statewide epidemiology and laboratory gaps and needs (e.g. staff, supplies, training opportunities, etc.): Conducts analysis on the annual Epidemiology & Laboratory Survey and prepare various communications (I.e. executive summary, annual report, presentation, etc.) about the survey: Participates in infectious disease outbreak investigations for high consequence infectious d sease and other notifiable conditions (Water bome, Respiratory. Vaccine Preventable, Foodbome, Mullidrug, resistant Organism) by coordinating data collection wilh local and regional health department partners, abstracting medical data from hospital and med cal records, designing or modifying questionnaires or report forms, interviewing exposed persons and/or cases, coordinating collection and transport of clin cal specimens, performing data analysis using statistical programs, assisting with recommendations for control measures. Analyzes and interprets epidem ological data, including laboratory fndings. Creates, maintains. and distributes databases using 4. Medical Research Specialist Ill 100% $0 $0 $0 12 $0 NEW {H21000/Posi1ion# TBD) ~ Description: Implements cross-jurisd ct onat activities with senior level epidemiologists to Implement detailed procedures that ensure data quality activities and training activities enhance disease surveillance and response lo infectious disease threats In Texas; Coordinating Peer to Peering Visit: Coordinate and assist with Infectious disease outbreaks, especi al y those outbreaks that cross multi-jurisdict onal boundaries (i.e. within different regions of Texas or outside Texas) through establishment of baseline data at county levels for certain diseases and establishing frequencies for review to identify unrecognized clusters of cases: Provide surge capacity for overwhelmed or displaced Texas health departments that need assistance in conducting an outbreak Investigation or other response actilllties; Work with existing ep:demiology teams to communicate with the health department about the outbreak investigation; Develop and conduct mulll-t;ered and scalable epidemiology exercise with asslstance from DSHS Community Preparedness 1 TX-DSHS-19-1309-A-002316 °'' 5. Title 100% Last, First Name (Budget/Position#) Position Description; B. $0 $0 t2 so FringeBenefits Fringe benefits are appncable to direct salaries and trealed as direct costs Current benefitrale is 36.62% and are categorizedIn the following manner: Social Security/Medicare• 7.65% Retirement- 10.00% Insurance-18 97% $34,287 TX-DSHS-19-1309-A-002317 C. Travel $10,362 1.~ $6.294 a. Travel description: Travel for seven speakers thal belong lo local health departments (LHOs) and/or public health regions (PHRs) who will present al the 2019 Texas Department of Stale Health Services Epidemiologyand Laboratory Capacity (ELC) Workshop. Mileage: 1 trips x 5 persons x 400 miles r/t @ $.58/mile Airfare: 2 persons @ $350 r/t x 1 trip $4.960 $1.160 $700 Ground Transportation: 2 persons @ $50 x 2 days Lodging: 2 nights @ $125/night x 7 persons x 1 trip Per Diem: 3 days @ $46/day x 7 persons x 1 trip Travel Fees: 7 persons @ $12.00 x 1 trip BaggageFees-determinedby carrier. 2 persons @ $50 r/l x 1 lrip S200 $1,750 $966 $84 S100 b. Travel description: Two in-state trips for the Cross Cutting Epi 11position to assist PHRs and/or LHDs with outbreak investigations. Mileage: 2 trips x 1 person x 460 miles r/t @ $.58/mile Airfare: # persons @ $? r/t Ground Transportation: # persons @ $? Lodging: 2 nights @ S125/nightx 1 person x 2 trips Per Diem: 3 days @ $46/day x 1 person x 2 trips Travel Fees: 1 person@ $12.00 x 2 trips Baggage Fees-delerminedby carrier. # persons @ $? $1,334 $534 $0 so $500 $276 S24 $0 2. out-of-State a. lll!l1§I description; Peer-2-Peer Visit: Visil another ELC jurisdiction (preferable California Dept of Public Health In Sacramento) to facilitate knowledge sharing. Mileage: # trips x # persons x ? miles r/l @ $.SB/mile Alrfare:3 persons@ S375 r/t x 1 trip Ground Transportation: 3 persons@ SS0/dayx 4 days Lodging: 3 nights @ $135/night x 3 persons x 1 trip Per Diem: 4 days@ $66/day x 3 persons x 1 trip Travel Fees: 3 persons@ S12.00 x 1 trip BaggageFees-determinedby carrier.3 persons @ $50 x 2 trip $4,068 $4,068 $0 S1.125 $600 $1.215 $792 $36 $300 b. Travel description; Advanced Molecular Detection (AMO) Training for ten Emerging & Acute Infectious Disease Epidemiologists(EAIDBJin Atlanta, GA so Mileage· # trips x # persons x ? miles r/1@ $ 58/mile Airfare 10 persons @ S325 r/t x 1 trip Ground Transportation: 3persons@ $50/day x 4 days Lodging: 3 nights@ $152/night x 1O persons x 1 trip Per Diem: 4 days@ $66/day x 10 persons x 1 trip Travel Fees. 10 persons@ $12.00 x 1 trip Baggage Fees-determinedby carrier. 1Opersons @ $50 x 1 trip $0 so $0 so so t $0 $0 loll TX-DSHS-19-1309-A-002318 D. so Equipment HamRequested 1. - lltv Unit Cost Amount $0 2. 3. 4. E. so Supplles Unit Cost Amount $0 1:1 F. so Contractual Sub-recipient {category 40001 $0 1. ProjectTitle: A Nameof Contractor{sl: B Methodof Selection; C. Periodof Perfonnance : D Scopeor Work : (EnterSOW detailhere] E. Methodof Accountabnity: rErter acco'.lll!ibi lity meJh>d "wl F. BudgetDetailand Justification. Vendor (category 2001 or 2009) $0 1. ProjectTitle: Nameof Contractorlsl. B. Methodof Selection· c. Periodor Performance; o. scope otWork: tEotersowdeli!JI11ere1 E. Methodof Accountabi"itv: (Enteraccountibililymethodhere) F. BudgetDetailand Justrealign: A. TX-DSHS-19-1309-A-002319 G Other $15,766 ItemRequested Number Estimated of Cost per Months 1. Quallrics XM license 2. 3. 12 Item Requested s Amount Number of Slaff Requested Month 24 00 Number Nlleded 2 $576 $576 Amount Raauuted Unit Cost $15.190 1. TexasDil!Hili;L!:, ljth An!J!!i!IW2r1"'J:' ~ :::: )f f :::';,)t Tler3 Tler3 Tler3 $607,702 $206,011 Please ne attached DSHS Indirect Cost attachment f-orcalculation. Total Budget: S813,713 TX-DSHS-19-1309-A-002387 ao11 ELC Category G2, Antibiotic Resistance Laboratory Network Budget Request Period: 8/1/19-7/31/20 - HEAL TH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018 @18.1% Provisional rate 9/1/2018-8/31/2021 @18.1% Personnel Direct Charges Total IDC Rate Applicable Amount at 18.1% charged JDC #of contracts $0 - $0 $0 $0 $0 Fringe $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 $0 0 Sub-total Contractual Other $0 Total - Health Programs $0 LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @33.9% 0 Direct #of Charges Total contracts Personnel 0 $0 $0 $0 $0 $0 Applicable Amount charged IDC IDC Rate at33.9% $237,160 $237,160 $80,397 Fringe $86,848 $86,848 $29,441 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 $245,405 $245,405 $83,192 Supplies (Less than $5,000; unless an exception Item) Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 1 $0 $0 1 $0 $0 $38,289 $12,980 1 $607,702 $206 ,011 1 $607,702 $206,011 Sub-total Contractual $0 Other - $38 ,289 Total - Laboratory Services $607,702 -= ,, - TOTAL INDIRECT COST ~ ' $607,702 The base for the Department is total direct costs, excluding : capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs . Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18 .1%; Laboratory Services- 33.9% . Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged . Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002388 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Granl Program Funclion or Activity (a) Calalog of Federal EsUmaled Unobllgated Funds Domestic Number (b) 1. Project H: VectorBorne Diseases: Building Comprehensive Programs to Identify, Diagnose. Report, Prevent, and Respond (Tier 1) Federal ( C) 93.323 New or Revised Budgel Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $268,096 $0 $268,096 $0 $0 $268,096 $0 $268,096 2. 3. 4. 5. TOTALS SECTION B - BUDGET CATEGORIES 6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (4) (5) a. Personnel $98,995 $98,995 b. Fringe Benefits $36,252 $36,252 $2,.084 $2 ,084 $0 $0 $79,121 $79,121 f. Contractual $0 $0 g. Construcllon $0 $0 h. Other $0 $0 c. Travel d. Equipment e. Supplies I. Tolal Direct Charges (sum of 6a - Bh} j. Indirect Charge k. TOTALS (sum of 61and 6j} 7 .. Program Income $216,452 $0 $0 $0 $51,644 $216,452 $51,644 $268,096 $0 $0 $0 $0 $0 $0 $0 $268,096 $0 Standard Form 424A (7-97) TX-DSHS-19-1309-A-002389 Prescribed by 0MB Circular A· 102 SECTION C • NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum of lines 8·11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $268,096 $67,024 $67,024 $67,024 $67,024 $0 $0 $0 $0 $0 $268,096 $67,024 $67,024 $67,024 $67,024 SECTION D • FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum of lines 13 and 14) SECTION E • BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Se T !rd (b) First (e) F rth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) $0 so so $0 21. Direct Charges: $216,452 Indirect Changes: $51,644 23. Remarks: The base for the Department ls total direct costs, excluding: capital expenditures (buildings, individual Items of equipment; alterations and renovations); that portion of each subaward in excess of $25.000. now-through funds and WIC food costs . Fixed rate 9/1/2017 • 8131/2018 and Provisional rate 9/1/2018. 8131/2021for Health Programs• 18.111'/o; Laboratory Services~ 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002390 Texas Department of State Health Services ELC Category H, Vecior-Bome Diseases: Bulldlng Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond CK14-14D1D5PPHF18, Epidemiology and Laboratory Capacity for lnfec:tlous Diseases (ELC) Budget Request Period: B/1/19-7/31/20 A. Personnel $98,995 Position "of Annual Annuli 71m• Salary Lonptrlly s-Rt Raplacflm.,,t Pa RP Months Total 1. Epidemiologist II 100¾ $51,508 $1,200 $0 12 $52,708 EPI Arshadmansab. Sepehr (H21400/Positlon # 85197) Position Description : Provides expertise and complex consultative support and technical assistance on zoonotic diseases with emphasis on arbovlral diseases. In coordination with Zoonosis Control Branch (ZCB) epidemiologists, communicates with public health regions and local health departments , laboratories , and other disease data providers for Issues involving case reporting and data management. The position supports the ZCB epidemiologists In data management including document intake, quality assurance, data entry, and filing that facilitate the ultimate reporting of data to CDC. This position Is currently federally-funded by ELC Zika Response funds that expire 7/31/2019. This position is vital to the day-today ZCB ELC activities. 2 . Program Specialist IV 100¾ $46 ,287 $0 SO 12 $46,287 EPI Owens, Kamesha (H21400/Positlon # 85198) Position Description: Performs advanced work related to epidemiology of and surveillance for vector-borne diseases including arbovlral diseases. The position also provides advanced consultative services and technical assistance to health care providers, public health regions and local health departments on the diagnosis, treatment. and reporting of these notifiable conditions. This position is currenlly federally-funded by ELC Zika Response funds that expire 7/31/2019. This position Is vital lo the day-to-day ZCB ELC activities , 3. Molecular Biologist Ill 0¾ $45 ,158 SO $0 12 $0 NEW (H41000/Posilion #TBD) LAB/ECO ; fQsil!o.!!Description: This will be a split position between the Arbovirus Laboratory and the Viral Isolation Laboratory. Performs highly complex (senior-level) molecular biology work. Primary responsibilities Include supervising, training and conducting arbovlrus testing on mosquilo specimens and clinical specimens. Coordinates and performs all aspects of arbovlrus diagnostic work including nucleic acid extractions . real-lime multiplex RT·PCR analyses and isolation of viruses, while using BSL2 and BSL3 praclices . Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents . Coordinates and assists with data analysis and organization, data requests from stakeholders and data reporting requirements Consults with medical personnel/Epidemiologists regarding test application and Interpretation. Participates in the preparation and supervision of validation studies. Prepares SOP documents. Supervises and trains staff. B. Fringe Benefits Fringe benefits are applicable to direct salaries and treated as direct costs , Current benelit rate Is 36.62% and are categorized in the fallowing manner: Social Security/Medicare- 7 .65% Retirement• 10.00% Insurance- 18.97¾ $36,252 TX-DSHS-19-1309-A-002391 C. Travel $2,084 so 1. In-Stale a. Travel description: DSHS Medical Entomologist , PSIII (Border Entomologist) , and three arbovirus laboratory staff will travel to the Texas Mosquito Control Association (TMCA) meeting. Opportunity to gain knowledge and discuss current trends In arbovirus surveillance ror Texas. Requesting attendance to develop presentation skills and to provide networking opportunities ECO Mileage; 1 trip x 5 persons x 350 miles r/t @ S.58/mlle Airfare : # persons @ $? r/t Ground Transportation : # persons @ $? Lodging: 3 nights @ $85/nlght x 5 persons x 1 trip Per Diem: 4 days @ 546/day x 5 persons x 1 trip Travel Fees; # persons @ S 12.00 x # trips Baggage Fees-determined by carrier:# persons @ S? so so so $0 $0 $0 so $0 b. Travel description : The Stale Medical Entomologist and one arbovirus Laboratory staff to attend the South Texas Tropical Medicine and Vector-borne Diseases Conference (South Padre Island, Feb 2020) , Opportunity to give a presentation on guidance ror integrated vector management and the services provided by the DSHS Arbovirus Surveillance Program in Texas. ECO Mileage # trips x # persons x # miles r/1@ S.58/mile Airfare: # persons @ $? r/t Ground Transportation : 2 persons @ $50 x 1 trip (2 staff traveling In stale vehicle . Includes gas .) Lodging; 3 nights @ $85/nlghl x 2 persons x 1 trip Per Diem. 4 days @ $46/day x 2 persons x 1 trip Travel Fees: #persons@ 512.00 x # trips Baggage Fees-determined by carrier.# persons @ S? $0 $0 $0 so ;of so $0 so so c Travel description ; The State Medical Entomologist and One arbovirus Laboratory staff lo attend the Western Gulf Center of Excellence for Vector-borne Diseases 4th Annual Conference (Location and Dale TBD). Opportunity lo discuss ongoing collaborations and training activities with local health departments and academic partners. ECO so MIieage: # trips x # persons x # miles r/1@ S.58/mile Airfare. # persons @ $? r/t Ground Transportation ; 2 persons @ $50 x 1 trip (2 staff traveling in stale vehicle . Includes gas .) Lodging; 2 nights @ $85/nlghl x 2 persons x 1 trip Per Diem; 3 days @ $46/day x 2 persons x 1 trip Travel Fees: #persons@ $12.00 x # trips Baggage Fees-determined by carrier ;# persons @ S? $0 $0 so $0 $0 $0 $0 d Travel description : Travel for rour zoonosis control branch staff to attend Diseases In Nature Conference (DIN) lo-be held in Austin or San Antonio in the Spring of 2020. DIN Is a onehealth, zoonolfc disease-focused annual conference which includes vector-borne disease topics Attendees include physicians. nurses . veterinarians . and public health professionals such as epidemiologists . Attending staff will have the opportunity to receive current. authoritative Information on zoonotic diseases Including surveillance , prevention , detection and control. Attending staff may also be on the conference agenda lo speak or present poster(s) based upon conference acceptance of abstracts . EPI Mileage. 1 trip x 2 persons x o miles r/1@ S.58/mile Airfare; # persons @ $? r/t Ground Transportation : 2 persons @ 5200 rental cars (2 staff travelling from Rio Grande Valley and Houston areas. 2 staff travelling In stale vehicles .) Lodging: 3 nights@ 5158/nighl x 4 persons x 1 trip Per Diem: 4 days @ $46/day x 4 persons x 1 trip Travel Fees: 4 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier:# persons@$? so so so $0 so so so so TX-DSHS-19-1309-A-002392 2 at) 2 . Out-or-state $2.084 a . Travel description : The medical entomologist , regional medical entomologist , and two arbovlrus team members will travel to the American Mosquilo Control Association (AMCA) meeting In Portland , Oregon . Opportunity to discuss current trends and protocols In arbovlrus surveillance nationwide . Also , meet with colleagues from other state health departments and CDC to discuss high throughput mosquito testing programs and mutual challenges we all face regarding endemic and newty emerging arboviruses . $0 Mileage ; # trips x # persons x? miles r/1@ $ ,58/mi le Airfare : 4 persons @ $800 r/1 x 1 trip $0 Ground Transportation : 4 persons @ $75 x 1 trip Lodging . 5 nights@ $169/nighl x 4 persons x 1 trip $0 $0 Per Diem : 5 days@ $46/day x 4 persons x 1 trip Travel Fees : 4 persons@ 512 .00 x 1 trip Baggage Fees-determined by carrier ; 4 persons @ $50 x 1 trip $0 $0 ECO } $0 $0 b . Travel description : The State Veterinarian and one laboratory arbovirus team member to attend the Annual ELC Grantee Meeting in Atlanta in 2020 , $0 Mileage : # trips x # persons x? mBes r/t@ $ .58/mile Airfare : 2 persons @ $450 r/t x 1 trip Ground Transportation : 2 persons @ $35 x 1 trip Lodging : 2 nights@ $120/night x 2 persons x 1 trip Per Diem ; 3 days @ $46/day x 2 persons x 1 trip Travel Fees : 2 persons@ $12 .00 x 1 trip Baggage Fees-determined by carrier ; 2 persons @ $50 x 1 trip ECO $0 so $0 $0 $0 so so ) c . ~ description : One Laboratory Staff to attend the Florida Advanced Mosquito Identification and Certification Course In 2020 for continued proficiency and skllls needed for mosquito surveillance In Texas . This advanced coursework for mosqu ito Identification Is not offered In Texas . Mileage : trips x # persons x? mKes r/1@ $ ,58/mile Airfare ; 1 person @ $500 r/t x 1 trip Ground Transportation : 1 person @ 580 X 17 trips Lodging : 16 nights@ $169/nlght x 1 person x 1 trip Per Diem : 17 days@ $46 /day x 1 person x 1 trip Travel Fees : 1 persons@ $12 .00 x 1 trip Baggage Fees-determined by carrier : 1 persons @ $50 x 1 trip so so $0 so so $0 ECO } so $0 TX-DSHS-19-1309-A-002393 3of ) d . Travel description : The Stale Medical Entomologist and One arbovirus Laboraloiy slaff to attend the CDC Vector•bome Disease Meeting In Fort Collins , Colorado (Spring 2020) . Opportunity lo discuss VBD collaborations and training activities with CDC colleagues ECO $2,084 so Mileage ; lrips x # persons x? miles r/t@ $,SB/mile Airfare : 2 persons @ $300 r/t x 1 trip Ground Transportation : 2 persons @ SS0 x 1 trip $600 $100 Lodging; 3 nlghts@S116/nlght x 2 persons x 1 trip Per Diem : 4 days @ $61/day x 2 persons x 1 trip Travel Fees : 2 persons @ $50 .00 x 1 trip Baggage Fees-determined by carrier ; 2 persons @ SSOx 1 trip 0. $696 $488 $100 $100 so Equipment Item Requested 1. [Item Name)• Qty Unit Cost Description : so Amount 0,00 E. Supplies $79,121 Item Requested 1 CDC Uohl Tracs 5 Unit Cost 90,95 2 3 4 5 6 7 8 5 5 5 165,85 112 ,65 97,00 5 5 5 50 29 .00 18.00 160.00 20.00 5 1 8 1 8 5 5 7 1 1 1 1 1 1 1 1 1 1 1 1 10 1 1 2 2 1 1 20 25 1 1 15 1 1 10 1 1 1 50.00 99 .99 490.00 45.00 504.00 53.00 53,00 497.00 130 .31 120.84 90.33 12.75 36,26 192 .16 162.19 90.32 28.28 20.00 104.D9 83.06 7.54 9.92 678.92 186.35 38.38 203 .94 112.11 1.81 3.63 59.49 64.55 10.90 51.00 51.00 24.00 104.55 165.57 113.55 9 10 11 12 13 14 15 18 BG Sentinel Traps 12 Voll Batteries CDC aravld traps 6 volt batteries Hanolmi drv Ice discensers aspirators Shlnnino mosauito samcles to lab Batterv Chamers lchone !RMEI DPP ZIKA laM Reagents DPP ZIKA laM Controls OENV Detect JaM Kit Denaue laM Posttlve Control Denoue loM Neoatlve Control CHJKV laM Kit 17 Samele Tube 4 ml 18 Screwcac w/ O·rtng 19 SO ml Conical Tube 20 Control Vlals 21 1.5 ml mlcrocentrtfuae tube 22 EP Tics 2·20 uL 23 EP Tlcs 2·100 UL 24 Pipette tics 1250ul 25 tips 2S0ul 28 tics 10ul 27 EPTlos 50· 1250 uL 28 Sleeve Protectors 29 Nltr11eGloves all sizes 30 Latex Gloves all sizes 31 Face Shield Full 32 N95 Disposable Respirator 33 Shoe Covers 34 Sleeve Protectors 35 VWR lmoervlous Gown U 38 Sharos 1 ouart 37 SharPs 8 ouart 38 Biohazard baas 14x19 39 Biohazard bags 32 quart 40 Biohazard container 41 DSX Samele TIP 42 DSX Reaoent TIP 43 DSX Reaaent Tube 44 Deeo Well Dilution 45 TMB ELISA HRP Substrate 46 10ml alass clcets Qty Amount 454 .75 H21400 829 .25 563 ,25 485 ,00 145_00 90.00 800 .00 1.000 .00 H21400 H21400 H21400 H21400 H21400 H21400 H21400 250 .00 H21400 99 .99 H21400 3,920.00 45 .00 4,032 .00 265 .00 265 ,00 3,479 .00 130 .31 120.84 90.33 12,75 36.26 192.16 162.19 90.32 28 .28 20 .00 104.09 83.06 75.40 9 .92 678 .92 372 .70 76 .76 203 .94 112 .11 36.20 90.75 59 .49 64 ,55 163.50 51.00 51 .00 240 .00 104,55 165.57 113.55 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 ECO ECO ECO ECO ECO ECO ECO ECO ECO ECO LAB S4,717 $74,403 Serology LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB TX-DSHS-19-1309-A-002394401) 47 5ml alass PIPets 48 Pipette 5 ml 49 Volumetric: Pipette 5 ml 50 Lockwell Frame 2HB lmmulon elates Culture tubes 12x75mm Culture tubes 16xlOOmm Paramm Film Polyester Sulfuric: Ac:ld 1.0N VWR Reaoent Reservoir 58 6B6C·1 Affinltv HRP ConJ 59 Goat Afflnltv Purified Ab la M 60 EL22·WNV antigen 61 EL325 - WNV tissue control 62 AG/TC diluent 63 PaoerTowel 64 6B6C·l Affinity HRP Conl 65 Goat Affinltv Purified Ab IaM 66 EL22-WNV antigen 87 EL325 - WNV tissue c:ontrol 68 AG/TC diluent 69 Nttrlle Gloves all sizes 70 Fac:eShield Full 71 VWR Reaoent Reservoir 72 Yellow TIDS, 200 UL 73 20 ul tlos 74 96•well Mlc:rotlter, 2205 75 Volumetric: Ploette 5 ml 76 Culture Tubes 12,asmm 77 Sharos 1 auart 78 Blohazard bag 79 12-weil slldes 80 Goat Serum 81 Tween-80 82 FITC-conjugate 11nv1trogenPlatinum 55 lll one step QK, 83 iDrR Eppendorf 0.1-10 µL epTlps FIitered Pipette 84 Tlos !Case of 9601 Eppendorf .5·20 µL epTlp FIitered Pipette 85 Tips (Case of 960) Eppendorf 2·200 µL epTlp FIitered Pipette 86 Tips ( Case of 960) Eppendorf 50-1000 µL epTlp FIitered Pipette 87 TIPS PCR !Case of 960) Eppendorf 20·300 µL Oualfllter T.l.P.S Seal 88 Max filtered tlos (Case of 9601 1·100 µL Sorenson Multlguard Barrier 89 Pipette Tips (Case of 960) rnermoSclentlflc 2160P Extended Length 90 ART 200 ulloack of 7681 Applied Biosystems MlcroAmp Optical 8-cap 91 Strips (Box of 300) 51 52 53 54 55 58 57 92 93 94 95 96 97 98 Applied Biosystems MicroAmp Optical Adhesive FIim (Box of 100) Applied Biosystems MlcroAmp Fast Optical 96-well Reaction Plates (Box of 201 1Eppenaort l.!> ml Natura, ::,are•LOcK Mlcn::entrlfuoe Tubes IBox of 500\ lnvltrogen Nuclease-Free Water (10 bottles X 50 ml) Kimberly-Clark Profeslonal Klmtech Science Klmwlpes 11.8 x 11.8 In (Case of 29401 Kimberly-Clari< Profesfonal Kimtech Science Kimwloes 8.4 ,c 4.4 In Cease of 601 Klmbeny-ClarK Small Surgical Gown, Case of 34 Kimberly-Clark Basic Plus Lab·Coat/Blue, Small 1 1 1 1 1 1 1 10 1 1 1 1 1 4 4 1 1 1 1 4 4 1 10 1 1 4 1 1 1 1 51 1 1 1 1 1 6 148.59 113. 55 113.55 240.67 227.00 35.89 47.74 19.75 37.18 8.00 153.73 625 ,00 158.60 63.00 33.00 20.00 19.54 625.00 158.60 63 .00 33.00 20.00 7.54 678 .92 153 .73 8.10 20.00 61.89 113.55 35.89 1.81 64.55 52.B5 US.OD 26.60 187.85 1,876.00 148.59 113.55 113.55 240.87 227.00 35.89 47.74 197.50 37.18 8.00 153.73 625.00 158.80 252.00 132.00 20.00 19.54 825.00 158.60 252.00 132.00 20.00 75.40 678.92 153.73 32.40 20.00 81.89 113.55 35.89 92.31 84.55 52.85 115.00 26.80 187.85 H41000 H410DO H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H4100D H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H41000 H4 1000 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB 11 256.00 H41000 LAB 2 838.20 H41000 LAB Viral lsolaUon 141.91 20 10 141.91 1 419.10 H41000 LAB 10 210.00 2100.00 H41000 LAB 15 141.50 2.122.50 H41000 LAB 3 126.84 380.52 H41000 LAB 1 158,27 158.27 H41000 LAB 5 112.43 562.15 H41000 LAB 1 111.00 111.00 H41000 LAB 1 209 ,10 209.10 H41000 LAB 895.00 H41000 LAB 793 .20 H41000 LAB 109.00 H41000 LAB 121.20 H41000 LAB 132.24 H41000 LAB 242.70 H41000 LAB 178.24 H41000 10 20 1 89.50 39.66 109.00 1 121.20 1 132 .24 1 242.70 99 1 100 Kimberly-Clark Basic Lab-Coat/Blue, Medium 1 11\lmDeny·ClarK~astc PIUSLab· 101 Coat/Blue Laroe 1 178.24 177 .15 177.15 H41000 LAB LAB 180 .00 180.00 H41000 LAB TX-DSHS-19-1309-A-0023955 ot I 102 103 104 105 106 Kimberly-Clark Basic lab-Coat/Blue, X-Large Rnase Away {6 x 475 mil Bleachrlte rcase of 4 bottlesl OIAamo OSP viral RNA mini Kit tolaaen) Ethanol {Molecular Grade) 500 ml Nunc Cryotubes 1.6 ml Starfoot Vials w/ 107 Marldna Area. Round Bottom Vials (case of Mag NA Pure LC Total Nucleic Add Isolation 108 kits 180.00 H41000 H41000 H41000 H41000 H41000 LAB LAB LAB LAB LAB 1 588.89 1 588.89 H41000 LAB 1 1 1 1 4 370.48 73.18 219.62 27.50 1 180.00 370 .48 73 .18 219 .62 110.00 1 499.00 499 .00 H41000 109 MagNA Pure LC Cartridge Seals 1 170 .00 170 .00 H41000 110 MagNA Pure LC Sample Cartridges (120) 111 MaaNA Pure LC TID Stands (200) 112 MaaNA Pure LC Reaction Tlos Lan:ie (960) MagNA Pure LC Mealum Reagent Tubs 20 113 IU50l MagNA Pure LC Tub Lids, Small/Medium 114 (3001 115 MaaNA Pure 96 svstem fluid 116 MaaNA Pure 96 1000 Tics 117 MaaNA Pure 96 Lysls 118 MagNA Pure96 Processing Cartridges 119 MaaNA Pure 96 Output 120 MaaNA Pure 96 Seal Foll 121 MaaNA Pure Small Volume Extraction Kits 122 MaaNA Pure 96 Needle (4) 123 EasyMaa Silica (48 tubes) 124 EasvMaa Lysls buffer (4 x ll bottles) 125 EasyMao Buffer 1 (4 x ll bottles} 126 EasvMaa Buffer 2 (4 x 1L bottles) 127 EasvMaa Buffer 3 (4 x 1L bottles) 128 EasvMaa Dlsoosables (48 sets) PerfeCTaMultlPlex qPCR SuperMlx, Low ROX 129 '200 x 50 mll 130 OlAamo OSP ONA Blood Mini Kit 131 Human Genomic DNA 132 Trlzma hydrochloride solution 1 1 1 121.52 274.00 381.00 12 L 52 H41000 274.00 H41000 381 .00 H41000 LAB LAB LAB LAB LAB 1 212.00 212 .00 H41000 LAB 335.00 117.90 936.90 135.00 275.40 246.60 244.80 2 108.70 279.90 901.13 707 .60 282 .54 194 .16 353.43 812 .74 335 .00 H41000 2 358 .00 H41000 4,684.50 H41000 675 .00 H41000 1,377.00 H41000 248 .60 H41000 244 .80 H41000 10 543.50 H41000 279 .90 H41000 901.13 H41000 707 .60 H41000 282 .54 H41000 194.16 H41000 353 .43 H41000 812 .74 H41000 LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB LAB F. 1 20 5 5 5 1 1 5 1 1 1 1 1 1 1 - 1 418.65 1 170.00 283.40 34.90 1 5 418 .65 170.00 283 .40 174.50 H41000 H41000 H41000 H41000 LAB LAB LAB LAB so Contractual Sub-recipient {category 4000) 1. Project Title : $0 iQ A. Name of Contractorlsl : B . Method of Selection : C. Period of Performance : o. scope of Work : E . Method of Accountability ~ { Ente1 accountibiht y methOd here) F. Budget Detail and Justification. Vendor (category 2001 or 2009) 1. Project Tille : A. Name of Conlractor(sl : $0 $0 B . Method of Selection : C. Period of Performance. D. Scope of Werle E . Method of Accountability; [Enter accounllbihty method here] F. Budget Detail and Justification. Vendor (category 2001 or 2009) 1. Project Tille : $0 $0 TX-DSHS-19-1309-A-0023966 ofl A. Nameof Contractorls): B. Method or Selection: C. Period of Performance: D. Scope of Work: [Enter SOW (!!!:tail here! E. Method of Accountability: (Enter accountlbihty method here] F. Budget Detail and Justification : TX-DSHS-19-1309-A-002397 7 of) G. so Other ~m Requested Number Estimated of Cost per Months Mom.II Numberof Staff Amount Requ111ted so 1. 2. 3. Item Raqu■sted Number Nnded Amount Raauested Unit Cost so 1. 7500 Fast Ox Service Contracts (Clinical Arbo Testing) 2. EasyMag Extractor Service Contract (clinical arbo PCR testing) 3. Roche MagNA Pure 96 Service Contract (Clinical Arbo PCR) 4. Roche MagNA Pure LC 2.0 (Clinical Arbo PCRl 5. Dynex OSX Service Contract (Serology 0 9,500.00 o.oo LAB 0 11,000 .00 0.00 LAB 0 17,500.00 0,00 LAB 0 3,500.00 0.00 0 10,000 .00 0.00 LAB LAB 6. TMCA Registration 0 95.00 0,00 ECO 7. AMCA Registration 0 400 .00 0,00 ECO 0 500 ..00 0.00 ECO 0 350 .00 0,00 EPI ) a. Advanced Mosquito Identification Course Registration 9. Diseases In Nature Conference Registration , Eoi/H21400 Total Direct Cost: Total Indirect Charges: Pleau SN Total Budget: $216,452 $51,644 attached DSHSlndlreet Cost attachment for calculation. S268,096 TX-DSHS-19-1309-A-002398 So l l ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Budget Request Period: 8/1/19-7/31/20 HEALTHPROGRAMSFixed rate 9/1/2017 - 8/31/2018@ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Direct Charges Total Personnel $98,995 Fringe $36,252 Travel #of contracts - $1,042 Equipment {Greater than $5,000; unless an exception Item) Supplies {Less than $5,000; unless an exception item) Contractual (Sub-recipient In excess of $25,000) Applicable Amount charged IDC I I $0 $4,717 IDC Rate at 18.1% $98,995 $17,918 $36,252 $6,562 $1,042 $189 $0 $0 $4,717 $854 $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 $0 0 0 $0 $990 $179 $141,996 $25,701 Sub-total Contractual Other $990 Total - Health Programs $141,996 - 0 - LABORATORY SERVICES • Fixed rate 911/2017 - 8131/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @33.9% Direct Charges Total Personnel $0 Fringe $0 Travel Equipment (Greater than $5,000; unless an exception Item) Supplies (Less than $5,000; unless an exception Item) #of Applicable Amount charged IDC contracts IDC Rate at33 .9% $0 $0 $0 $0 $1,041 $1,041 $353 $0 $0 $0 $74,403 $74,403 $25,223 • Contractual {sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 $0 0 $0 $0 0 $0 $0 $1,085 $368 $25,943 Contractual (Vendor contracts • DSHS Category 2000) Sub-total Contractual $0 Other $1,085 Total• Laboratory Services - - - - $76,529 0 $76,529 $218,526 0 $218,526 - TOTAL INDIRECT COST - $51,6~ The base for the Department is total direct costs, excluding : capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs . TX-DSHS-19-1309-A-002399 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project H - Vector Borne Diseases - Tiers 2 and 3 Federal { C) 93.323 New or Revised Budget Non-Federal (d) Federal {e) Non-Federal (f) Total (g) $0 $0 $418,529 $0 $418,529 $0 $0 $418,529 $0 $418,529 2. 3. 4. 5, TOTALS SECTION B - BUDGET CATEGORIES 6, Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) a. Personnel $84,549 $84,549 b. Fringe Benefits $30.962 $30,962 $8,708 $8,708 $0 $0 $881 $881 $210.000 $210,000 g. Construction $0 $0 h. Other $0 $0 c. Travel d. Equipment e. Supplies f. Contractual i. Total Direct Charges (sum of Ba - 6h) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $335,100 $0 $0 $0 $83,429 $335,100 $83,429 $418,529 $0 $0 $0 $418,529 $0 $0 $0 $0 $0 TX-DSHS-19-1309-A-002400 Standard Fonn 424A (7-97) Presaibed by 01\ABCircular A-102 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum aflinss 8·11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $418,529 $104,632 $104,632 $104,632 $104,633 $0 $0 $0 $0 $0 $418,529 $104,632 $104,632 $104,632 $104,633 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum aflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) rth 16. 17. 18. 19. 20. Totals (sum aflines 16·19) $0 $0 $0 21. Direct Charges: $335,100 22. Indirect Changes: $83,429 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment: alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/ 1/2017 - 8/31/2018 and Provisional rate 9/1/2018 • 8/31/2021 for Health Programs- 18,1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002401 Texas Department of State Health Services ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Report, Prevent, and Respond (Tiers 2 and 3) CDC-RFA•CK19-1904, 2019 Epldemlology and Laboratory Capacity for PrevenUon and Control of Emerging Infectious Diseases (ELCJ Budget Request Period: 8/1/19-7/31/20 A. Personnel $84,549 Position ""' Time Annual Salary Annlllll Longevity Benefit Rep/lfC9IMflt Months Total P• 1. Microbiologist II 100% S4D,086 S480 SD 12 S4D,566 ECO Hancock, Joseph (H4100018703) Position Description: Participates In all aspects of the Texas Department of State Health Services Arbovirus Laboratory (DSHSAL) mosquito surveillance program. Responsibilities include data entry Into the Laboralory Information Management System (LIMS), mosquito species identification and pooling of vector species, arbovirus testing, and insecticide resistance testing for Jurisdictions in Texas Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents. Coordinates and assists with maintenance of laboratory mosquilo colonies and specimens submilted for insecticide resistance testing. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting requirements. Participates in preparation of standard operating procedure (SOP) documents and training other staff. Tier 2, Assists with Tier 1·3 activlUes. 2. Microbiologist II 100% S41,823 $2,160 $0 12 $43,983 ECO Day, Joanne (H41000/8706) Position Description: Participates In all aspects or the DSHSAL mosquito surveillance program. Responsibilities include data entry into the LIMS, mosquito species Identification and pooling of vector species, arbovirus testing, and insecticide resistance testing ror Jurisdictions in Texas. Coordinates and performs all aspects of arbovirus diagnostic work including nucleic acid analyses and isolation of viruses, while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for arbovirus diagnostic reagents. Coordinates and assists with maintenance of laboratory mosquito colonies and specimens submitted for insecticide resistance testing. Coordinates and assists with data analysis and organization, data requests from stakeholders. and data reporting requirements. Participates In preparation of SOP documents and training other staff. Tier 2, Assists with Tier 1-3 actlvlUes. SD ECO ' 3. Program Specialist 111 0% SSS,000 SD SO 12 NEW (H21400/Position # TBD) Position Description: Border entomologist to cover international border areas in Public Health Regions 8, B. 10. and 11. They should have a Master's Degree in Entomology or related field. They will support local border jurisdictions as a subject matter expert. Duties will include consultation and training on, and, at times, performance of a range of integrated vector management-relaled activities, e .g. conducling veclor surveillance. the analysis and interpretation of which informs timely control activilies ; conducting IR testing, the results of which inform decisions on product selection and applicalion; and disseminating findings, The posilion will submit data for entry into MosquitoNet; assist local jurlsdiclions in coordinaling investigation and response lo VBD outbreaks, implementing emergency vector control aclivities; and composing rouline and emergency-related risk communication plans. Tier 2, WIii Assist with Tier 1-3 activities. 4. Geographic Information Specialist I 0% $39,521 SO SO 12 $0 NEW (H21400/H41000 (50/50)/Position # TBD) Position Description: This will be a split posilion between the Arbovirus Laboratory and the Zoonosis Control Branch. Primary responsibilities will include organizing mosquito surveillance and insecticide resistance testing data and generating reports from them; coordinating and assisting wilh maintenance or databases to capture relevant spatial and temporal information; documenting procedures; validating data for accuracy and completeness; completing approved metadata rorms; and producing maps to display the data: coordinating and assisting with lhe generation of maps and summary lables for distribution between epi and laboralory staff, for MosquitoNET reporting, for responding to submitter requests, and for updating the DSHS website Tier 2, WIii assist with Tier 1·3 activities. EC JO . rP r TX-DSHS-19-1309-A-0024021 gf J B. FringeBenefits $30,962 Fringe benefits are applicable to direct salaries and treated as direct costs . Current benefit rate is 36 .62% and are categorized In the following manner : Social Security/Medicare- 7 .65% Relirement-10.00% Insurance- 18.97% C. Travel $8,708 1. In-State $8,708 a . Travel description : The medical entomologist will travel once to visit with the PS Ill to assist with any trainings or assistance in working with the LHD or the vector control Jurisdictions . The medical entomologist will travel once to each of the Public Health Regions to assist with any trainings or assistance In working with entities that receive the surveillance kits , Enhancing mosquito surveillance capacity throughout the state , ECOIH21400 Assist with Tier 1·3 activities $8 .708 $2 ,123 Mileage 15 trips x 1 person x 244 miles r/1@ $ ,58/mile Airfare : # persons @ $? r/1 Ground Transportation : # persons@ S? Lodging ; 3 nights @ $85/nlght x 1 person x 15 trips Per Diem : 4 days@ $46/day x 1 person x 15 trips Travel Fees : #persons@ S12.00 x # trips Baggage Fees-determined by carrier ;# persons @ S? ECO so so S3,825 S2.760 so so b. Travel description. The border entomologist will have weekly duties that will require them to travel throughout the public health regions where they have responsibilllies . We estimate that they will travel at least three times per week up to 350 mr.es per week . We expect at least one trip will be an overnight trip to set out and pick up mosquito traps . The border entomologist will also travel once a quarter to Regional Headquarters to work with the State Medical Entomologist . ECOIH21400 Assist with Tier 1·3 activities so so $0 so Mileage : 56 trips x 1 person x 350 miles r/1@ S.58/mlle Airfare · 1 person @ $450 r/1 x 2 trips Ground Transportation : 1 person@ $167 x 3 trips Lodging : 3 nights @ $85/night x 1 person x 56 trips Per Diem : 4 days@ $46/day x 1 person x 56 trips Travel Fees . 1 person@ $12 .00 x 2 trips Baggage Fees-determined by carrier · 1 person @ $50 x 1 trip $0 so $0 so so 2. Out-of-State a. Travel description : so so so so so so so so Mileage trips x # persons x ? miles r/t @ S.58/mile Airfare : # persons @ r/1 Ground Transportation 1 persons @ $ lodging ; nights @ $/night x persons x trips Per Diem : days @ S/day x persons x trips Travel Fees : persons@ 512 .00 x trips Baggage Fees-determined by carrier :# persons @ S? D. so Equipment Item Requested 1. (Item Name] • Description. Unit Cost Amount so 0 ,00 TX-DSHS-19-1309-A-002403 2011 E. Supplies $881 Item Requested 1. Culex Insecticide resistance tesUngsupplies 0 2.500.00 2. COC Light Traos 1 90.50 3. CDC caravldtraps 4. BG santJnal2 traos 1 97.00 1 165.85 5. 6 volt batteries 29.00 6. 12 volt batteries 1 0 112.65 H21400 90.50 H21400 97.00 H21400 165.85 H21400 29.00 li21400 0.00 H21400 7. binocularstero microscope 1 424.64 424.64 Unit Cost 8. hanging dry ice di,.,,..nser 1 18.00 9. MoSQulloID Books 1 54 .95 0 0 99 .00 135.90 0 10. l!JIIQ_na 11. Plpet Basins (case of 200) Thermo Scientific"" ClipTlp"" Pipette Tips 12. (960 tips In each unit) MagMax Deep well plates l!iO p1ates In eacn 13. unit) MagMax Standard plates (48 standard plates 14. In each unit) MagMax Deep well tip combs (100 combs In 15. each unit) coming universal lid with comer notch 16. (COmtng 3099) case of 50 Axygen"' SmL Snaplock Mlcrocentrifuge 17. Tubes-case of 5 packs roack = 250 tubes) 1;:,upe,- .. pt 111 i-1aonum 1 - .. u:p q.,., - ,.._.,.''" 18. l('iOO rxnsl 36. BA DIiuent 2 ml each •prep In house 1n11aunan,r11ter i-aper \..IIUC:O 1.>raae4, llU 37. mm (#1nn41101100/na,-k $20.40 38. Labels for tubes, $60/oack, 2,380/pack 39. Infection supolies for cell culture 40. Processing supplies for cell culture 41. Equine processing 42. Dlsoosable micro pipettes (Dk of 500) ll'lpette r-l11er{wnee1} PacK or J lZ, 10, & Z!i 43. ml) 44. 250 ml Glass Wheaton bottles (case of 48) 45. Acetone (100%) 4 L Plastic Graduated Cylinders (100 ml) case of 46. 12 Heavy-duty Glass Beakers (250 ml} pack of 47. 12 COvldlen Tendersorb'" Underpads (case of 46. 150) 49. Aspirators ,- .,,_..,_, lU'' uu111:, MIL 50. ( 1 r-artnn = 1 nnn h~nr \ Amount 0.00 H21400 18.00 H21400 54.95 H21400 0.00 H21400 ECOmer2 Jf ECOmer2 Ecomer2 ecomer2 ECOmer2 ECOffier 2 ECOmer2 116.59 0.00 H41000 ECOffier 2 0 366.00 0.00 H41000 ECOmer2 0 172.00 0.00 H41000 ECOmer2 0 587.00 0.00 H41000 ECOmer2 0 126.03 0.00 H41000 ECOITTer 2 0 419.99 0.00 H41000 ECOITTer2 0 0 1840.00 0. 08 0.00 H41000 0.00 H41000 20 20 0 0 0 0 0 0 0 0 0 0 0.03 0.03 0.83 D.90 3.30 105.64 135.73 347.75 236.38 329.37 117.40 58.49 0 90.00 0 0 93.00 156.64 0 24.20 0.60 0.80 0.00 0.00 0.00 0.00 H41000 H41000 H41000 H41000 H41000 H41000 ECOmer2 Ecomer2 Ecomer 2 ECO/Tier 2 ECOITTer 2 ECOITTer 2 0.00 H41000 0.00 H41000 0.00 H41000 ECOITTer 2 ECOmer2 Ecomer 2 0.00 H41000 ECOITTer2 0.00 H41000 ECO/Tier2 0.00 H41000 ECO/Tier 2 0.00 H41000 ECOmer2 0.00 H41000 Ecomer2 0.00 H41000 ECOffier 2 0.00 H41000 ECOmer2 j\oJ $210,000 Sub-recipient (category 40001: A. Name or Conlractor(s1 : _.f~ Ecomer2 EComer Ecomer2 Contractual 1. Project Title: Ecomer2 0.00 H41000 X l.l 51. Labeling tape-Rainbow pack (case of 24) Richmond Braidedcotton Roll 3/8* 52. diameter, 6* length (pk of 200) F. Qty Harris County Public Health Vector and ~ ECO/Tier Mosquito Control Program ! Harris County Public Health Mosquito Vecto r Control District (HCPHMVCD) B. Method or Selection: Sole Source C. Period of Perfonnance. 8/1/19-7/31/20 ·:xf o. ScopeorWork : TX-DSHS-19-1309-A-002404 3d' J The funding to HCPHMVCDwill fund one technicianthat will be Involved in the surveillance and testing or mosquitoes. The technicianwill conduct surveillance to monitor mosquitoes and wild bltd (avian) specimensfor the presence of arboviruses, Including SLE and WN viruses, collect routine mosquito and avian specimens, screen mosquito pools for SLE and WN, Zika, CHIK, DEN virus, report significant results to DSHS within twenty-fourhours, and provide DSHS program with a fmat progress report. Sole Source E. Method of Accountab~ltv: System Agency will monitor PerformingAgency's performanceof the requirementsIn the SOW and compliancewith the Contract'sterms and conditions. F. Budget Detail and Justification. See atlachment. so Vendor (category 2001 or 2009) 1. ProjectTille. Improve InformationReach and RetentionUpdate and enhance Arbovirus Laboratorywebsite by adding informationaltraining videos $75,000 to produce a series of 5 videos Arbovirus Surveillancern Texas, Mosquito Trapping, Collecting GPS Coordinates. Shipping Mosquitoesto DSHS Laboratory,Forms and Data Qua~ty.H4100D A. Name or Contractor($) B. Method of Selection 12 ecomar i ARROWHEADFILMANOVIDEOINC Sole Source 8/1/19-7/31/20 C. Period of Performance. D. Scope of Work: Improve lnrormation Reacn and RetentionUpdate and enhance Art>ovlrusLaboratory website by adding informationaltraining videos to produce a series of 5 videos· Arbovirus Surveillancein Texas, MosquitoTrapping, CollectingGPS Coordinates,Shipping Mosquitoesto DSHS Laboratory, Forms and Data Qualily. : E. Method ofAccounlabiMty System Agency wift monitor PerformingAgency's performanceof the requirementsin the SOW and compliancewith the Contracts terms and conditions. F. Budget Detail and Justification: Basedon estimated total cost of $75,000 ror 5 videos over 3 years. $25,000 estimated for first year. Vendor(category 2001 or 2009) 1. Project Title;_Vector-bome diseaseand Insecticideresistancesurveillance along the Texas-Mexico Border, H21400 $160,000 s160,000 ecomer i A. Name of Contractons). Universityof Texas Rio Grande Va!ley (UTRGV) B. Melhod or Selection: So'eSource C Periodof Performance. 8/1/19-7/31/20 D. Scope or Work: The goal or this project ls lo continue the ongoing surveillance of vector mosquiloesand mon toring of insecticide resistance along the Texas-Mexicoborder, a region that is of particularconcern for Introductionand local transmissionof veclor•bome diseases sucnas Zika, dengue, and chikungunya. E, Method or Accountability; wi• System Agency monitor PerformingAgency's performanceof the requirementsin the SOW and compliancewith the Contract's terms and condltlons F. Budget Detail and Justification: Vendor feategory2001 or 2009) 1. Project Title· Insecticide Resistancetesting H21400 $50,000 ~ecomer i A. Name or Conlractons): Texas Tech University B. MethodofSelection: Sole Source c. Period of Performance: 8/1/19-7/31/20 D. Scope of Work: TX-DSHS-19-1309-A-002405 4 ofl A. Receive mosquito eggs for rearing and subsequent insectlclde resis tance testing from as many as 50 submitting Jurisdictions up to twice annually as coordinated by System Agency. B. Use the Centers for Disease Control and Prevention (CDC) bottle bioassay for detecting resistance to insecticides in vector mosquito populations . C. Determine the diagnoslic dose and diagnostic time for each insecticide , for each region and for each vector species that is tested , D. Provide testing of resistance/susceptibilily of mosquito populations from each submitter of mosquitoes against a panel of at least 2 different insecticides (types/families) at 3 concentrations (high/med/low) and controls E. Electronically submit. in a format provided by DSHS, a bl-annual report of the testlng data to DSHS at Whitney .Qualls@dshs.texas gov . E. Method of Accountability : System Agency will monilor Performing Agency's performance of the requirements in the SOW and compliance with the Contract's terms and conditions . F. Budget Detail and Justification : See attachment. G. Other Item Requested Number EsUmated of Cost pt1r Months Month $0 Number of Staff Amount Requnted so 1. 2. 3. ttemRequested 1. Kingfisher Flex Extraclor Service Contract (Mosquilo Surveillance Testing) 2. 7500 Fast Dx Service Contracts (Mosquito Number Needed Unit Cost Amount Requested s.o 0 4,500 .00 ODOEcomer2 Surveillance) 0 3. DSHS is requesting $26,250 (equal to the last 9,500 .00 0.00 Ecomer2 . ELC award for this activity) to increase the Disease In Nature conference attendance by reducing the registration fee. With the full award, the fee will be reduced from $350 to $250. This significant reduction in cost will assist in attracting speakers and broadly facilitate attendance by physicians, nurses , veterinarians, and public health professionals such as epidemiologists for whom DIN is the only opportunily to attend a zoonosis•focused . One Health In-state conference , Epi/H21400 0 Total Direct Cost: Total Indirect Charges: Pl-■se see attached DSHS Indirect Cost attachment for calculatlon. Total Budget: 26,250 .00 0.00 EPI $335,100 $83,429 $418,529 TX-DSHS-19-1309-A-0024065 of I ELC Category H, Vector-Borne Diseases: Building Comprehensive Programs to Identify, Diagnose, Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017- BI31/2018@1B.1% Provisional rate 9/1/2018 -8/31/2021@ 18.1% Direct #of Charges Total contracts Personnel Applicable Amount charged IDC $0 - IDC Rate at 1B.1% $0 $0 $0 $0 Fringe $0 Travel $8,708 $8,708 $1,576 $0 $0 $0 $880 $880 $159 Equipment (Greater than $5,000; unless an exception Item) Supplies (less than $5,000; unless an exception Item) Contractual (Sub-recipient In excess of $25,000) $0 1 $25,000 $4,525 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 $210,000 2 $210,000 $38,010 $210.000 3 235.000 $42 535 $0 $0 $244,588 $44,270 Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other $0 Total - Health Programs - - - - $219,588 3 ~ LABORATORY SERVICES Fixed rate 9/1/2017 - 8131/2018 @33.9% Provisional rate 9I1/201B - B/31/2021 @ 33.9% Direct #of Charges Total contracts Personnel $84,549 Fringe Applicable IDC Rate Amount at33.9o/o charged IDC $84,549 $28,662 $30,962 $30,962 $10,496 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $1 $1 $0 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 1 $0 $0 $0 1 $0 $0 $0 $0 Sub-total Contractual Other $0 Total - Laboratory Services TOTAL INDIRECT COST -- - -- I - $115,512 1 $115,512 $39,159 $335,100 4 $360,100 $83,429 The base for the Department is total direct costs, excluding: capital expenditures {buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002407 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMAf"(Y Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project J - Binational Border Infectious Disease Surveillance (BIDS) Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $243,914 $0 $243,914 $0 $0 $243,914 $0 $243,914 2. 3. 4. 5. TOTALS SECTION CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY 6. Object Class Categories (1) a. Personnel B - BUDGET (2) (3) Total (4) (5) $122,111 $122,111 b. Fringe Benefits $44,717 $44,717 c. Travel $19,942 $19,942 $0 $0 e. Supplies $2,762 $2,762 f. Contractual $5,000 $5,000 $0 $0 $12,000 $12,000 d. Equipment g. Construction h. Other i. Total Direct Charges (sum of6a - 6h) j. Indirect Charge k. TOTALS (sum of Bi and 6j) 7. Program Income $206,532 $0 $0 $0 $37,382 $206,532 $37,382 $243,914 $0 $0 $0 $0 $0 $0 $0 $243,914 Standard Fonn 424A $0 (7-97) TX-DSHS-19-1309-A-002408 Prescribed by 0MB Circular A-102 SECTION G - NON-FEDERAL {a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum of lines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $243,914 $60,979 $60,979 $60,979 $60,977 $0 $0 $0 $0 $0 $243,914 $60,979 $60,979 $60,979 $60,977 SECTION D - FOREGASTED Total for 1st Year GASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflinss 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE (b) First OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (e) Fourth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) 21. Direct Charges: $206,532 22. Indirect Changes: $37,382 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alteralions and renovalions); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8131/2021for Health Programs- 18.1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002409 Texas Department of State Health Services ELC Project J - Blnatlonal Border Infectious Disease Surveillance (BIDS) CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: August 1, 2019 -July 31, 2020 A. Personnel $122,111 ~ I Position "of Time Annual Salafy ' Senefff Annu_alLongevity Replacement Months Pav.lBRPJ Total Program Specialist 1. Ill 100% $0 $0 $0 12 $0 NEW (H21400/Position # TBD) Position Description: The Border Entomologist performs highly advanced (senior-level) consultative services, technical assistance, and field work relating to medical entomology and the prevention and control of vector-borne diseases pursuant to statute and to rules adopted by the Texas Health and Human Services Commission; works with the State Medical Entomologist to develop policy on the role of the Department of State Health Services (DSHS) in vector control; serves as a DSHS liaison to the border regions and with representatives from industry, professional organizations, academic institutions, local programs, and local health officials on vector-related issues and projects; organizes, provides leadership, or represents DSHS on project teams whether in-house or in collaboration with groups of representatives from a wide range of stakeholders, e.g. professional organizations and local, state, or federal governmental agencies; develops short-term goals and long- range plan objectives for vector control in Texas; serves as an expert consultant for vector-control matters and provides highly advanced technical advice and direction to DSHS program staff, local programs, and local health officials, plus the publlc; manages, develops and coordinates training programs; and maintains working knowledge of laws and rules that directly affect DSHS activities concerning vector control programs. Works under minimal supervision, with extensive latitude for the use of initiative and independent judgment. Employee actively participates and/or serves In a supporting role to meet the agency's obligations for disaster response and/or recovery. 2. Epidemiologist II 85% $53,697 $0 $0 10 $38,012 NEW (R1 F000/Posilion # TBD) TX-DSHS-19-1309-A-0024101 oq Position Description: Limited infrastructure exists to support binational disease detection, reporting and prevention in DSHS Public Health Region 8. An epidemiologist II will help fill this gap. The Epidemiologist II position will be managed by the Communicable Disease Manager and will serve as the binational infectious disease control and prevention lead. Using the US Mexico Guidelines, the Epidemiologist will conduct surveillance of notifiable conditions, improve disease detection, reporting and prevention of infectious diseases of binational concern in the Texas-Coahuila border region including the Kickapoo Traditional Tribe of Texas via the established Region 8 Trinational Epidemiology Workgroup. Develops and implements programmatic guidelines and protocols to improve surveillance activities on diseases of interest to the Trinational Epidemiology Workgroup. Plans, develops and directs epidemiologic investigations and surveillance programs. Plans, develops and conducts disease surveillance through rapid investigation of binational oubreaks, and improved detection and timely reporting. Will implement and work with providers to carry out enhanced surveillance as it relates to chagas testing among pregnant women and refer for care as necessary and implement mosquito surveillance activities. The Epidemiolgist II will lead the efforts of the Trinational Epidemiology Workgroup as it relates to the binational information sharing and collaboration protocols. The epidemiologist will conduct research to assess access to medical care and sources of health information, cross-border mobility and demographics. Data collected will be used to develop and Initiate epidemiological projects. Provides epidemiological consultation, peer to peer training, direction, and mentoring for program personnel, field staff, local public health partners, community-based organizations, health care professionals, animal health professionals, tribal directors, binational planning committees and public health students. Develops effective relationships and communication networks with regional health care professionals, partners, stakeholders and others to enhance preparedness and response and reporting and surveillance. Provides technical assistance to local health departments in conducting timely and effective disease surveillance activities, assist with binational outbreak investigations. In communities that do not have a local health department, oversees all disease surveillance and investigation activities. Develop community health worker curriculum to educate on the emergence and spread of antimicrobial drug resistant organisms and present to the Trinational Epidemiology Workgroup for adoption binationally. C:11n,aill~nro tnnlc: /cnrc~r4c:hcu:atc 3. Epidemiologist I 100% r4-::at~h-:acoc\ u,itl ho 11c:cA fn,- ,-.nUArtinn $42,244 $0 ~nrt c:t1h""ittinn $0 12 rlinir~I nr $42,244.00 Torres, David (R1G000/62542) Position Description: Region 9/10 Epidemiologist. Under the supervision of the Office of Border Health (OBH) Program Manager provides leadership for the Border Infectious Disease Surveillance (BIDS) Program in matters of epidemiology, surveillance and related prevention activities. Performs advanced (senior-level) epidemiological work. Work involves serving on teams of health specialists and investigating public health problems; planning, developing, coordinating, and conducting investigations; designing and implementing unit data collection systems; analyzing data; and disseminating Investigation results. May supervise the work of others. Works under limited supervision, with considerable latitude for the use of initiative and independent judgment. Will plan, develop, and present statistical data and reports. Arranges for the cooperative use of epidemiological data with other agencies.states and national organizations such as the US Centers for Disease Control and Prevention. Networks and develops partnerships with various blnational public health professionals, and other public health entities. Will manage confidential and sensitive medical information, as well as collect, handle, package, and transport biological specimens. Will function in a professional, responsible manner, and will work under general supervision with moderate latitude for the use of initiative and independent judgment. Program Specialist 4. Ill 50% NEW (R1G0O0/Position# TBD) $42,244 $0 so 10 $17,602 TX-DSHS-19-1309-A-002411 2 Ofl Position Description: New entry level position in Region 9/10 requires a Bachelor's Degree. Under the supervision of the Office of Border Health (OBH) Program Manager provides technical and consultative assistance to the Border Infectious Disease Surveillance (BIDS) Program in matters of epidemiology, surveillance and related public health activities. Performs moderately complex (joumeylevel) epidemiological work. Collaborates in the planning, development, implementation, analysis, and documentation of the projects within BIDS. Serves as a liaison to staff, government agencies including the Centers for Disease Control and Prevention, and community stakeholders, to provide technical assistance on program specifics and requirements. Collaborates in the planning, development, implementation, analysis, and documentation of BIDS projects. Assists in the collection, organization, analysis, and/or preparation of materials in response to requests for program information and reports. Reviews and evaluates information on service delivery system methods, outputs, and activities to identify gaps in resources and recommend Improvements. May recommend and coordinate activities to produce a more effective program. May develop policy and procedure manuals or training materials and train others. Will function in a professional, responsible manner, and will work under general supervision with moderate latitude for the use of initiative and independentjudgment. 5. Epidemiologist II 54% $53,697 $0 $0 10 $24,253 NEW (R1H000/Position # TBD) Position Description: Under the supervision of the Epidemiology Program Manager provides leadership for the Border Infectious Disease Surveillance (BIDS) Program in the implementation of epidemiology, surveillance and related prevention activities. Performs moderately complex (joumeylevel) epidemiological work. Work involves assisting in the design, implementation, and analysis of epidemiological investigations or studies; and participating in general data management and report writing for epidemiological investigations or studies. Will use data gathering methodologies including study designs, surveHlance systems, development survey instruments, and data analysis software. Will plan, develop, and present statistical data and reports. Arranges for the Cooperative use of epidemiological data with the other agencies, states and national organizations such as the US Centers for Disease Control and Prevention. Networks and develops partnerships with various binational public health professionals, and other public health entities. Will manage confidential and sensitive medical information, as well as collect, handle, package, and transport biological specimens. Will function in a professional, responsible manner and will work under general supervision with moderate latitude for the use of initiative and independent judgment. B. Fringe Benefits $44,717 Fringe benefits are applicable to direct salaries and treated as direct costs. Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare-7.65% Retirement- 10.00% Insurance- 18.97% TX-DSHS-19-1309-A-0024123of J C. Travel $19,942 1. In-State $13,442 a. Travel description: The border entomologist within the Zoonosis program will have weekly duties that will require them to travel throughout the border area of the public health regions to which they are assigned. We estimate that they will travel at least three times per week up to 350 miles per week. We expect at least one trip will be an overnight trip to set out and pick up mosquito traps. The border entomologist will also travel once a quarter to a specified Regional Headquarters office to work with the State Medical Entomologist. Mileage: 56 trips x 1 person x 350 miles r/1@ $.58/mile Airfare: 1 person @ $450 r/t x 2 trips Ground Transportation: 1 person@ $167 x 3 regions x 2 trips Lodging: 3 nights @ $85/night x 1 person x 56 trips Per Diem: 4 days @ $46/day x 1 person x 56 trips Travel Fees: 1 person @$12.00 x 2 trips Baggage Fees-determined by carrier :# persons @ $? $0 $0 $0 $0 $0 $0 $0 $0 b. Travel description: Travel by PHR 8 staff to attend Diseases in Nature Conference or other conferences/trainings needed to meet program goals and objectives. Mileage: # trips x # persons x? miles r/t@ $.58/mile Ground Transportation: 4 days @$37/day x 2 trips Fuel for Car Rental: $40 x 4 trips x 1 person Lodging: 3 nights @ $85/night x 1 person x 2 trips Per Diem: 4 days @ $46/day x 1 person x 2 trips Travel Fees: 1 person@ $12.00 x 2 trips Baggage Fees-determined by carrier: # persons @ $? $0 $0 $0 $0 $0 $0 $0 $0 c. Travel description: Travel by PHR 8 staff to conduct vector surveillance and trainings in Public Health Region 8 border and surrounding counties. Counties included Maverick, Val Verde, Dimmit, Zavala, Kinney , Uvalde, La Salte, Frio and Medina. Mileage: # trips x # persons x? miles r/t@ $.58/mile Ground Transportation: 5 days @$37/day x 24 trips Fuel for Car Rental: $21.67 x 24 trips Lodging: 1 night @ $85/night x 1 person x 4 trips Per Diem: 2 days@ $46/day x 1 person x 4 trips Travel Fees: 1 person@ $12.00 x 4 trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 $0 $0 $0 TX-DSHS-19-1309-A-0024134o f] d. Travel description: PHR 9/10 service area is large, requiring long trips to reach providers in rural areas, often requiring an overnight stay. During the months of October- February (Flu Season), the BIDS EpidemiologistII travels to consult with providers, delivers supplies and educational materials, and transports specimens as needed. The counties covered include El Paso, Hudspeth, Culberson, Reeves,Jeff Davis, Presidio, Brewster and Pecos. The Epidemiologist I and Program Specialist 111positions would have fairly similar travel descriptions in many respects, as they would trade off with each other in traveling to some of the more distant locations of the reglon to consult with providers, deliver surveillance supplies and educational materials, and transport specimens as needed. The EpidemiologistI would have additional travel requirementsrelated to the binationalvariable initiative. $4,670 Mileage: 10 trips x 1 person x 500 miles r/t@ $.58/mile $2,900 Airfare: # persons @ $ r/t ·x # trips $0 Ground Transportation: # persons @ $ x # trips $0 Lodging: 1 night @ $85/night x 1 person x 10 trips $850 Per Diem: 2 days @ $46/day x 1 person x 1O trips $920 Travel Fees: #person@ $12.00 x # trips $0 Baggage Fees-determinedby carrier: # persons @ $? $0 e. Travel description:. The PHR 9/10 BIDS EpidemiologistI (II) will travel to Austin for to attend a required training at the Annual ELC Epidemiology Workshop. The conference is tentatively scheduledfor September24-26, 2019. Mileage: # trips x # persons x # miles r/t @ $.58/mile Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 2 nights @ $85/night x 1 person x 1 trip Per Diem: 3 days@ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 $0 $0 Baggage Fees-determinedby carrier: 1 person@ $50 x 1 trip $0 f. Travel description: The PHR 9/10 BIDS EpidemiologistI (II) will travel to the Annual Influenza Conference in July 2020. Location is TBD. Mileage: # trips x # person x # miles r/t @ $.58/mile Airfare: 1 person@ $400 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 2 nights @ $85/night x 1 person x 1 trip Per Diem: 3 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 $0 $0 Baggage Fees-determinedby carrier: 1 person@ $50 x 1 trip $0 g. Travel description: The PHR 9/10 BIDS EpidemiologistI (II) will travel to the One Health Conference. Date and Location is TBD. $0 Mileage: # trips x # persons x # miles r/t @ $.58/mile $0 Airfare: 1 person @ $400 r/t x 1 trip $0 Ground Transportation: 1 person @ $50 x 1 trip $0 Lodging: 2 nights@ $85/night x 1 person x 1 trip $0 Per Diem: 3 days@ $46/day x 1 person x 1 trip $0 TX-DSHS-19-1309-A-0024145of) Travel Fees: 1 person@ $12.00 x 1 trip $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 h. Travel description: The PHR 9/10 BIDS Epidemiologist I (II) will travel to the Texas Public Heatlh Association Conference. Date and Location is TBD. Mileage: # trips x # persons x # miles r/t@ $.58/mile Airfare: 1 person @ $490 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 3 nights @ $85/night x 1 person x 1 trip Per Diem: 4 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person @$12.00 x 1 trip $0 $0 $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 i. Travel description: PHR 9/10 service area is large, requiring long trips to reach providers in rural areas, often requiring an overnight stay. During the months of October - February (Flu Season), the BIDS Program Specialist Ill travels to consult with providers, delivers supplies and educational materials , and transports specimens as needed. The counties covered include El Paso, Hudspeth, Culberson, Reeves, Jeff Davis, Presidio, Brewster and Pecos. The Epidemiologist I and Program Specialist Ill positions would have fairly similar travel descriptions in many respects, as they would trade off with each other in traveling to some of the more distant locations of the region to consult with providers, deliver surveillance supplies and educational materials, and transport specimens as needed. The Epidemiologist I would have additional travel requirements related to the $0 Mileage: 10 trips x 1 person x 500 miles r/t @ $.58/mile $0 Airfare: # persons @ $ r/t x # trips $0 Ground Transportation ~ # persons @ $ x # trips $0 Lodging: 1 night@ $85/night x 1 person x 10 trips $0 Per Diem: 2 days@ $46/day x 1 person x 10 trips $0 Travel Fees: #person@ $12.00 x # trips $0 Baggage Fees-determined by carrier: # persons @ $? $0 \ \ \ j. Travel description : The PHR 9/10 BIDS Program Specialist Ill will travel to Austin for to attend a required training at the Annual ELC Epidemiology Workshop. The conference is tentatively scheduled for September 24-26 , 2019. Mileage: # trips x # persons x # miles r/t @ $.58/mile Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 2 nights @ $85/night x 1 person x 1 trip Per Diem: 3 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 k. Travel description: The HSR 9/10 BIDS Program Specialist Ill will travel to the Annual Influenza Conference in July 2020. Location is TBD. $0 Mileage: # trips x # person x # miles r/t@ $.58/mile $0 TX-DSHS-19-1309-A-0024156 orj Airfare: 1 person @ $400 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 2 nights @ $85/night x 1 person x 1 trip Per Diem: 3 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person @$12.00 x 1 trip Baggage Fees-determined by carrier: 1 persons @ $50 each X 1 trip $0 $0 $0 $0 $0 $0 I. Travel description: PHR 11 service area is large, requiring long trips to reach providers in rural areas, often requiring an overnight stay. During the months of October - February (Flu Season), the BIDS Surveillance Officer travels to consult with providers, delivers supplies and educational materials, and transports specimens as needed. The counties covered include Cameron, Hidalgo, Starr, Webb, Duval, Brooks, Willacy, La Salle and McMullen. Mileage: 15 trips x 1 person x 586.2 miles r/t@ $.58/mile Airfare: 1 person @ $350 r/t x 2 trips Ground Transportation: # person @ $ x # trips Lodging: 1 nights @ $85/night x 1 person x 1O trips Per Diem: 2 days @ $46/day x 1 person x 10 trips Travel Fees: #person@ $12.00 x # trips Baggage Fees-determined by carrier:# persons @ $? $6,000 $4,230 $0 $0 $850 $920 $0 $0 m. Travel description: The PHR 11 BIDS Manager and Surveillance Officer will travel to Austin for to attend a required training at the Annual ELC Epidemiology Workshop. The conference is tentatively scheduled for September 24-26, 2019. Mileage: # trips x # persons x # miles r/t @ $.58/mile Airfare: 2 persons @ $400 r/t x 1 trip Ground Transportation: 2 persons @ $50 x 1 trip Lodging: 2 nights@ $85/night x 2 persons x 1 trip Per Diem: 3 days @ $46/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 2 persons @ $50 each X 1 trip $0 $0 $0 $0 $0 $0 $0 $0 n. Travel description: The PHR 11 BIDS Manager and Surveillance Officer will travel to the Annual Influenza Conference in July 2020. Location is TBD. Mileage: # trips x # person x # miles r/t@ $.58/mile Airfare: 2 persons @ $400 r/t x 1 trip Ground Transportation: 2 persons @ $50 x 1 trip Lodging: 2 nights @ $85/night x 2 persons x 1 trip Per Diem: 3 days @ $46/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier : 2 persons @ $50 each X 1 trip $0 $0 $0 $0 $0 $0 $0 $0 I o. Travel description : Travel for two people from Central Office to visit regional sites in El Paso and Harlingen. Mileage: 2 trips x 2 persons x 10 miles r/t @ $.58/mile Airfare : 2 persons @ $306.50 r/t x 2 trips $2,036 $23 $613 TX-DSHS-19-1309-A-0024167of] Ground Transportation: 2 persons @ $60 Lodging: 2 nights @ $85/night x 2 persons x 2 trips Per Diem: 3 days @ $46/day x 2 persons x 2 trips Travel Fees: 2 persons@ $12.00 x 2 trips Baggage Fees-determined by carrier:# persons @ $? $120 $680 $552 $48 $0 p. Travel description: Travel for two people from Central Office to visit regional site in Del Rio or Eagle Pass. Mileage: # trips x # persons x ? miles r/t @ $.58/mile Airfare: # persons @ $? r/t Ground Transportation: 2 persons @ $60 x 1 trip Lodging: 2 nights @ $BS/night x 2 persons x 1 trip Per Diem: 3 days @ $46/day x 2 persons x 1 trip Travel Fees: #persons@ $12.00 x # trip Baggage Fees-determined by carrier:# persons @ $? $736 $0 $0 $120 $340 $276 $0 $0 2. Out-of-State $6,500 a. Travel description: Zoonosis Entomologist to attend BIDS meeting. National BIDS meeting date and location TBD. $0 Mileage: # trips x # persons x? miles r/t@ $.58/mile Airfare: 1 person @ $700 r/1x 1 trip1 Ground Transportation: 1 person @ $60 Lodging: 2 nights@ $174/night x 1 person x 1 trip Per Diem: 3 days@ $71/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 b. Travel description: PHR B staff out of state travel to attend BIOS Meeting. National BIDS meeting date and location TBD. Mileage: # trips x # persons x ? miles r/t @ $.58/mile Airfare: 1 person@ $1071 r/t x 1 trip Ground Transportation: 3 days@ $37 x 1 trip Lodging: 3 nights@ $174/night x 1 person x 1 trip Per Diem: 4 days@ $71/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier:# persons @ $ $2,000 $0 $1,071 $111 $522 $284 $12 $0 c. Travel Description: PHR 9/10 for out of state travel for National BIDS Surveillance Conference and any required grantees meetings. Location and date TBD. $1,450 Mileage: # trips x # persons x? miles r/t@ $.58/mile Airfare: 1 person @ $505 r/t x 1 trip Ground Transportation: 1 person @ $50 x 4 days x 1 trip Lodging: 3 nights@ $133/night x 1 person x 1 trip Per Diem: 4 days@ $71/day x 1 person x 1 trip $0 $505 $200 $399 $284 TX-DSHS-19-1309-A-0024178 of I Travel Fees: 1 person@ $12.00 x 1 trip $12 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $50 d. Travel description: One out of state trip for BIDS Surveillance Officer national conference, date and location TBD. Mileage: # trips x # persons x? miles r/t@ $.58/mile Airfare: 1 person@ $501 r/t x 1 trips Ground Transportation: 1 person @ $50 x 4 days x 1 trips Lodging: 4 nights@ $133/night x 1 person x 1 trip Per Diem: 5 days @ $71/day x 1 person x 1 trip Travel Fees: 1 person @$12.00 x 1 trip Baggage Fees-determined by carrier: 1 persons@ $50 x 1 trip $1,650 $0 $501 $200 $532 $355 $12 $50 e. Travel description: Travel for two people from Central Office to attend National BIDS conference, date and location TBD. Not fully funded by CDC Mileage: # trips x # persons x? miles r/t@ $.58/mile Airfare: 2 persons @ $700 r/t x 1 trip Ground Transportation: 2 persons @ $60 x 1 trip Lodging: 2 nights@$174/night x 2 persons x 1 trip Per Diem: 3 days@ $71/day x 2 persons x 1 trip Travel Fees: 2 persons@ $12.00 x 1 trip Baggage Fees-determined by carrier: 2 persons@ $50 trip $1,400 $0 $1,400 $0 $0 $0 $0 x1 $0 TX-DSHS-19-1309-A-0024189ot I D. Equipment $0 Item Raqu"stad Unit Cost Qty 1. [Item Name]• Descrii;ition: Amount $0 0.00 2. E. Supplies $2,762 1,amRequested Qty~ Zoonosis Laboratory Testing including traps and other applicable supplies such as batteries, hanging dry ice, mosquito ID books and trap 1. refills. 1 PHR 8 Laboratory Testing including traps and all other applicable supplies such as batteries, hanging dry ice, mosquito ID books and trap 2. refills. 1 PHR 8 general office supplies II Unit Cost Amount 0.00 0.00 0.00 0.00 ~ / such as paper, pens, 3. highlighters, ink cartridges. $2,762 1 1,000.00 1,000.00 1 762.00 762.00 1,000.00 1,000.00 0.00 0.00 PHR 9-10 general office supplies such as paper, pens, 4. highlighters, ink cartridges. PHR 11 general office supplies such as paper, pens, 5. highlighters, ink cartridges. 1 PHR 11 Laboratory Testing including traps and all other applicable supplies such as batteries, hanging dry ice, mosquito ID books and trap 6. refills. 1 7. 8. 9. 10. 11. F. Contractual Sub-recipient {category 4000) 1. Project T itle: $5,000 $0 A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: TX-DSHS-19-1309-A-002419 10af J o. Scope of Work: [Enter SOW detail here] E. Method of Accountability: (Enter accoun tibility method here) F. Budget Detail and Justification : Vendor (category 2001 or 2009) 1. Project Title : PHR 9-10 anticipates awarding one (1) contract to provide translation services during project meetings. $5,000 2. Project Title: PHR 11 anticipates awarding one (1) contract to provide translation services during project meetings. A. Name of Contractor(s): TBO B. Method of Selection: Information for Bid (IFB) C. Period of Performance : August 1, 2019 - July 31 , 2020 D. Scope of Work: As needed, contractor will provide translation services in meetings attended by Spanish speaking Public Health officials from Mexico. E. Method of Accountability: Participants feedback and acknowledgment by participants that the content was understood. F. Budget Detail and Justification: Funding in the amount requested is needed to provide adequate translation services to the regions along the US / Mexico border. TX-DSHS-19-1309-A-002420 G. Other $12,000 Item Requested - 1. 2. 3. Number Estimated of Cost par Months Month Item Requested Number Needed Numberof Staff I ' >- Unit Cost Amount Requested Amount Raquastad Venue Rental: Binalional 1. Workgroup Meetings 3 1,500.00 0.00 6 200.00 0.00 100 120.00 12,000.00 1 2,200.00 0.00 1 5,743.00 0.00 $0 $12,000 BIDS Conference Registration 2. Fees for attendees 3. Advanced Diagnostics supplemental Lab testing to differentiate among various fever and rash illnesses 4. PHR 8 ArcGIS training software requires user training 5. PHR 8 ArcGIS software spatial analysis and mapping software Total Direct Cost: Total Indirect Charges: $206,532 $37,382 Please sea attached DSHS Indirect Cost attachment for calculatlon. Total Budget: $243,914 TX-DSHS-19-1309-A-002421 12 of] ELC Project J - Blnational Border Infectious Disease Surveillance (BIDS) Budget Request Period: August 1, 2019 - July 31, 2020 Direct Charges Total HEAL TH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018@ 18.1% Provisional rate 9/1/2018 - 8/31/2021@ 18.1% Applicable Amount charged IDC #of contracts IDC Rate at 18.1% $122,111 $122,111 $22,102 Fringe $44,717 $44,717 $8,094 Travel $19,942 $19,942 $3,610 $0 $0 $2,762 $500 Personnel Equipment (Greater than $5,000; unless an exception Item) $0 $2,762 Supplies (Less than $5,000; unless an exception Item) - Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 $5,000 0 $5,000 $905 55000 0 Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual $12,000 Other Total - Health Programs - $206,532 & -- 0 5000 $905 $12,000 $2,172 $206,532 $37,382 - - Direct Charges Total LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @33 .9o/e Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% # of contracts Applicable Amount charged IDC IOC Rate at 33.9•/o Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 $0 0 $0 $0 $0 $0 $0 $0 $206,532 $37,382 Contractual (sub-contracts In excess of $25,000) Sub-total Contractual Other $0 Total - Laboratory Services $0 ---- - TOTAL INQIRECT COST - 0 - - $206,532 0 The base for the Department is total direct costs, excluding : capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs . Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018- 8/31/2021 for Health Programs-18.1 %; Laboratory Services- 33 .9%. Indirect Cost on vendor contracts will be calculated at 100%. At OSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures• and are exempt from indirect costs. TX-DSHS-19-1309-A-002422 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - E3UDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project L - Prion Surveillance Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $106,435 $0 $106,435 $0 $0 $106,435 $0 $106.435 2. 3. 4. 5. TOTALS SECTION B - BUDGET CATEGORIES 6. Object Class Categories GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) a. Personnel $64,548 $64,548 b. Fringe Benefits $23,638 $23,638 $1,937 $1,937 d. Equipment $0 $0 e. Supplies $0 $0 f. Contractual $0 $0 g. Construction $0 $0 h. Other $0 $0 c. Travel i. Total Direct Charges (sum of Ba - Bh) $90,123 j. Indirect Charge $16,312 k. TOTALS (sum of Bi and Bj) 7. Program Income $0 $0 $0 $90,123 $16,312 $106,435 $0 $0 $0 $106,435 $0 $0 $0 $0 $0 Standard Form 424A (7-97) Prescribedby 0MB CircularA-102 TX-DSHS-19-1309-A-002423 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e) TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum of/ines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $106,435 $26,609 $26,609 $26,609 $26,608 $0 $0 $0 $0 $0 $106,435 $26,609 $26,609 $26,609 $26,608 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) $0 $0 $0 $0 21. Direct Charges: $90,123 22. Indirect Changes: $16,312 23 . Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33 .9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002424 Texas Department of State Health Services ELC Project L - Prlon Surveillance CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases(ELC) Budget Request Period:8/1/19-7/31/20 A. Personnel $64,548 ,- Position I "of Time Annual Salary 1 Senefft Annual Longevity Replacement Months Pav(BRPJ Total Medical Research 1. Specialist 95% $67,600 $0 $0 12 $64,548 Straver, Mary (Rachael) (H21000/8899) Position Description: Responsible for managing and coordinating surveillance activities for Cruetzfeldt-Jakob Disease (CJD) and other prion-related diseases in Texas, as well as Chronic Wasting Disease (CWD). Establishes appropriate data collection systems and procedures. Collaborates with other Unit staff in the planning, development, and implementation of field research studies. Analyzes, evaluates, and interprets data. Reviews patient medical charts and interviews patient proxies to collect demographic, medical, and laboratory findings and exposure histories. Responds to requests for CJD and CWD information from medical professionals and the general public. Contributes to the development and preparation of epidemiologic investigation reports, presentations, and manuscripts. Represents the Department in attending meetings and conducting oral presentations on aspects related to CJD and CWD surveillance. Assists existing high consequence infectious disease (HCID) two person team in preparedness and response activities. Serves as the lead contact on the HCID team for interfacing with and providing technical guidance and expertise to the medical community. 2. Tille 0% $0 $0 $0 12 $0 so so $0 12 so so $0 $0 12 so so $0 $0 12 so Last, First Name (Budget/Position #) Position Description: 3. Tille 0% Last, First Name (Budget/Position #) Position Description: 4. Title 0% Last, First Name (Budget/Position #) Position Description: 5. Title 100% Last, First Name (Budget/Position #) Position Description: TX-DSHS-19-1309-A-0024251 of ) B. Fringe Benefits $23,638 Fringe benefits are applicable to direct salaries and treated as direct costs. Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% TX-DSHS-19-1309-A-0024262of) C. Travel $1,937 1. In-State $0 a. Travel description: Medical Research Specialist to travel and serve as speaker for one conference; location and date TBO. Mileage: 1 trip x 1 person x 250 miles r/t@ $.58/mile Airfare: # persons @ $? r/t Ground Transportation ! # persons @ $? Lodging: 2 nights@ $125/night x 1 person x 1 trip Per Diem: 3 days@ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier:# persons @ $? !! ~f $0 $0 $0 $0 / b. Travel description: Mileage:# trips x # persons x ? miles r/t @ $.58/mile Airfare: # persons @ $? r/t Ground Transportation: #persons@$? Lodging: ? nights @ $85/night x # persons x # trips Per Diem: ? days@$46/day x # persons x # trips Travel Fees: #persons@ $12.00 x # trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 $0 $0 $0 2. Out-of-State $1 ,937 a. Travel description : Medical Research Specialist to travel and participate in the national CJD conference in Washington DC, Date: TBD. Mileage: trips x persons x miles r/t@ $.58/mile Airfare: 1 person @ $600 r/t x 1 trip Ground Transportation : 1 person @ $50 x 1 trip Lodging: 4 nights @ $220/night x 1 person x 1 trip Per Diem: 5 days@ $69/day x 1 person x 1 trip Travel Fees: 1 person @$12.00 x 1 trip Baggage Fees-determined by carrier : 1 person @ $50 x 1 trip $1,937 $0 $600 $50 $880 $345 $12 $50 b. Travel description: $0 Mileage: # trips x # persons x ? miles r/t @ $.58/mile Airfare : # persons @ $? r/t Ground Transportation: # persons @ $? Lodging: ? nights @ $85/night x # persons x # trips Per Diem: ? days @$46/day x # persons x # trips Travel Fees: # persons @ $12.00 x # trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 $0 $0 3 of) TX-DSHS-19-1309-A-002427 D. Equipment Item Requestad $0 Qty Unit Cost 1. [Item Name] - Descri12tion: 2. E. $0 Amount 0.00 Supplies Item Raquastad 1. [Item Name]- Description: $0 Qty Unit Cost Amount 0.00 $0 2. F. $0 Contractual Sub-reclglent (catego[ll 4000) 1. Project Title: $0 iQ A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work : [Enter SOW detail here] E. Method of Accountability : [Enter aocountibiliJy meJhod here) F. Budget Detail and Justification: Vendor (categoD( 2001 or 2009) 1. Project Title: $0 iQ A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scope of Work : IEnter SOW de tail here] E. Method of Accountability: [Enter accountibility method here] F. Budget Detail and Justification: TX-DSHS-19-1309-A-0024284 of] G. Other $0 ' Number ltam Requested I Ei~lmated Cost par Month of Months Number of Staff I Amount > Requested $0 1. 2. 3. Item Requested Number Needed Amount Requested Unit Cost $0 1. Printing : [Justification} 0 2. Item: [Justification} 0.00 0.00 0 Total Direct Cost: Total Indirect Charges: Please see attached DSHS Indirect Cost attachment for calculation. Total Budget: $90,123 $16,312 $106,435 TX-DSHS-19-1309-A-002429 ELC Project L - Prion Surveillance Budget Request Period: 8/1/19-7/31/20 HEAL TH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018@18.1% Provlslonal rate 9/1/2018 - 8/31/2021 @ 18.1% Direct Charges Total Personnel #of contracts Applicable Amount charged IDC I $64,548 Fringe $23,638 Travel $1,937 I - IDC Rate at 18.1% $64,548 $11,683 $23,638 $4,278 $1,937 $351 $0 $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 Supplies (Less than $5,000; unless an exception Item) $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 $0 0 $0 $0 $0 0 0 so $0 $0 Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other $0 Total - Health Programs $90,123 LABORATORY SERVICES • Fixed rate 9/1/2D17 - 8/31/2018 @ 33.9% Provlslonal rate 9/1/2018 - 8/31/2021 @33.9% 0 - $90,123 $16,312 - - - Direct #of Charges Total contracts Applicable Amount charged IDC IDC Rate at 33.9% Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception item) $0 $0 $0 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 $0 0 $0 $0 $0 $0 Sub-total Contractual Other $0 Total - Laboratory Services -= - - - TOTAL INDIRECT COST t - $0 0 $0 $0 $90,123 0 $90,123 $16,312 -- The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18 .1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002430 0MB ApprovalNo. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - 8UDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project N • Parasitic Diseases Surveillance Federal ( C) 93 ,323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $16,758 $0 $16,758 $0 $0 $16,758 $0 $16,758 2. 3. 4. 5. TOTALS SECTION 6. Object Class Categories B - BUDGET CATEGORIES GRANTPROGRAM,FUNCTIONOR ACTIVITY (2) (3} (4) (1) Total (5) a. Personnel $0 $0 b. Fringe Benefits $0 $0 c. Travel $2,756 $2,756 d, Equipment $5,582 $5,582 e. Supplies $2,554 $2,554 f. Contractual $0 $0 g. Construction $0 $0 $3,037 $3,037 h. Other i. Total Direct Charges (sum of 6a - 6h) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $13,929 $0 $0 $0 $13,929 $2,829 $2,829 $16,758 $0 $0 $0 $0 $0 $0 $0 $16,758 StandardFonn 424A $0 (7-97) Prescribed by 0MB Circular A-102 TX-DSHS-19-1309-A-002431 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) Stale (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum af/ines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 41hQuarter $16,758 $4,189 $4,189 $4,189 $4,191 $0 $0 $0 $0 $0 $16,758 $4,189 $4,189 $4,189 $4,191 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum aflines 16-19) $0 $0 $0 21. Direct Charges: $13,929 22. Indirect Changes: $2,829 23 . Remarks.: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment: alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Heallh Programs-18 .1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002432 Texas Department of State Health Services ELC Project N • Parasitic Disease Surveillance CDC-RFA-CK19-1904, 2019 Epldemlology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: 8/1/19-7/31/20 A. so Personnel Position 1. Tille "°' T7me Annual Salary 100% B-nt Annual ReplllCfllffent lllonlhs Longevity SO p so Total RP so 12 so Last. First Name (BudgeUPositlon #) Position Description : B. so Fringe Benefits Fringe benefits are applicable to direct salaries and treated as direct costs . Current benefit rate is 36 62¾ and are categorized In the following manner : Social SecurityJMedicare- 7.65% Retirement - 1O00% Insurance- 18.97% C. Travel S2,756 so 1. In-State a. Travel description : MIieage: # trips x # persons x? miles r/t@ S.58/mile Airfare # persons @ $? r/t Ground Transportation : # persons @ S? Lodging : ? nights @ SBS/night x # persons x # lrips Per Diem : ? days @ $46/day x # persons x # trips Travel Fees: #persons@ S12.00 x # trips Baggage Fees-determined by carrier :# persons @ $? so so so so so so $0 so 2. Out-or-state $2,756 a. Travel description : Travel for one Laboratorian to attend Algorithms in Diagnostic Molecular Parasitology Wor1tshop in Atlanta , GA, Septermber 2527, 2019. Mileage : 1 trip x 1 person x 20 miles r/t @ $.58/mile Airfare : 1 person @ S400 r/1 Ground Transportation : 1 person @ $75 Lodging : 3 nights@ 152/night x 1 person x 1 trip Per Diem: 4 days @ $66/day x 1 person x 1 trip Travel Fees.: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier; 1 person @ $50 $1,269 $12 $400 $75 $456 $264 $12 $50 b. Travel description : Travel for one Laboratorian to attend Diagnostic Parasitology : Bloodbome and Intestinal Parasites Workshop in Atlanta , GA. Time and date TBD . $1 ,487 Mileage: 1 trip x 1 person x 20 miles r/1@ $.58/mile Airfare : 1 peraon@ $400 r/t $12 $400 Ground Transportation : 1 person @ $75 Lodging . 4 nights@ 152/night x 1 person $75 $608 x 1 trip TX-DSHS-19-1309-A-002433 1 oll Per Diem : 5 days@ S66/day x 1 person x 1 trip Travel Fees: 1 person@ S12.00 x 1 trip Baggage Fees-determined by carrier:1 person @ S50 S330 512 S50 D. Equipment S5,582 Item Requested Dtv 1. Digital lmaglna Camera Unit Cost 1 5,582 .26 S5.582 Amount 5 ,582.26 2. 3 E. Supplies $2,554 Item Requested 1. Chagas lgG Kil Unit Cost Dtv 0 Amount 490 .00 0 .00 2 . Nilrile Gloves all sizes 0 7 54 0 .00 3 . Face Shield Full 4. VWR Reagent Reservoir 0 678 92 4 0 .00 615 .00 5. Blohazard container 6. Blohazard bag 7_ Sarstedt PP 11x66 tubes a. Screw Caps ror 11x66 g EP Tips 2·100 uL F. 0 153.75 10.90 0 4 64.55 152.40 8 24.25 194.00 7 162.20 1,135.40 $2,554 0 .00 0 .00 609 ,60 Contractual Sub-recipient (category 40001 1. Project Title: $0 iQ A. Name of Contractor(s} : B. Method of Selection : C . Period of Performance : D. Scope of Work : [Enter SOW detail here) E. Method of Accountability : (Enter accountibility method here] F. Budget Detail and Justificallon : so Vendor (category 2001 or 2009) 1. Project Tille : IQ A. Name or Conlractorls}: B, Method or Selection : C, Period of Performance : D. Scope of Work: (Enter SOW detail here] E. Method of Accountab mtv. [Enter accountibility method here] F. Budget Detail and Justification : G. Other $3,037 Number Estimated Item ReqUHted I I of Cost pet' Months MOllth Numberof Staff Amount Requested $0 1. 2. TX-DSHS-19-1309-A-0024342of ) 3.I Item Requested Number Neecled Unit Cost Amount Requested 1. Software configurati on for Enzyme Immunoa ssay automation /Chagas Analysis 2. cellSens Software 0 2.000 .00 0 .00 1 1,450 56 1,450 56 3. 22 G4 Tower, Win 10 1 1,586 00 1,586 00 Total Direct Cast : Total Indirect Charges : $3,037 S13,929 $2,829 Please SN attached DSHS Indirect Cost attachment for calculaUon. Total Budget : $16,758 TX-DSHS-19-1309-A-002435lof} ELC Project N - Parasitic Disease Surveillance Budget Request Period: 8/1/19-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 -8/31/2018@18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% ·- Direct #of Charges Total contracts Applicable IDCRate Amount at 18.1% charged IDC Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 $0 0 Sub-total Contractual Other - $0 Total• Health Programs $0 0 0 $0 $0 $0 $0 $0 - ·- I LABORATORY SERVICES Fixed rate 9/1/2017 • 8/31/2018 @ 33.9% Provisional rate 9/1/2018 - 8/31/2021 @ 33.9% Direct #of Charges Total contracts Applicable IDC Rate Amount at33.9% charged IDC Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $2,756 $2,756 $934 Equipment (Greater than $5,000; unless an exception Item) $5,582 $0 $0 Supplies (Less than $5,000; unless an exception Item) $2,554 $2,554 $866 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 0 $0 $0 $3,037 $1,029 0 $8,347 $2,829 0 $8,347 Sub-total Contractual $0 Other $3,037 Total• Laboratory Services - ~ - $13,929 - - TOTAL INDIRECT COST - $13,929 I _$2,829 The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIG food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002436 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - 0UDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project O - Enhanced Vaccine-Preventable Diseases Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $198,843 $0 $198,843 $0 $0 $198,843 $0 $198,843 2. 3. 4. 5. TOTALS SECTION B - BUDGET CATEGORIES 6. Object Class Categories a. Personnel GRANTPROGRAM,FUNCTIONOR ACTIVITY (2) (3) (4) (1) Total (5) $123 ,238 $123,238 $45.130 $45,130 c. Travel $0 $0 d. Equipment $0 $0 e. Supplies $0 $0 f. Contractual $0 $0 g. Construction $0 $0 h. Other $0 $0 b. Fringe Benefits i. Total Direct Charges (sum of Ba - 6h) j. Indirect Charge k. TOTALS (sum of Bi and Bj) 7. Program Income $168,368 $0 $0 $0 $168,368 $30,475 $30,475 $198,843 $0 $0 $0 $0 $0 $0 $0 $198,843 Standard Form 424A $0 (7-97) TX-DSHS-19-1309-A-002437 Prescribed by 0MB Circular A-102 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sumoflinesB-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $198,843 $49,711 $49,711 $49,711 $49,710 $0 $0 $0 $0 $0 $198,843 $49,711 $49,711 $49,711 $49,710 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a} Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) Fourth 16. 17. 18. 19. $0 $0 $0 $0 21. Direct Charges: $168,368 22. Indirect Changes: $30,475 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Heallh Programs- 18.1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002438 Texas Department of State Health Services ELC Project O - Enhanced Vaccine Preventable Disease (VPO) CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: August 1, 2019 -July 31, 2020 A. Personnel $123,238 - 1, Posftlon %of Time 11 Annual Salary Benefit Annual Longevity Replacement Months PavfBRPJ Total 1. Epidemiologist II 100% $50,209 $240 $0 12 $50,449 Sanders, Kelsey( H21000/85196) Position Description: Coordinates Vaccine Preventable Disease(VPD) surveillance, including designing and implementing Acute Flaccid Myelitis (AFM) surveillance, enhancing meningococcal surveillance and improving data quality for all VPDs. 2. Epidemiologist Ill 100% $72,789 $0 $0 12 $72,789 NEW (H21000/TBD) Position Description: Under the general supervision of the group manager, the Epidemiologist Ill is responsible for performing complex epidemlologic work related to VPDs with an emphasis on AFM. Initiates, plans, and conducts epidemiological studies, surveillance projects, and outbreak investigations of vaccine preventable diseases and AFM. Addresses inquiries from (consults with) physicians, health care facilities, state and national organizations, public health officials, and the public regarding the epidemiology of VPDs and AFM. Prepares oral and written presentations describing the outcomes of epidemiologic investigations or surveillance findings. Duties performed under limited supervision with extensive latitude for use of initiative and independent judgment. B. Fringe Benefits $45,130 Fringe benefits are applicable to direct salaries and treated as direct costs. Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% TX-DSHS-19-1309-A-0024391 o:r) C. Travel $0 1. In-State f a. Travel description: Travel expenses for three trips within Texas for the VPD Surveillance Coordinator and Epi Ill to train and consult with local health departments (LHDs) on VPD surveillance perfonnance (locations TBD). Mileage: 3 trips x 2 persons x 400 miles r/t @ $.58/mile Airfare: # persons @ $? r/t Ground Transportation: #persons@$? Lodging: 3 nights@ $125/night x 2 persons x 3 trips Per Diem: 4 days@ $46/day x 2 persons x 3 trips Travel Fees: 2 persons@ $12.00 x 3 trips Baggage Fees-determined by carrier:# persons @ $? ___ ° $0 Sf \ . ___;:;$$$.;;..0 0 / $0 $0 $0 $0 $0 2. Out-of-State $0 a. Travel descriplion:Travel expense for Epi Ill to attend the 2019 Clinical Vaccinology Course - November 16-17, 2019 in Washington, D.C. Mileage: 1 trip x 1 person x 400 miles r/t @ $.58/mile Airfare: 1 person @ $600 r/t x 1 trip Ground Transportation: 1 persons@ $50/day x 4 days Lodging: 3 nights@ $150/nlght x 1 person x 1 trip Per Diem: 4 days@ $65/day x 1 persons x 1 trips Travel Fees: 1 person@ $12.00 x 1 trip Baggage Fees-determined by carrier: 1 person@ $50 x 1 trip $0 $0 $0 $0 $0 $0 $0 $0 ~J) /' ' 0 b. Travel description: CDC required travel for VPD Surveillance Coordinator to attend the 2020 Council of State and Territorial Epidemiologists (CSTE). Date and Location: TBD. Mileage: 1 trip x 1 persons x 50 miles r/t @ $.58/mile Airfare: 1 persons @ $575 r/t x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 4 nights@ $166/night x 1 person x 1 trip Per Diem: 5 days@ $62/day x 1 persons x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 TX-DSHS-19-1309-A-0024402of) D. Equipment $0 Item Requested Qty Unit Cost $0 Amount 1. 2. E. Supplies $0 Item Requ~sted Qty Unit Cost $0 Amount 1. [Item Name) - Descrii;ition: 0.00 I l 2. F. Contractual G. Other II $0 $0 Number Item Requested of Months 1. SAS software 2. 3. Estimated Cost per .• Month 12 $ -- Item Requested 1. Plotkin's Vaccines (Vaccines (Plotkin)) 7th Edition 2. Field Epidemiology Number Needed 2 2 Number of Staff - 2 \ Amount Requested $0 Amount Reouested Unit Cost 0.00 0.00 0.00 0.00 $0 Jf I - $0 Total Direct Cost: Total Indirect Charges: $168,368 $30,475 Please see attached DSHS Indirect Cost attachment for calculation. Total Budget: $198,843 TX-DSHS-19-1309-A-0024413 of) ELC Project O - Enhanced Vaccine Preventable Disease (VPD) Budget Request Period: August 1, 2019 - July 31, 2020 HEALTH PROGRAMS Fixed rate 9/1/2017 • 8/31/2018@ 18.1% Provisional rate 9/1/2018 • 8/31/2021 @ 18.1o/a Direct #of Charges Total contracts Personnel - $123,238 Fringe $45,130 Travel $0 Equipment (Greater than $5,000; unless an exception Item) $0 Supplies (Less than $5,000; unless an exception Item) $0 -- - - - < Applicable Amount charged IDC IDC Rate at 18.1% $123,238 $22,306 $45,130 $8,169 $0 $0 $0 $0 $0 $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 $0 0 $0 so $0 0 0 $0 $0 $0 $168,368 $30,475 Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other $0 Total • Health Programs - - $168,368 -- 0 - - LABORATORY SERVICES . • Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 • 8/31/2021 @33.9% Direct #of Charges Total contracts Applicable Amount charged IDC IDC Rate at33.9% Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual {sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 0 $0 $0 $0 $0 Sub-total Contractual $0 Other $0 Total - Laboratory Services TOTAL INDIRECT COST - $0 0 $0 $0 $168,368 0 $168,368 $30,475 - -- - The base for the Department is total direct costs, excluding: capital expenditures (buildings , individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100% . At OSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002442 0MB Approval No. 034S-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) 1. Project P Legionnaires' Disease Prevention Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $30.470 $0 $30.470 $0 $0 $30,470 $0 $30.470 2. 3. 4. 5. TOTALS SECTION 6. Object Class Categories a. Personnel B - BUDGET CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) $18 ,884 $18,884 $6,915 $6,915 c. Travel $0 $0 d . Equipment $0 $0 e. Supplies $0 $0 f. Contractual $0 $0 g. Construction $0 $0 h. Other $0 $0 b. Fringe Benefits i. Total Direct Charges (sum of 6a - 6h) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $25,799 $0 $0 $0 $25,799 $4,671 $4,671 $30.470 $0 $0 $0 $0 $0 $0 $0 $30,470 Standard Form 424A $0 (7-97) TX-DSHS-19-1309-A-002443 Prescribed by 0MB Circular A-102 SECTION C - NON-FEDERAL (a) Grant Program RESOURCES (b) Applicant (c) State (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum oflines 8-11) $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $30,470 $7,617 $7,617 $7,617 $7,619 $0 $0 $0 $0 $0 $30,470 $7,617 $7,617 $7,617 $7,619 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum of lines 16-19) $0 $0 $0 21. Direct Charges: $25,799 22. Indirect Changes: $4,671 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alleralions and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18 .1%: Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002444 Texas Department of State Health Services ELC Project P - Legionnaires' Dlseaese Prevention CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period: August 1, 2019 - July 31, 2020 A. Personnel Pos/tfon $18,884 ¾of Tline Annual Salary Benefit Annual Longevity Replacement PavlBRP> Months1 Total 1. Epidemiologist ll 29.684% $63,616 $0 $0 12 $18,884 NEW (H21000/Position # TBD) Position Description: Texas DSHS is requesting an Epidemiologist II position be funded in budget period 1 (BP1) and beyond. The requested Epidemiologist II position will serve as the primary contact for the execution of many of the ELC target capabilities. The following processes under the ELC grant proposal will be the requested Epidemiologist ll's primary job duties: 1)Train Epidemiologists statewide who investigate Legionellosis reports. This training will include epidemiological investigation, surveillance reporting, and the environmental component of Legionella investigations. 2) Train DSHS Environmental Health Specialists on the interaction between Legionella colonization and facility water systems, HVAC systems, and other systems. This will refine the Environmental Health investigation and remediation of Legionella during routine and outbreak response inspections. 3) Development and enhancement of the CDC HypothesisGenerating Questionnaire for all statewide Epidemiologists investigating Legionella reports. 4) Coordinate with healthcare facilities throughout the State to increase respiratory specimens submitted to the DSHS State Laboratory for culturing and genotyping. 5) Development and implementation of a survey for facilities with an elevated risk of Legionella colonization. This survey will better assess the prevalence of Water Management Plans in facilities where Legionella is of higher concern (Hotels, aquatic centers, large buildings). Once completed, this position will assist in increasing prevalence and utilization of WMP's in these high-risk facilities. 6) Coordination and collaboration with industry partners who work with Legionella (building engineers, American Association of Healing, Refrigerating and Air Conditioning Engineers, Environmental Protection Agency, Occupational Safety and Health Administration, etc.). 7) Development and dissemination of Legionella educational documents; clinical and environmental. 8) Development and implementation of Legionella After Action Reports during clusters and outbreaks. 2. Title 100% so $0 $0 12 $0 Last, First Name (Budget/Position #) Position Description: B. Fringe Benefits $6,915 Fringe benefits are applicable to direct salaries and treated as direct costs . Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7 .65% Retirement- 10.00% Insurance- 18.97% TX-DSHS-19-1309-A-0024451 of] C. Travel $0 1. In-State $0 a. Travel description: Provide Legionella training to Regional Health Department Epidemiologists across Texas. Mileage: 3 trips x 1 person x 1,000 miles r/t @ $.58/mile Airfare: # persons @ $? r/t $0 $0 $0 Ground Transportation: # persons @ $? Lodging: 1 night@ $125/night x 1 person x 3 trips Per Diem: 2 days @ $46/day x 1 person x 3 trips Travel Fees: 1 person@ $12.00 x 3 trips Baggage Fees-determined by carrier:# persons @ $? $0 $0 $0 $0 $0 2. Out-of-State $0 a. Travel description: Epidemiologist II to attend the National Legionella conference. Date and Location TBD. $0 $0 Mileage: 1 trip x 1 person x 40 miles r/1 @ $.58/mile Airfare: 1 person @ $450 r/I x 1 trip Ground Transportation: 1 person @ $50 x 1 trip Lodging: 3 nights@ $125/night x 1 person x 1 trip Per Diem: 4 days @ $46/day x 1 person x 1 trip Travel Fees: 1 person@ $12.00 x 1 trip $0 $0 $0 $0 $0 Baggage Fees-determined by carrier: 1 person @ $50 x 1 trip $0 TX-DSHS-19-1309-A-0024462of ) D. Equipment ~ - Item Requested $0 Qty = - Unit Cost 1. [Item Name] - Descrigtion: Amount 0.00 $0 2. E. Supplies ItemRequested 1. [Item Name] - Description: $0 Qty - Unit Cost $0 Amount 0.00 2. F. Contractual Sub-recl1;1lent (catego!'.)l4000) 1. Project Title: $0 $0 IQ A. Name of Contractor{s): B. Method of Selection : C. Period of Performance : D. Scope of Work: [Enter SOW detail here] E. Method of Accountability : [Enter accountibility method here) F. Budget Detail and Justification: Vendor (catego!Jl2001 or 2009) 1. Project Title: $0 ~ A. Name of Contractor(s): B. Method of Selection: C. Period of Performance: D. Scoge of Work: (Enter SOW detail here] E. Method of Accountability: (Enter accounlibility method here] F. Budget Detail and Justification : TX-DSHS-19-1309-A-0024473 of} G. Other Item Requested $0 1; Number Estimated I> Cost per Number of Staff Month I of I Months 1. 2. 3. Item Requested Number Needed I I Amount Requested Amount 1Re_quested Unit Cost $0 $0 1. Printing: [Justification} 2. Item: [Justification} 0 0 0.00 0.00 Total Direct Cost: Total Indirect Charges: $25,799 $4,671 Please sea attached DSHS Indirect Cost attachment for calculation. Total Budget: $30,470 TX-DSHS-19-1309-A-0024484 or] ELC Project P - Legionnaires' Diseaese Prevention Budget Request Period: August 1, 2019 - July 31, 2020 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8131/2018@ 18.1% Provisional rate 9/112018 - 8/31/2021 @ 18.1% Direct #of Charges Total contracts Personnel Applicable IDCRate Amount at 18.1% charged IDC $18,884 $18,884 $3,418 Fringe $6,915 $6,915 $1,252 Travel $0 $0 $0 Equipment {Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 -- - $0 $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 $0 0 $0 $0 $0 0 0 $0 $0 $25,799 $4,671 Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other $0 Total - Health Programs ·~ = - - -- ~ --= =- ---- LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @33.9% Provisional rate 91112018- 8/31/2021 @ 33.9% $25,799 0 $0 - 11 Direct # of Charges Total contracts Personnel $0 Fringe $0 Applicable Amount charged IDC I IDC Rate at33.9% $0 $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 0 $0 $0 $0 $0 $0 - $0 Sub-total Contractual $0 Other $0 Total - Laboratory Services TOTAL INDIRECT COST - $0 ·- - 0 -< $25,799 0 $25,799 I $4,671 The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, now-through funds and WIC food costs. Fixed rate 9/1/2017 • 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002449 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligaled Funds Domestic Number (b) 1. Project Q - Influenza Surveillance and Diagnostic Testing A - B UD GET SU M MARY Federal Non-Federal (d) ( C) 93.323 New or Revised Budget $0 Federal (e) Non-Federal (f) Total (g) $0 $89,768 $0 $89,768 $0 $89,768 $0 $89,768 2. 3. 4. 5. TOTALS $0 SECTION 6. Object Class Categories B - BUDGET CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) a. Personnel $52,386 $52,386 b. Fringe Benefits $19,184 $19 ,184 c. Travel $0 $0 d. Equipment $0 $0 $1,842 $1,842 f. Contractual $0 $0 g. Construction $0 $0 h. Other $0 $0 e. Supplies i. Total Direct Charges (sum of 6a - 6h) $73,412 j. Indirect Charge $16,356 k. TOTALS (sum of 6i and 6}) $89,768 $0 $0 $0 $0 $0 $0 $0 7. Program Income $0 $0 $0 $73.412 $16,356 $89,768 Standard Fonn 424A $0 (7-97) TX-DSHS-19-1309-A-002450 Prescribed by 0MB Circular A-102 SECTION C - NON-FEDERAL (a) Granl Program RESOURCES (b) Applicanl (c) Stale (d) Other Resources (e)TOTALS 8. $0 9. 10. 11. 12. TOTALS (sum oflines 8-11) $0 $0 $0 $0 1sl Quarter 2nd Quarter 3rd Quarter 4th Quarter $89,768 $22,442 $22,442 $22,442 $22,442 $0 $0 $0 $0 $0 $89,768 $22,442 $22,442 $22,442 $22,442 SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Granl Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS) (c) Second (d) Third (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum oflines 16-19) $0 $0 $0 21. Direcl Charges: $73,412 22. lndirecl Changes: $16,356 23. Remarks: The base for the Departmenl is total direct costs, excluding: capital expendilures (buildings, individual ilems of equipment: alterations and renovations); that portion of each subaward in excess of $25,000, now-through funds and WIC food costs. Fixed rate 9/1/2017 - B/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs- 18.1%~Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002451 Texas Department of State Health Services Project Q - Influenza Surveillance and Diagnostic Testing CDC-RFA-CK19-1904, 2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Budget Request Period : August 1, 2019 • July 31, 2020 A. Personnel Posit/on Public Health and Prevention 1. Specialist I $52,386 "of Time 100% Annual Salary $35,614 Benefit Annual Longevity Replacement Months PavfBRPJ $2,880 $1,027 12 Total $39,521 Russin, Robert (H21000/11373) Position Description: Under the supervision of the Manager Ill of the Vaccine Preventable Disease & Invasive and Respiratory Infectious Disease Teams of the Emerging and Acute Infectious Disease Branch within the Infectious Disease Control Unit, performs recruitment and retention functions for influenza surveillance including but not limited to the US Outpatient Influenza-Like Illness Network (ILINet). Performs data entry and database management functions for influenza surveillance, which includes but is not limited to preparing and emailing the Centers for Disease Control and Prevention an Excel spreadsheet containing contact information for Texas ILINet providers. Mails out new ILINet work-folders with reporting instructions to enrolled ILINet providers annually. Contacts influenza surveillance providers to determine interest in participating in laboratory surveillance and contacts them quarterly to determine whether supplies are needed for submitting influenza specimens to DSHS laboratory. Monitors ILINet data for completeness. Provides basic information on influenza and influenza activity to private practitioners, hospitals, and local and regional health department staff. Provides information on the Department of State Health Services reporting procedures for influenza surveillance. Assists in the preparation of influenza and related reports from surveillance data for professional staff in central office, health service regions, hospitals, local health departments, and the general public, using a variety of software applications such as Word, PowerPoint, Excel, and Access. May participate in outbreak investigations. 2. Molecular Biologist II 26% $49,673 $0 $0 12 $12,865 New (H41000/Position #TBD) Position Description: Performs highly complex (senior-level) molecular biology work. Primary responsibilities include supervising, training, and conducting influenza PCR testing on clinical specimens. Coordinates and performs all aspects of influenza diagnostic work including but not limited to nucleic acid extractions, master mix preparation, specimen addition, and analysis while using BSL2 and BSL3 practices. Coordinates and assists with reagent preparation and quality testing for influenza diagnostic reagents. Organizes and prepares biweekly National Influenza Reference Center (NIRC) shipments. Coordinates influenza laboratory testing surveillance activities and submission of positive influenza specimens from the Texas LRN laboratories to the DSHS Viral Isolation laboratory for confirmation and inclusion to NIRC routine shipments. Coordinates with CDC to submit influenza unsubtypable specimens, co-infections, and diagnostic specimens as required. Consults with medical personnel/Epidemiologists regarding test application and interpretation. Coordinates and assists with data analysis and organization, data requests from stakeholders, and data reporting requirements, Participates in the preparation and supervision of validation studies. Prepares SOP documents. Supervises and trains staff. TX-DSHS-19-1309-A-002452 1 of ) B. Fringe Benefits $19,184 Fringe benefits are applicable to direct salaries and treated as direct costs. Current benefit rate is 36.62% and are categorized in the following manner: Social Security/Medicare- 7.65% Retirement- 10.00% Insurance- 18.97% TX-DSHS-19-1309-A-002453 2ofj C. Travel $0 1. In-State $0 a. Travel description: The State ILINet Coordinator will conduct two recruitments in various areas of the state to recruit healthcare providers to participate in ILINet. Mileage: trips x persons x miles r/t @ $.58/mile Airfare: 1 person @ $450.00 r/t - 2 trips Ground Transportation: 1 person @ $50/day x 5 days Lodging: 4 nights@ $125/night x 1 person x 2 trips Per Diem: 5 days @ $46/day x 1 person x 2 trips Travel Fees: 1 person@ $12.00 x 2 trips Baggage Fees-determined by carrier: 1 person @ $50/flight x 2 trips $0 $0 $0 $0 $0 $0 $0 ,f $0 2. Out-of-State $0 a. Travel description: A member of the DSHS Influenza Surveillance Team will attend the 2020 National Influenza Surveillance Coordinators Meeting. The exact location of the conference is still to be determined . Mileage: # trips x # persons x ? miles r/t@ $.58/mile Airfare: 1 person @ $450 r/t x 1 trip Ground Transportation: 1 person @ $50/day x 5 days Lodging: 4 nights@ $125/night x 1 person x 1 trip Per Diem: 5 days @ $46/day x 1 person x 1 trip Travel Fees: 1 persons@ $12.00 x 1 trips Baggage Fees-determined by carrier: 1 person @ $50/flight x 1 trip $0 $0 $0 $0 ) $0 $0 $0 $0 TX-DSHS-19-1309-A-002454 3of) 0. Equipment 1r Item Requested $0 ~ Qty Unit Cost 1. (Item Name] - Descri(,2tion: Amount 0.00 $0 2. E. Supplies Item Request,!! 1. 2. Avery® Repositionable Inkjet Shipping Labels, 58163, 2" x 4", While, Pack Of250 Business Source Storage Pockets Fastener Folders Letter - 8 1/2" x 11" Sheet Size- 100 Sheet Capacity- 3 x Prong Fastener(s) - 1/2" Fastener Capacity - 2 Inside Front & Back Pocket(s)Leatherette - Light Blue Recycled - 25 / Box $1,842 Qty Unit Cost Amount 1 0.00 0.00 4 0.00 0.00 2 0.00 0.00 1 0.00 0.00 5 0.00 0.00 1 0.00 0.00 10 0.00 0.00 $1,842 Geographies Fleur Border Blank Certificates - 8.50" x 11" - Inkjet, Laser Compatible Aqua Marine with Aquamarine Border-25 /Pack 3. 4. 5. 6. 7. Geographies Traditional Award Certificates - 24 lb Laser, Inkjet Compatible Gold100 / Pack Oxford Linen-finish Certificate Holders - Letter - 8 1/2" x 11" Sheet Size - Linen - Dark Blue - 5 / Pack SKILCRAFT® Reamless Multipurpose Paper, Letter Size Paper, 20 Lb, 100% Recycled, White, Pack Of 2,500 Red Book 2018: Report of the Committee on Infectious Diseases Thirty-first Edition TX-DSHS-19-1309-A-0024554 of] Supplies for shipping flu specimens to meet Right Size Road Map specimen numbers: 5 sites x ((6 shipping boxes *$10.04 (per shipping box))+ (50 secondary containers " $6.00 (per secondary container)) + (24 ice packs • $0.34 (per ice pack)))"' $1,842. F. 8. 100 18.42 1,842.00 Viral Transport Media 72 9. tubes"' $89.47 68 0 0.00 Contractual $0 TX-DSHS-19-1309-A-002456Sof) G. Other Number of Months Item Requested Estlmateit Cost per Month SAS Software 12 1. Licenc:o Travel reimbursement for approximately 5 speakers at the 2020 DSHS lnfluenza/ELC Surveillance Workshop. Airfare: 1 person @ $700 r/t- TBD to Austin, TX; 1 person @ $600 r/t- TBD to Austin; 1 person @ $600 r/t- TBD to Austin; 2 persons @ $500 r/t- TBD to Austin $2,900; Ground Transportation: 5 persons @ $50 *3 days = $750; Lodging: 2 nights@ $125/night x 1 person x 5 trips $1,250; Per Diem: 3 days @ $46/day x 1 person x 5 trips = $690; Travel Fees: 5 persons @ $12.00 x 1 trips= $60; Baggage Fees-determined by carrier 5 persons @ $50 r/t = $250 $0 - Number of Staff Amount Requested 2 $0 5 $0 $0 = = 2. 3. $0.00 Item Requested Number Needed Amount . Reauasted Unit Cost $0 1. Printing: Printing educational materials for ILINet recruitment trips that will be handed out to healthcare providers and printing presentations, labels, etc. for the DSHS Annual Influenza (Flu) Surveillance Workshop; For the DSHS Flu Surveillance workshop there would be a total of 4340 ( 70 attendees • 1 folder/attendee* 62 pages/folder)pages needing printed. The number of pages that needs printing is dependent on the number of presentations that are submitted by DSHS Flu Workshop presenters. For the ILINet recruitment trips, -200 pages of education materials (10 providers/recruitment trip*2 recruitment trip*10 pages of educational materials given to a provider) 4,540 2. ABI 7500 Fast Ox PCR Instrument service contract 2 0.00 0.00 0.00 0.00 TX-DSHS-19-1309-A-0024576 of J 3. Roche MagNA Pure Compact service contract 1 0.00 Total Direct Cost: Total Indirect Charges: 0.00 J $73,412 $16,356 Please see attached DSHS Indirect Cost attachment for calculation. Total Budget: $89,768 TX-DSHS-19-1309-A-0024587off Project Q - Influenza Surveillance and Diagnostic Testing Budget Request Period: August 1, 2019 - July 31, 2020 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018@ 18.1% Provisional rate 9/1/2018 - 8/31/2021 @ 18.1% Direct #of Charges Total contracts Personnel Applicable IDC Rate Amount at 18.1% charged IDC $39,521 Fringe $14,473 Travel $0 Equipment (Greater than $5,000; unless an exception Item) Supplies (less than $5,000; unless an exception Item) - ·- $0 T $39,521 $7,153 $14,473 $2,620 $0 $0 $0 $0 $0 $0 ~- $0 - Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 Contractual (Sub-recipient up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts-DSHS Category 2000) $0 0 $0 $0 Sub-total Contractual Other so 0 0 so $0 $0 $53,994 $9,773 $0 Total• Health Programs $53,994 -LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @ 33.9% Provisional rate 9/1/2018 • 8/31/2021 @33.9% 0 -- -- ·- Personnel Direct #of Charges Total contracts Applicable IDC Rate Amount at33 .9% charged IDC $12,865 $12,865 $4,361 Fringe $4,711 $4,711 $1,597 Travel $0 $0 $0 $0 $0 $1,842 $624 Equipment (Greater than $5,000; unless an exception Item) Supplies (Less than $5,000; unless an exception Item) I $0 $1,842 - Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 $0 0 $0 $0 $0 $0 Sub-total Contractual Other $0 Total• Laboratory Services $19,419 0 $19,419 $6,583 $73,412 0 $73,412 $16,356 -- - - TOTAL INDIRECT COST The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002459 0MB Approval No. 0348-0044 BUDGET INFORMATION - Non-Construction Programs SECTION A - BUDGET SUMMARY Grant Program Function or Activity (a) Catalog of Federal Estimated Unobligated Funds Domestic Number (b) Project T - GISP Federal ( C) 93.323 New or Revised Budget Non-Federal (d) Federal (e) Non-Federal (f) Total (g) $0 $0 $12,001 $0 $12,001 $0 $0 $12,001 $0 $12,001 2. 3. 4. 5. TOTALS SECTION 6. Object Class Categories B - BUDGET CATEGORIES GRANT PROGRAM, FUNCTION OR ACTIVITY (2) (3) (1) Total (5) (4) a. Personnel $0 $0 b. Fringe Benefits $0 $0 c. Travel $0 $0 d. Equipment $0 $0 e. Supplies $0 $0 $10,162 $10,162 g. Construction $0 $0 h. Other $0 $0 f. Contractual i. Total Direct Charges (sum of 6a - Bh) j. Indirect Charge k. TOTALS (sum of 6i and 6j) 7. Program Income $10,162 $0 $0 $0 $1,839 $10,162 $1,839 $12,001 $0 $0 $0 $12,001 $0 $0 $0 $0 $0 Standard Form 424A (7-97) Prescribed by 0MB Circular A-102 TX-DSHS-19-1309-A-002460 SECTION C - NON-FEDERAL RESOURCES (b) Applicant (a) Grant Program (c) State (d) Other Resources (e) TOTALS $0 8. 9. 10. 11. $0 $0 $0 $0 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter $12,001 $3,000 $3,000 $3,000 $3,001 $0 $0 $0 $0 $0 $12,001 $3,000 $3,000 $3,000 $3,001 12. TOTALS (sum oflines 8-11) SECTION D - FORECASTED Total for 1st Year CASH NEEDS 13. Federal 14. NonFederal 15. TOTAL (sum oflines 13 and 14) SECTION E - BUDGET ESTIMATES (a) Grant Program OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT FUTURE FUNDING PERIODS (YEARS ) (c) Second (d) Thtld (b) First (e) Fourth 16. 17. 18. 19. 20. Totals (sum of lines 16-19) $0 $0 $0 $0 21.DirectCharges: $10,162 22. lndirectChanges: $1,839 23. Remarks: The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018- 8/31/2021 for Health Programs- 18.1%; Laboratory Services- 33.9%. SF 424A (7-97) Page 2 TX-DSHS-19-1309-A-002461 Texas Department of State Health Services TB/HIV/STD Section, HIVPrevention and Care Services Branch CDC-RFA-CK19-1904, 2019 Epidemlology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Project T: Gonococcal Isolate Surveillance Project (GISP) Budget Request Period: 8/1/2019-7/31/20 A. Personnel $0 B. Fringe Benefits $0 C. Travel $0 D. Equipment $0 E. Supplies $0 F. Contractual Sub-recipient (category 4000) $10,162 $10,162 1. Project Title: GJSP project laboratory $10.162 A. Name of Contractor(s): Dallas County Health and Human Services Deoartment B. Method of Selection: lnterlocal Agreement C. Period of Performance: August 1, 2019- July 31, 2020 D. Scope of Work: Contractor will perform all GISP activities for collecting specimens and demographic data from male patients, processing specimen for culture, and shipment of specimens to GISP reference lab. E. Method of Accountability: Semiannual progress reports F. Budget Detail and Justification: See attached. G. Other $0 Total Direct Cost: Total Indirect Charges: $10,162 $1,839 Please see attached DSHS Indirect Cost attachment for calculation. Total Budget: $12,001 TX-DSHS-19-1309-A-002462 TB/HIV/STD Section, HIV Prevention and Care Services Branch Budget Request Period: B/1/2019-7/31/20 HEALTH PROGRAMS Fixed rate 9/1/2017 - 8/31/2018@ 18.1% Provisional rate 9/1/2018- 8/31/2021 @ 18.1% Direct Charges Total #of contracts Applicable Amount charged IDC IDC Rate at 18.1% I $0 Personnel Fringe $0 Travel $0 --- $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 Supplies (Less than $5,000; unless an exception Item) $0 Contractual (Sub-recipient In excess of $25,000) $0 0 $0 $0 $10,162 1 $10,162 $1,839 $0 0 $0 $0 $10.162 1 10.162 $1.839 $0 $0 $10,162 $1,839 Contractual (Sub-recipient up to $25,000) Contractual (Vendor contracts-DSHS Category 2000) Sub-total Contractual Other $0 $10,162 Total - Health Programs - =-=--,.;..~_-:- - = - 1 - LABORATORY SERVICES Fixed rate 9/1/2017 - 8/31/2018 @33.9% Provisional rate 9/1/2018 - 8/31/2021 @33.9% - Direct #of Charges Total contracts Applicable Amount charged IDC IDC Rate at33.9% Personnel $0 $0 $0 Fringe $0 $0 $0 Travel $0 $0 $0 Equipment (Greater than $5,000; unless an exception Item) $0 $0 $0 Supplies (Less than $5,000; unless an exception Item) $0 $0 $0 Contractual (sub-contracts In excess of $25,000) $0 0 $0 $0 Contractual (sub-contracts up to $25,000) $0 0 $0 $0 Contractual (Vendor contracts - DSHS Category 2000) $0 0 $0 $0 0 $0 $0 $0 $0 Sub-total Contractual $0 Other $0 Total - Laboratory Services $0 TOTAL INDIRECT COST - = $10,162 - 0 $0 $0 1 $10,162 $1,839 The base for the Department is total direct costs, excluding: capital expenditures (buildings, individual items of equipment; alterations and renovations); that portion of each subaward in excess of $25,000, flow-through funds and WIC food costs. Fixed rate 9/1/2017 - 8/31/2018 and Provisional rate 9/1/2018 - 8/31/2021 for Health Programs-18.1%; Laboratory Services- 33.9%. Indirect Cost on vendor contracts will be calculated at 100%. At DSHS these contracts are expended in the Other category and full indirect cost is charged. Indirect Cost on IT vendor contracts that are classified as "capital expenditures" and are exempt from indirect costs. TX-DSHS-19-1309-A-002463 Name of Contractor: Dallas County Health and Human Services Department TB/HIV/STD Section, HIV Prevention and Care Services Branch Budget Request Period: 8/1/2019-7/31/20 A. Personnel $2,322 Total Salaries $2,322 Time Position 1. MicrobioloAISt (%) 5% #of months 12 Total Salary $46,430 Amt Requested $2,322 Wright. Jackie Position# Position Description/Justification (include required Certification or Ucensure ): Processes cultures submitted to laboratory from STD Clinic for isolation and identification of Neisseria gonorrhea. Performs all tests necessary for preliminary identification of organism (gram slain and oxidase test). Performs finial identification using DNA Probe identification kid. Freezes cultures to send lo Refemce laboratory for susceptibility testing. B. Fringe Benefits Itemized elements of fringe benefits: C. Travel 1. In-State Rate(%) $561 24.15000 % $0 $0 a. None. 6. Dallas Counly•GISP 1 of 3 TX-DSHS-19-1309-A-002464 2. Out-of-State a. None. $0 Indicatewith an •x•whlch policy is used for travel: RespondentsTravel Policy• a•inelude DSHS Travel Policy a copy of the policy with the application D. Equipment For computer requests, attach Vendor Certification for Computer Equipment purchased by DSHS Contractor 1. Description{iustification of Eguipment E. Unit Cost # of Units $0 Tol $0.00 0 $0 Supplies $7,279 # of staff Amt/Month #ofMonlhs Tot. 1. Laboratory supplies to include media, ID system, cryo vials, and dry ice F. 1. A. B. C. D. E. 1.00 12 $606.57 $7,279 Contractual Project Title $0 Name of Contractor(s): Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Description of how contract(s) will be accounted for and the number of contract(s) anticipated. G. Other $0 $0 Use format of item 1 for building or equipment rental, telephone or internet seNice . postage or other such casts. Cost/mo. # of months 1. Descriplion(justification: #FTEs Total $0 Use fonnat of item 2 for all other requests in this category . Total 2. Descriplion(Juslification: Total Direct Charges 6. Dallas County-GISP $0 $10,162 2of3 TX-DSHS-19-1309-A-002465 H. Total Indirect $0 Charges Amount Total Amount of Indirect Costs Allocab le to the project: Indirect Costs are based on (mark the statement that is appl!cable and provide the rate, base and type, as applicable ): $0 Rate □The respondent's most recent Indirect cost rate approved by a federal cognizant agency or state single audit coordinating agency . Expired rate agreements are not acceptable. Attach a copy of the rate agreement to the budget. 0.00000% Applies only to governmental entitles. The respondent's current central service cost rate or indirect cost rate based on a rate proposal prepared In accordance with 0MB Circular A-87. Attach a copy of Certification of Cost Allocation Plan or Certification of Indirect Costs. Note: Govemmental units with a Central Service Cost Rate must also include the indirect cost of the govemmental units department (i.e., Health Department) . In this case Indirect costs will be comprised of central service costs (determined by applying the rate) and the Indirect costs of the governmental department. The allocation of indirect costs must be addressed in Park V - Indirect Cost Allocation of the Cost Allocation Plan that is submitted to DSHS. 0.00000 % Base Type (central service or Indirect) A cost allocation plan. A cost allocation plan as specified in the DSHS Contractor's Financial Procedures Manual (CFPM), Appendix A must be submitted to DSHS within 60 days of the contract start date. The CFPM is available on the following intemet web link: http://www.dshs.state.Ix.us/contracts/. D Total Budget 6. Dallas County•GlSP $10,162 3or3 TX-DSHS-19-1309-A-002466 STATE AND LOCAL GOVERNMENTSRATE AGREEMENT EIN: 32-0113643 ORGANIZATION: Texas Department 1100 W. 49th Austin, of State Health Services Street DATE:09/17/2018 FILING REF.: The preceding agreement was dated OG/lS/ 2 0 17 TX 78756- The rates approved in this agreement are fer use en grants, contracts and ether to the conditions in Section III. agreements with the Federal Government, subject SECTION I: RATE TYPES: INDIRECT COST RATES FIXED PP.OV. (PROVISIONAL) FINAL PRED. ( PREDETERMHIED) EFFECTIVE PERIOD :nJ!.i FIXED FIXED EBQM l'.Q 09/01/2017 08/31/2018 09/01/2017 08/31/2018 PROV. 09/01/2018 OB/31/2021 LOCATION 18 .10 On Site 33. 90 On Site RATE(%) APPLICABLE TO Health Program Lab Program Use same rates and conditions as those cited for fiscal year ending August 31, 2018. !.SAS.t Total direct costs excluding capital expenditures (buildings, individual items of equipment; alterations and renovations), that portion of each subaward in excess of $25,000, flow-through funds and ,uc food costs. Pagel of 3 G36574 TX-DSHS-19-1309-A-002467 ORGANIZATION:Texas Department AGREEMENT DATE: 9/17/2018 SECTION II: of State Health Services SPECIAL REMARKS TREATMENT OF FRINGEBENEFITS; The fringe benefits charged individually listed below. are specifically as direct costs. identified to each employee and are The directly claimed fringe benefits are TREATMENT OF PAIDABSENCES vacation, holiday, sick leave pay and other paid absences are included in salaries and wages and are claimed on grants, contracts and other agreements as part of the normal cost for salaries and wages. Separate claims are not made for the cost of these paid absences. Equipment Definition of nonexpendable, tangible p~rsonal Equipment means an article property having a useful life of more than one year and an acquisition cost of $5,000 or more per unit. FRINGE BENEFITS: FICA Retirement Worker's Compensation Unemployment Insurance Health Insurance Post Retirement Health Benefits based on actual Your next proposal was du@ in our office 02/28/2018. costs for the fiscal year ending 08/31/2017 Page 2 of 3 TX-DSHS-19-1309-A-002468 ORGANIZATION:Texas Department AGREEMENT DATE: 9/17/2018 SECTION III: of State Health Services GENERAL A~ t,IHIVsIJQKS The rat es in ch1a Agreement ara auDj&ct to any at•tu t ory or adminis t rat i va l i c tt atlolUI and appl y to a given 9rant, ccntract or other •greecent only to the CKtont th• t funds are •vail&ble , Acceptance o! the rates is subject to the !ollowing c:onditiona , Il l Only coats incurred by the or91n l zation were included in lta indir ect coat pool aa finally and are a l lowable under the governing cost principle•: accepted · auch c~•=• are legal ob11ga~iont at the organization Ill TIie UIM: caato that have besn treated as indirect coa t s are not clallllltd •• direct costs : Ill Si milar cypeo o! costs t..ve be en accord ed cona l atent •ccountln9 creattnant : and (4 1 The l ntorutlon provided by the organi:ation which wao used to establioh the rateo lo not later found to De uccrially inco..pletc or lnaca.rate by the Federal Coverr.ment ln ouch of the F1deral Cov•rnaw:nt . 11tu•tlon, th• rata(t ) ""uld be subject to renegotiatio n •t the discretion B. Aa:?LliIIbVOfr't:Ki~s ~ Thio ~•••aent la baa ed on the accounting ay1 t em purported by the organltet!on to be in atfe:t durlng the Agreement period . Changea to the method o! accounting for co1:a which affect the atcount of rcl fflbur1Cfflent r e1ultin9 frOffl t he use o f this Agrcciacnt requ1rc prior approval of t he auth ori:ed representati ve of the cognltant agency . Such changeo 1ncl~de, bu: Failure co obtain are not li~lted to . changeD ln the charging or • partL: ular type o! cost fr 11mindirect to direct. approva l =•Yrea ult In co1t dlsallowa nce, . c. FtJrp BATTS · lf a fixed r ate l s in t h l~ Agracll'Ont , it l s baa ed on 1n ecc l -..te of t he cost9 for t he period covered by ch« ratc . Whe~ the actual coot• fo: thla per10d arc deter mined, an adju •toie nc will ba T!Sl de ta• ro:e of a f uture yc•rlal to roe-pens~:• fo: the dlfle ren:: bet~cc n the co• •• uaed to es:abl l sh ch• f i xed ra:e and a ct ual cent• . D USE exm~B ua=-Pa!. 8GE7:f,.fES · Tl\e r~t •• i n t hi s ~grea~ ant wore •ppr ovcd in a,:cord,n ee wl:h tho au: horl t y in Title 2 of the Code of rederal Regul ~tl o:io, Pa:t 200 12 CFR 2001, ar.d should be applle'J co gr ont a , eo~t ra c t1 and o ther ~grec~ enca covered by 2 CFR 200, subject to any 11•1tatlons In A aba~c . Tl\e org■n1;ation ""' Y pro v ide cop i es of the "9rcemt nt t o ot h er Federal A<)enc1c3 to g1ve them early notltlcat icn a t t he A9reeC1Cnt. £ a:I:ll.EA:. H any Fe:!eral contract , grant in thh ra:elal or other a;,rcc,oent h r=ifflbuning i ndirect coat ■ l:ly a c:ean• other t.han the app roved ra t elt l A!Jrccinent. t he OC"91 nl:a:lo n 1hou ld (11 cre d it 1ueh cost ■ to th: athcted progr1ms , and Ill apply t he appro ·,ed to t he appropriate baae to ide ntify t he proFcr amaun: o! ln:!lrect costs allocable to the ■• prograca , Bl TIIJ: lllST!TI/TlO!l, Oil BEHALF OF' Tl!E FEiltAAL GOVER!ll1ENT r Taus Dcpart...,nt of State Health Service ■ Dil'Mntt!IT OF HEALTH ~ID HtltWI SEIIVlc::tS ......... .,~"·--, ._" .... n,..,,•.._ ............ 0.,.,,.-..., (AGENl:ll .....'~-· , Darryl W. Mayes-S • •-"-......... ..,..,...... . •,-4'W ~ ISICIIATUR!I (SlC!IATt/1.EI u~-slil'. !!.. . lffNIEI i)LR(( ITlTLtl ,J for Arif Karim UH\NCI b 1P Dire c tor, C'Oat Al\oca:1on Service ■ CTITI.EI ;;q/~ol:t1J1e ,,nnou ICATtl IOATEI &514 Page NII$aEPRESEIITA TIVE Wanda Rayfield Teleph c:ne {214) 767 • 3261 3 of 3 TX-DSHS-19-1309-A-002469 From: Aldridge,Tiffany (DSHS) Sent: Thursday, August 29, 2019 3:48 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,Imelda M (DSHS) Subject: Re: Requirements requested in the Notice of Award (NOA) You’re welcome! Tiffany Sent from my iPhone On Aug 29, 2019, at 2:08 PM, Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) wrote: Thank you From: Aldridge,Tiffany (DSHS) Sent: Thursday, August 29, 2019 3:01 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) Good Afternoon De’Lisa, The Texas Technical Review and Budget Revision has been submitted as a Grant Note intoGrantSolutions.gov. Please let me know if you have any questions. Thank You, Tiffany Aldridge From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Wednesday, August 21, 2019 12:08 PM To: Aldridge,Tiffany (DSHS) Cc: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) We cannot extend the date. I recommend completing the response and missing contractual information as requested by OGS. You can submit a redirection at any time. We are aware of the missing indirect from some of the programs and hope to fill those gaps during our rapid awards process. You can submit a redirection after those awards are released. De’Lisa From: Aldridge,Tiffany (DSHS) Sent: Wednesday, August 21, 2019 12:51 PM To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Cc: Garcia,Imelda M (DSHS) Subject: RE: Requirements requested in the Notice of Award (NOA) Hi De’Lisa, We are working to complete the ELC Budget Revisions and Technical Review responses as quickly as possible. Many projects were not fully funded in the Indirect Cost area so we are still working with agency programs to find funding to cover this cost. We would like to know if we could have a deadline extension until COB Monday, September 23, 2019 to submit the budget revisions and technical reviews. Please let me know if you have any questions for me. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 TX-DSHS-19-1309-A-002470 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Thursday, August 8, 2019 1:42 PM Subject: Requirements requested in the Notice of Award (NOA) Importance: High WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, There have been many questions regarding the requirement for responses to the technical reviews and revised budgets requested in the Notice of Awards (NOA). A response to the weaknesses and revised budgets must be submitted into GrantSolutions as a Grant Note by September 2, 2019 as outlined in the NOA. I recommend compiling one document with each specific program/project areas and upload one attachment. If you do not have any significant comments on certain sections, you may indicate the reviews are acknowledged and the recipient will work with CDC post award to address any concerns. Revised budgets are needed for the contractual element (approved & funded) ONLY where the 6 elements were missing when your budget template was submitted. This can also be submitted as one document in GrantSolutions as a Grant Note. I have attached our Office of Grant Services Budget Guidance for your convenience; the contractual elements are listed on page 6. If you need to revise your budget for any other reason (i.e. change to indirect, moving a position to a contract, etc.) please contact me directly. Feel free to contact me directly with any questions or concerns. De’Lisa De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002471 From: Centers for Disease Control and Prevention Sent: Friday, August 30, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Fungi Articles in the September 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 9 - September 2019 Issue Now Online FUNGI ARTICLES Ahead of Print Current Cover Podcasts Candida auris in Germany and Previous Exposure to Foreign Healthcare Contact EID A. Hamprecht et al. Announcements Disseminated Emergomycosis in a Person with HIV Infection, Uganda I. Rooms et al. CDC Invasive Fungal Disease, Isavuconazole Treatment Failure, and Death in Acute Myeloid Leukemia Patients A. Bellanger et al. Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA EID Podcasts R. Ginn et al. Characterization of Clinical Isolates of Talaromyces marneffei and Related Species, California, USA L. Li et al. Disease Exposure and Antifungal Bacteria on Skin of Invasive Cane Toads, Australia C. L. Weitzman et al. Soft Tissue Infection with Diaporthe phaseolorum in Heart Transplant Recipient with End-Stage Renal Failure J. C. Howard et al. Delays in Coccidioidomycosis Diagnosis and Relationship to Healthcare Utilization, Arizona, USA R. Ginn et al. Climate Classification System–Based Determination of Temperate Climate Detection of Cryptococcus gattii sensu lato E. S. Acheson et al. Potential Fifth Clade of Candida auris, Iran, 2018 N. A. Chow et al. Medscape CME Activity Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions A. Ganesan et al. Blastomycosis Misdiagnosed as Tuberculosis, India A. Kumar et al. Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis S. M. Rudramurthy et al. Clonality of Fluconazole-Nonsusceptible Candida tropicalis in Bloodstream Infections, Taiwan, 2011–2017 Epidemiologic Shift in Candidemia Driven by Candida auris, South Africa, 2016–2017 P. Chen et al. E. van Schalkwyk et al. F. P. Sellera and C. E. Larsson Genotyping Approach for Potential Common Source of Enterocytozoon bieneusi Infection in Hematology Unit Beatrix Potter, Author, Naturalist, Mycologist Etymologia: Sporothrix schenckii B. Breedlove G. Desoubeaux et al. Click to update or subscribe to EID's Expedited article emails. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002472 From: Reyes, Monica (OS/OGA) Sent: Friday, August 30, 2019 2:13 PM EDT To: Alexander, Thomas (OS/OGA) ; Hellerstedt,John W (DSHS) ; De La Rosa, Jose (OS/OGA) ; Benavides, Luis (OS/OGA) ; Dutton,RJ (DSHS) ; Kunkel, Kathy, DOH ; San Filippo, Bruce (OS/OGA) ; Forster-Cox, Susan (HHS/OS/OGA) ; Leyva, Travis, DOH ; cara.christ@azdhs.gov ; Torres, Emma (OS/OGA) ; Robert Guerrero ; Kline, Lawrence (OS/OGA) ; Rodiles, Horacio (OS/OGA) ; Fernandez, April@CDPH CC: Darrow, Juliana (HHS/OS/OGA) ; Baker, Nicole (OS/OGA) ; Albertorio, Juan R. (CDC/DDPHSS/NCHS/OD) ; Notzon, Sam (CDC/DDPHSS/NCHS/OD) ; Fowler, Erin (HRSA) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) Subject: US Section Call - 09.06.19 - 8:00 AM PDT 9:00 AM MDT 10:00 AM CDT 11:00 AM EDT Attachment(s): "Offical_MINUTES AND ACTION ITEMS_2019 Annual Meeting_XD.pdf","Transcript_MINUTES AND ACTION ITEMS_2019 Annual Meeting_FINALFINAL_XD.pdf","M_USS TC_080219 Final.pdf","A_USS TC_090619.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon all, hope this note finds you well. In preparation for our September call next week, please find four embedded attachments in the body of the email that will be utilized during our call. If you have any questions or suggestions, let us know. • • • • US Section TC Agenda – 09.06.19 Official FINAL 2019 Annual Meeting Minutes and Action Items - please note three action items/agreements on final page (p.12) Unofficial Transcript 2019 Annual Meeting Minutes and Action Items US Section TC Minutes – 08.02.19 Have a safe and joyful Labor Day weekend, Monica Conference Line: 1-877-932-3364 Participant Code: 3490650 Monica Reyes, PhD, MPH Global Health Officer U.S. Section, U.S.-Mexico Border Health Commission Office of the Secretary, Office of Global Affairs U.S. Department of Health and Human Services P: (915) 532-1006 Ext. 121 W: www.HHS.gov/borderhealth TX-DSHS-19-1309-A-002473 UNITED STATES-MÉXICO BORDER HEALTH COMMISSION U.S. Section Conference Call Friday, September 6, 2019 – 9:00 AM MDT (8:00 A.M. PDT; 10:00 A.M. CDT; 11:00 A.M. EDT) Conference Line: 1-877-932-3364 Participant Code: 3490650 AGENDA  Welcome and Roll Call - M. Reyes  FY20 BIDS Projects overview - K. Moser  AZ-Mexico Commission June Meeting Update - E. Torres  14th Annual Border Health Conference for the Border Health Caucus Report out- L. Benavides  Healthy Border 2020 & Healthy Border 2030 – R. Guerrero  OGA/BHC Updates- T. Alexander o BHC Executive Director Position o BHC Annual Report Participants California Larry Kline Horacio Rodiles April Fernandez Arizona Emma Torres New Mexico Bruce San Filippo Texas J. Manuel de la Rosa HHS/OGA Cara Christ Sue Forster-Cox Luis Benavides Juliana Darrow Robert Guerrero Kathy Kunkel John Hellerstedt Carlos Sanchez Travis Leyva R.J. Dutton Monica Reyes Nicole Baker Thomas Alexander Guest Participants Kathy Moser, CDC Alfonso RodriguezLainz, CDC Juan Albertorio, NCHS Sam Notzon, NCHS Erin Fowler, HRSA Note: This teleconference will be recorded for the purpose of drafting minutes TX-DSHS-19-1309-A-002474 UNITED STATES-MÉXICO BORDER HEALTH COMMISSION U.S. Section Conference Call Friday, August 02, 2019 – 9:00 AM MDT (8:00 A.M. PDT; 10:00 A.M. CDT; 11:00 A.M. EDT) Minutes Welcome and Roll Call: Monica Reyes Updates: Tom Alexander o Briefly discussed the Resiliency Directorate, which is comprised of NSC, DOD, OMB, HHS, and DHS. At this time, OGA is working through how the BHC could play a role in the current migration issues. o Tom and Juliana have a call scheduled with Dr. Michael Parker, whom reached out to OGA to discuss possible inputs on border health issues that will be fed into a white paper being worked on my the government about how to better leverage existing legal authority and resources to support the border states. o The five year MOU with Mexico signed in 2014 is under review by the Office of General Counsel. HHS/OGA plan to bring the Commission into this process as much as possible. o Michelle McConnell has left her position as Health Attaché and transitioning to be the CDC liaison for DoD. Once her replacement is found the BHC will be informed. June Annual Meetings Discussion: Juliana Darrow o Binational meeting minutes were sent back from the Mexico section and are being translated for review before dissemination. o Dr. de la Rosa and Monica Reyes have met to delineate a work plan regarding the research committee. The majority of the work plan is to reconstitute the ad-hoc workgroup to a formal structure within the Commission. First step is to dig up historical data on previous actions and recommendations followed by a set of meeting between the co-chairs, eventually culminating in a series of meetings with the workgroup members. Finally, a formal recommendation is to be drafted for consideration at the next annual meeting. HRSA Investment report: o Dr. de la Rosa noted that there may be need for clarification within the final report regarding data reported and whether the expenditures were for the border states or the border region. Erin acknowledged this missing component and will work with her programs to clarify what is for the region and what is for the states. Border Data Initiative: o Juan Albertorio provided updates following the June meetings, including that CDC WONDER is working on instructional videos for the platform. He is working to connect with ORR regarding mental health, especially in the unaccompanied children population at the border and hopes to do an exchange with scholars that work with the topic. TX-DSHS-19-1309-A-002475 Dr. de La Rosa shared about a joint mental health project currently between Texas Tech and the Universidad Autónomo de Juarez. The project is looking at mental health interventions for children. One of the unique components to the project is its ability to reach a broad range of audiences as it is not language based and uses cartoons. Dr. de la Rosa will put Juan into contact with the leads for this program. o Monica Reyes shared that there is effort being made to include the Healthy Border Observatory on the current US Section website. o Alfonso Rodriguez spoke on current efforts regarding data collection and highlighted that this work is a follow up to the 2018 US Section Meeting in DC, at which time a decision was made to focus on US data initially and identify existing HHS federal data tools that could be useful including efforts for the Border Health Observatory. Juan and Alfonso have identified three tools to capture and add previously unavailable border data for border specific health indicators: 1.CDC Wonder, 2. HCUP, 3. ATLAS. Currently, the plan is to develop something similar to ATLAS with more emphasis on mapping and visualization along with additional publically available data covering clusters of border counties. The workgroup decided to use TB as the pilot and have a draft project data request for the Division of Tuberculosis at the CDC to provide the border data. Also, the division of Global Migration and Quarantine at the CDC is exploring the ability to develop the dashboard utilizing in-house resources. Healthy Border 2020/2030 o Tom and Juliana met with Healthy People to discuss collaborating with them for HB 2030; preference is that we work off the indicators already decided by Healthy People to provide continuity. o Robert Guerrero responded to a question on how to make the document binational, referring to the Healthy Border 2020 strategic plan, written binationally and agreed upon at every step binationally. The CDC and Secretaria de Salud were consulted for additional information but the border states were the main sources of information, not the federal government. He expressed concern, if the US Section chooses indicators and then Mexico section chooses indicators there will be two separate documents rather than one binational document. o Juliana suggested a call between the two sections to decide how to close out HB2020 and using Healthy People Indicators to select a list that both sections agree upon that are reasonable to get data continuity across the border. - Other Topics o Emma Torres was unable to connect to the call, her update on the AZ-Mexico Commission June Meeting will be tabled to the September call. Action Items and Recommendations o Alfonso Rodriguez recommended a meeting to discuss the different projects to look at any existing overlap, how they are connected and to gain guidance from members. o Juliana recommended a call with Mexico to decide the process to close out Healthy Border 2020 and then move forward with a binational task force. She requested that TX-DSHS-19-1309-A-002476 each state identify an epidemiologist to be a part of the task force and then a call will be convened to move forward. Next month Healthy Border 2030 will be a larger portion of the agenda. o Juliana requested for Robert to reach out to Gudelia about closing out HB2020 and he agreed. Participants California Arizona Emma Torres Larry Kline x Horacio Rodiles April Fernandez New Mexico X Cara Christ x Robert Guerrero X Bruce San Filippo Sue ForsterCox Texas x Luis Benavides Kathy Kunkel Travis Leyva J. Manuel de la Rosa x x R.J. Dutton Thomas Alexander Juliana Darrow Michelle McConnell John Hellerstedt x Guest Participants HHS/OGA x Monica Reyes x Nicole Baker x Carlos Sanchez Kathy Moser, CDC x x Alfonso RodriguezLainz, CDC Juan Albertorio, NCHS Sam Notzon, NCHS x Erin Fowler, HRSA Note: This teleconference is being recorded to draft the conference call minutes. TX-DSHS-19-1309-A-002477 U.S.-Mexico Border Health Commission (USMBHC) 2019 Annual Meeting June 19-20 San Diego, California MINUTES U.S. Section (new members, delegates are in bold): California Arizona New México Texas HHS/OGA/GUESTS Larry Kline Emma Torres Kathy Kunkel John Hellerstedt Thomas Alexander Karen Smith Robert Guerrero Bruce San Filippo Manuel de la Rosa Garret Grigsby April Fernandez Sue Forster-Cox Ronald J. Dutton Juliana Darrow Prisci Quijada Trav is Leyv a Luis Benav ides Michelle McConnell John Villareal Kathleen Moser Esmeralda Iniquez- Stevens Juan Albertorio Erin Fowler Nicole Baker Monica Reyes Xochitl Diaz Mexico Section (new members, delegates are in bold): Baj a California Sonora Chihuahua Coahuila Martha Romero Nuev o León Néstor Hernández José Raymundo López V. Jesús M. Flores Montana Alfonso Valenzuela Filiberto Pérez Gumaro Barrios Dora Elia Cortés Melissa Machado Arnoldo Álvarez Martha Sánchez Cecilia García Tamaulipas María del Socorro Rodríguez BHC Central Office/GUESTS Gloria Molina Gudelia Rangel María de la Luz Vázquez Gregorio Sánchez Rogelio Zapata Gabriela Escalante Cecilia Rosales Barbara Jiménez Eduardo González The Annual Meeting began with the welcome by Thomas B. Alexander, J.D., Principal Deputy Director for Global Affairs, Department of Health and Human Services of the United States, and Acting Executive Director, US Section. In turn, Dr. Gudelia Rangel, Executive Secretary of the Mexican Section welcomed the members and opened the meeting asking everyone to introduce themselves, with a special welcome to the new members who just became part of the Border Health Commission. Upon introducing herself, Dr. Gloria Molina Gamboa, Secretary of Health for the state of Tamaulipas requested permission to leave one day early due to an emergency in her state. 1 TX-DSHS-19-1309-A-002478 Members approved her request and she was allowed to move up her presentation to the first day of the meeting. As part of the agenda, Garrett Grigsby, Delegate for Commissioner, Alex M. Azar II, JD, offered opening remarks highlighting the purpose of the meeting, which was to reestablish and build connections, learn from each other and work together. He stressed the long relationship of the two countries, strongest along the vibrant US-MEXICO border. He went on to say that everyone’s presence in the meeting confirms the shared interest for health, the border region and the commitment to work collaboratively to protect and strengthen the life of the approximately 18 million people who live along the border region. He mentioned that as the 20th anniversary of the USMBHC is approaching, it is necessary to reflect on the past successes and to look for opportunities to improve in the future, that is why he expects the health experts attending this meeting contribute with their experience and share their efforts because diseases do not stop at the border; he emphasized that what we do in one side benefits everyone. Dr. Gudelia Rangel welcomed all attendees and offered words on behalf of Dr. Jorge Alcocer Varela, Secretary of Health of Mexico, and Dr. Alejandro Svarch, Director General of International Relations of the Secretary of Health of Mexico. Dr. Rangel said that among its functions, the USMBHC is to support public organisms in health prevention and protection, strengthen information systems in the order, and train those responsible for health to face the health challenges that prevail in this region. There are challenges ahead, including strengthening binational collaboration in priority topics established in Healthy Border 2020 and that which be established in Healthy Border 2030. Per the agenda, Tom Alexander and Dr. Rangel presented to the members the United StatesMexico Border Health Commission (USMBHC) mission, vision, functions and structure with the purpose of identifying the roll each one plays within the Commission and the local and binational context. When discussing the specific function of the Commission to conduct or support the establishment of an extensive and coordinated system, that uses advanced technologies to the extent possible, for gathering health-related data and monitoring health problems in the United States-Mexico border area, Dr. Rangel highlighted that several years ago there was an attempt by the USMBHC to develop such an information system with the help of the National Institutes of Health. However, she is not aware if this project was ever completed, but the data system seems to have been in place for two to three years with several health indicators and in use by all 10 states. She thinks it worthwhile to reconsider this topic for discussion given the work that apparently went into the project. After this presentation all members, delegates and OGA leadership posed for a group photo. During Dr. Gloria Molina’s participation, she recognized the work of Dr. Svarch, Dr. Rangel and Dr. Maria de la Luz Vazquez Saavedra for all the support given to the state of Tamaulipas. Dr. Molina went on to share a video presenting the Tam Te Cuida model, a program to care for the most vulnerable population; its general objective is effective, timely and resolute access to social assistance at home. Services are rendered by a multifunctional group of health professionals, nurses, psychologists, nutritionist, etc. In addition, as part of the collaboration with the USMBHC, she mentioned personnel training on MhGAP guide. To close, she thanks the participation with the USMBC for regularizing the work of the COBINAS, which has facilitated an effective technical communication between Texas and Tamaulipas. Plenary Session Per the agenda, Garrett Grigsby led the National Anthems ceremony. Dr. Karen Smith, Director and State Health Officer for California offered opening remarks for this public session of the Commission. In her remarks, Dr. Smith welcomed the Commission and 2 TX-DSHS-19-1309-A-002479 guests. She went on to present the scope of the Department of Health in California and the work of the Office of Binational Border Health in San Diego which was established in 1999 to facilitate the cooperation between California and Mexico’s public health officials and health professionals to reduce the risk of disease in the California border region and in binational communities throughout the state. This has been an extremely helpful ongoing me thod of communicating in the past to inform the communities on both sides of the border what is happening in terms of public health. This is possible only because of the commitment of public health officials and professionals on both sides of the border facilitating through communication, cooperation and collaboration. The next point in the agenda was Drs. Gudelia Rangel and Dora Elia Cortes presenting the report of the main binational activities from the Mexico Section. Dr. Rangel began by thanking members, delegates and guests for attending given that one of the most important commitments of the Commission is to hold this annual meeting where it reports its activities to the public in an open session. Dr. Rangel reported about the activities developed by the Mexico Section, organized in three strategic projects: Health promotion and disease prevention, research and training; and communication, collaboration and outreach. The activities she highlighted were Migrant Modules for Repatriated Migrants, Mobile Units, Border Health Month, Binational Research Network, Leaders across Borders, Mental Health Initiative, as well as some research projects that are currently being developed. To close, they presented the main results and achievements of the Mexico Section of the U.S.-Mexico Border Health Commission. In turn, Thomas Alexander presented some projects that the U.S. is developing in each border state: California, Arizona, Nuevo Mexico and Texas. He stated that Secretary Azar has encouraged the Commission to play a critical role in identifying border issues that can impact national health security and serve as a key body to gain local, state and federal stakeholders. Secretary Azar believes the commission is well-positioned to find solutions and has focused all border funds to infectious disease, specifically to the Border Infectious Disease Surveillance System (BIDS). The details of the 18 projects were: Arizona, MEDSIS- State Surveillance System, Captures Binational Cases of Communicable Illnesses; New Mexico, US-Mexico Tuberculosis ECHO Program, Partner with University of New Mexico and Mexican National Respiratory Institute (INER); Texas, Communication and Response in the Paso del Norte Region, Influenza Surveillance Expansion; California, Flu Surveillance at five border sites, Statewide Identification of Binational Cases of disease, Expanded use of Queso Fresco Questionnaire. Following, there are a few minutes for comments from members and guests. Dr. Kline expressed his astonishment for the achievements of the Mexico Section. He mentions the importance of having leaders that know how to lead and guide the activities beyond the budget, to improve health in the border. In turn, Dr. Filiberto Perez congratulates Dr. Rangel and her team for the report. In turn, Dr. Alfonso Valenzuela remarks on the importance of having coordinated guidance with clear objectives; this is the most important contribution that has been made, and he sees the future of the commission as secure because there truly are leaders that know what to do, and for this he congratulates everyone in the Commission. Some guests commented about the importance of developing binational initiatives to procure border health. Another guest, a graduate from Leaders across Borders, thanks the Border Health Commission for the investment made and suggests focusing the efforts in infectious diseases and nutrition to reduce the high index of child obesity. Another guest emphasizes the importance of binational collaboration, beyond the political aspects. To end the day’s activities, Dr. Gudelia Rangel and Tom Alexander commented on the intention of each country to renew the Joint Declaration agreement in 2020 to continue impacting public 3 TX-DSHS-19-1309-A-002480 health in the border, maximizing binational communication, commitment and collaboration, committing to manage resources and strengthen the structure of the Commission to deliver results. On the other hand, they commented that their corresponding countries have each begun to work in the legal aspects to be able to sign the agreement the following year. On Thursday the 20th of June, the meeting continued with the discussion and presentations on Binational Coordination and Collaboration, with the objective to share best practices carried out in the border region and for the migrant population. Dr. Rangel began by explaining the relevance of the presentations of the Mexico Section that followed, adding that some of the initiatives were not born within the Commission but begun in other agencies and the Commission has participated in them and take n them to a different level. Local initiatives may be replicable along the border region. Our role as a Commission is to support and promote those initiatives that may benefit our border populations. The initiatives presented by the Mexico Section were initiated by the states or some other organization but in all cases, without the support and promotion of the Mexican Section, they would not have the level that they have now. The initiatives presented were: Binational Campaign Ama tu Corazón, by Dr. Melisa Machado and Barbara Jimenez; Meta Salud, Diabetes, by Dr. Filiberto Pérez Duarte and Dr. Cecilia Rosales and Ventanillas de Salud 4T, by Dr. Cecilia Rosales. In the next point in the agenda, Dr. Rangel announced the presentation of the Binational Health Councils (COBINAS), stating that this is a binational initiative that, again, was not born in the Commission, but has always been supported by the Commission. First, Dr. Jesús Flores presented the activities carried out by the Sonora-Arizona COBINAS and the Paso del Norte Region; Gregorio Sanchez, representing Dr. Gloria Molina, presented their experience in the Tamaulipas COBINAS and RJ Dutton on behalf of Texas. Furthermore, Garrett Grigsby said a few words about the presentation of best practices from the U.S.: Overview of California’s Best Practices, by April Fernandez; New Mexico’s Operation Cascarones, by Travis Leyva, Director; Overview of Texas Border/Binational Initiatives, by RJ Dutton and Arizona’s Best Practices with Sonora, by Robert Guerrero. Tom Alexander introduced the discussion on future binational collaboration and gave the floor to Dr. Eduardo González-Fagoaga and Robert Guerrero who provided a brief presentation on the Healthy Border 2020 Program. Some of the comments during the Healthy Border discussion were: - - Dr. Alfonso Valenzuela commented that it is very important to have a unified data system available and supports the Commission to continue developing such a system. Dr. Karen Smith says that the four states do not have a unified data system and believes Mexico’s system is far superior to the US at this time. Dr. Nestor Hernandez talked about the need to include environmental health in the Baja California and California region as a priority in 2030. Dr. Dora Elia Cortez believes there is a definite need to have a unified data system and that it is very important that the Commission find alternative ways to work on an analysis program following the vision of the Commission. Robert Guerrero said that before talking about data as it pertains to Healthy Border, there is a basic question that needs to be answered and that is—Does the Binational Commission want to develop HB2030? If neither federal government supports it, then this is just a nice academic discussion. Dr. Filiberto Perez also supports environmental health to be included as a priority for 2030. Dr. de la Rosa expressed his support for carrying out HB2030. 4 TX-DSHS-19-1309-A-002481 - - Dr. Kline supports the idea stating that many institutions use HB2020 as a research document – not having anything is not an option – the question is whether the Commission will have federal support. Dr. Rangel stated that she and Tom Alexander both believe that there is a commitment to conclude HB2020 and suggests that they should work on a timeline. They commit to the completion of HB2020 and would agree to continue with HB2030. Dr. de la Rosa said there must be a disclosure which indicates the HB2030 document is an exercise in measurement, in tracking and nothing else to intervene or change health outcomes. Dr. Karen Smith said she will participate sharing data but cannot commit any resources as her Border Health Office is currently only state funded. Tom Alexander said he has reached out to the Office of the Assistant Secretary (OASH) for help. They are responsible for publishing Healthy People 2030 – and on a preliminary basis have offered to work with the Commission to share the data they have. Although not definitive, they have offered to produce a companion document, subject to agreement by the Commission. Dr. Rangel states the Mexican federal government fully supports the completion of HB2020 and Tom Alexander and herself would work on next steps for HB2030. As a matter of fact, this action is included in the Mexico Section work plan for 2019-2020. After the discussion among the attendees, they agree to complete HB2020, to present a timeline with next steps to finalize HB2020 and to continue with the HB2030. Dr. Rangel gives the floor to begin the discussion on the topic of infectious diseases. Some of the comments were: ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ Dr. Rangel mentioned that infectious diseases have been part of various collaboration projects, such as TB, HIV, vector borne, etc. Robert Guerrero suggests including STDs to the list of infectious diseases and to include drug resistant TB (DRTB). Tom Alexander mentions the OVITRAP project that was very successful to which Robert Guerrero cautions that the Commission is not an operations organization but rather a policymaking entity. We are not to issue services of any kind because it is confusing for the group. Dr. Kline also reminds people of the danger to get into operations. He says that as a Commission we can advocate and we can encourage other agencies to do it bu t when we start doing it, it becomes confusing. Dr. Hellerstedt says that the OVITRAP project was a perfect opportunity for Texas to learn from Mexico – the value of that particular project focused on an immediate threat. If both sides have the funds and the opportunity, he would totally support the project. Dr. Maria de la Luz Vazquez remarked on the importance of the vector program and how the work of the Commission is of great importance to bring together other groups to collaborate with the rest of the organizations. The Commission should not get involved in operations but rather focus its efforts in managing collaborations, offering strategic support. Dr. Rangel states that she also believes we should not go into operations especially because the Commission could never match or even come close to having the resources of any of the states; however, there are a lot of activities where the Commission can do a great job. Dr. Karen Smith seconds what Dr. Rangel says but also adds that she would have several areas in California where she could have the Commission participate in operational areas. 5 TX-DSHS-19-1309-A-002482 ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ Dr. Kline and Dr. San Filippo presented Dr. Rangel with a certificate of recognition for her work on border health. On behalf of Dr. Molina, it is requested to include measles, plus sharing systems and communication channels for the promotion of vaccinations along the border. Dr. Dora Elia Cortez proposed to have projects such as EWIDS or BIDS using the COBINAS or the Consortium. Dr. Karen Smith says that even though the California systems are very robust, currently there is a lot of data that is not being captured. There’s a huge influx of people coming into our areas yet we’re not capturing all that data, on either side. She mentions chicken pox as an example. Dr. Alfonso Valenzuela states that there’s already been some support in the past from EWIDS or BIDS in terms of laboratories and technical support – he believes something like this would also be very beneficial. For example, there is data being generated on the migrants, but it is not unified. R. Guerrero reminds everyone that the Commission used to be involved in immunization programs, including chicken pox. Dr. Karen Smith states that California has some immunization programs but with migrants the health needs are much more urgent and difficult, sometimes as basic as providing water. Dr. Hellerstedt says that he would like the Commission to back immunization preventable diseases. He says that a lot of data that is captured of migrants is not reaching the state level. The concept of health security includes treating these people with dignity and doing health screening that would benefit both migrants and the communities that are rece iving them. He also ads that he would like the federal government and other authorities to understand the Global Health Security Agenda and to implement humanitarian health support for the safety of the communities. Dr. Karen Smith adds to Dr. Hellerstedt’s comment suggesting the inclusion of training of people who are carrying out screenings with migrants. Kathy Moser (CDC) suggests asking the Department of Homeland Security information about who is doing the screenings. The reason that there are differe nt answers is because the situation has been evolving. She states surveillance is one thing and that is what BIDS is doing and knowing what is binational and not binational; but what is needed is rapid reporting. USM-U Notify is a rapid-reporting system. Currently what is not operational is the definitions that exist even with a rapid-reporting system. Barbara Jimenez (Department of Health, San Diego) states that she has data she can share with the Commission on California’s shelters. Continuing with the agenda, on the topic of migrant health, Dr. Martha Romero took the floor to present the Health Security Operations in Coahuila implemented upon the arrival of the migrant caravan in her state. In turn, Dr. Nestor Hernandez presented the strategy and r esults of care and coordination upon the presence of Central American migrants in Baja California. Per the agenda, there would be a discussion on the topic of mental health, however given the time constraints, it was agreed to discuss the topic at another time. The discussion regarding committee structure opened with a proposal by Dr. Bruce San Filippo and Dr. de la Rosa to change the status of the Research Committee from ad hoc or work group into a permanent standing committee was presented and discusse d. The rationale behind this proposal is that an ad hoc committee may be dissolved at any time and a research committee requires permanency to move forward with the type of work it generates. Dr. Dora Elia Cortes seconds the proposal in the belief that research is an area that provides the Commission guidance as to the areas it must support. 6 TX-DSHS-19-1309-A-002483 ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ Dr. Kline states that we need to use the committees, if they are used, he would support it. He states that it is ok from his perspective as long as it is used and usa ble. Dr. Rangel says that she has no vote but only speaking on behalf of the Mexico section, states that she must be critical of the work they all do in the Commission. She sees that the research committee works only to meet, and then after that nothing h appens. When Cristina Rabadán- Diehl was here there was a very good session in San Diego, researchers were selected, there was a meeting in Monterrey, with a facilitator to develop a strategic plan, that all happened in 2015, and after that nothing happened. She expressed her embarrassment with this special group that was formed as there was never any communication with them again. She said that as leader of this group, she felt embarrassed and she was putting this situation on the table for consideration. She suggests that an apology letter be sent to the expert panel group and then move forward. She added that Mexico has worked in the Border Binational Health Network and have been very fortunate because it’s been funded by CONACyT and it’s working successfully. Dr. Alfonso Valdez seconds Dr. Rangel’s comments. Dr. Kline states he sees that we need new energy in this committee and so that it has a feeling of permanency would support changing it to a permanent committee. Dr. de la Rosa believes the committee would change if it changes from ad hoc to permanent. He believes what has happened with the research committee reflects what is happening in the Commission as a whole. Dr. Hellerstedt believes it is important to have a research committee but would be disappointed if nothing happened. He would want to see a plan specifying what it would do, a work plan with objectives, budget needs, etc. Dr. Cortez believes the Research Group would need analysis and clarification of its roles and responsibilities so that it is part of the committees, not to work on right now but to discuss frequently in the near future. She clarifies that the Mexico Section had to move to alternative actions to continue with the research work. Dr. de la Rosa changed his proposal for a study and discussion on the viability of a research committee and that this study be presented in the 20th anniversary annual meeting. Dr. Hellerstedt supports studying the situation and presenting a plan, how it is supported, what activities, and to show that it can operate under the Commission. Dr. Smith says she has been witness to two years of nothing happening with the Research Group. She does not believe turning this ad hoc work group into a permanent committee would change anything, but she would like to see the work plan, activities and budget if possible. Dr. Perez says he would like to see a deep reflection on this matter and include it in the list of projects. Dr. Dora Elia Cortez wants to make sure we ask ourselves if a research committee is necessary, and to see what the benefits are of having one. Should it be an evaluation organism of the Commission itself? We must reflect on this, study it and present a serious proposal. The agreements that were proposed by consensus or majority of the membe rs of the U.S.-Mexico Border Health Commission were read: Regarding Healthy Border 2020 (HB2030) Following the discussion regarding next steps for Healthy Border 2020, it was agreed to complete it, presenting a timeline with next steps to finalize the study and begin the HB2030 program. 7 TX-DSHS-19-1309-A-002484 Regarding Committee Structure A proposal was accepted to perform a viability study of a permanent standing research committee and that this study be presented in the Commission’s 20th Anniversary annual meeting in 2020. Renewal of the Joint Declaration in 2020 It was reported that the intention to renew the Joint Declaration Agreement in 2020 was approved by both federal governments. The Annual Meeting is adjourned. 8 TX-DSHS-19-1309-A-002485 U.S.-Mexico Border Health Commission 2019 Annual Meeting June 19-20 MINUTES The 2019 Annual Meeting of the US-Mexico Border Health Commission was held at the Embassy Suites by Hilton San Diego Bay Downtown in San Diego, California on June 19-20. U.S. Section (new members, delegates are in bold): California Arizona New México Larry Kline Emma Torres Kathy Kunkel Robert Bruce San Karen Smith Guerrero Filippo Sue ForsterApril Fernandez Cox Prisci Quijada Travis Leyva Esmeralda IniquezStevens Texas John Hellerstedt Manuel de la Rosa HHS/OGA/INVITADOS Thomas Alexander Garret Grigsby Ronald J. Dutton Juliana Darrow Luis Benavides Michelle McConnell John Villareal Kathleen Moser Juan Albertorio Erin Fowler Nicole Baker Monica Reyes Xochitl Diaz Mexico Section (new members, delegates are in bold): Baja California Sonora José Néstor Raymundo Hernández López V. Alfonso Filiberto Valenzuela Pérez Melissa Arnoldo Machado Álvarez Chihuahua Coahuila Jesús M. Flores Montana Gumaro Barrios Martha Sánchez Martha Romero Nuevo León María del Socorro Rodríguez Dora Elia Cortés Cecilia García Tamaulipas Oficina Central CSF/INVITADOS Gloria Molina Gudelia Rangel María de la Luz Vázquez Gregorio Sánchez Rogelio Zapata Gabriela Escalante Cecilia Rosales Barbara Jiménez Eduardo González Thomas B. Alexander, J.D., Principal Deputy Director for Global Affairs, Department of Health and Human Services of the United States, and Acting Executive Director, US Section, and Dr. Gudelia Rangel, TX-DSHS-19-1309-A-0024861 Executive Secretary of the Mexican Section welcomed the members and opened the meeting asking everyone to introduce themselves, with a special welcome to the new members and delegates on both sections. Dr. Gloria Molina Gamboa, Secretary of Health for the state of Tamaulipas requested permission to leave one day early due to an emergency in her state. Members approved her request and she was allowed to move up her presentation to the first day of the meeting. Garrett Grigsby, Delegate for Commissioner, Alex M. Azar II, JD, offered opening remarks highlighting the purpose of the meeting, which was to reestablish and build connections, learn from each other and work together. He stressed the long relationship of the two countries, strongest along the vibrant USMEXICO border. He went on to say: Our presence here today affirms the shared interest on health, the border region and our commitment to work collaboratively to protect and strengthen the lives of the roughly 18 million people who live along the U.S.-Mexico border region. As we approach the 20th anniversary of the USMBHC it’s an appropriate time to reflect upon the past successes of the Commission and to look for opportunities to improve in the future. Health in the border region has never been more important or more scrutinized, therefore the timing of this meeting cannot be better and he encouraged everyone to use this opportunity to discuss how we, as a binational commission, can use the unique structure and function to improve the health of those who live and travel across the shared border. One of the primary objectives of the international work of the US DHHS is to build and strengthen worldwide health security capacity to prevent, protect and respond to infectious disease outbreaks. For this reason, the secretary of HHS, Alex Azar, has asked his entire public health staff to bring to his attention the best regional levers and mechanisms now in place to support these vital efforts and to convene the key policy, technical and political leaders to formulate proposals to combat public health threats. Secretary Azar has been aware of the role of the USMBHC for many years since he served for HHS under George W. Bush administration. He believes now as the statutory commissioner of the US Section that the Commission is a vital forum to anticipate and to confront infectious disease on the U.S.-MEXICO border. The Commission serves as an early warning radar system and a public health force in place in the U.S.-MEXICO border. At a meeting in his office last year, just prior to the UN General Assembly high-level meeting on tuberculosis, he said that we must use every lever and mechanism and forums at our disposal to stay ahead and to confront infectious disease at the border. The USMBHC is a group perfectly formulated to take on this task. To this end, the US Section activities at a federal level have focused primarily on projects that can strengthen and respond to communicable disease with a particular focus on global health security and adding antimicrobial resistance. The Commission’s contribution to global health security will supplement the administration’s strategy to prepare for and combat biological threats and pandemics and protect the health of the region across our shared border. What benefits one side of the border benefits us all. We all agree that the 125-mile border region should be considered as a single unit when it comes to population health and examining disease data. The unique chronic disease issues and threats cannot be separated by a line in a map. Diseases don’t stop at borders, public health in the region TX-DSHS-19-1309-A-0024872 must then be a collaborative effort. This annual meeting serves as an example of how we as public health leaders can work together to improve not only regional health conditions but national well-being. We will accomplish so much more by working horizontally, taking advantage of situations like this where we have convened the right people to share and learn from each other. Dr. Gudelia Rangel welcomed all attendees and offered words on behalf of Dr. Jorge Alcocer Varela, Secretary of Health of Mexico, and Dr. Alejandro Svarch, Director General of International Relations of the Secretary of Health of Mexico. Both had to excuse themselves from the annual meeting due to the migrant situation in the southern border of Mexico. Dr. Rangel said: The mission of the USMBHC is to provide binational leadership to improve health and quality of life along the U.S.-Mexico border through binational communication, coordination and collaboration between the two federal governments, 10 border states and 44 counties, 80 municipalities and their multiple local partners. Dr. Rangel summarized the list of functions of the Commission focusing on three main areas: 1) support public and private health infrastructure efforts on health prevention, promotion and care, 2) strengthen communication systems related to public health along the border while providing public health resources trainings, and 3) establish the relationships with binational public health partners to be able to combat the threats that prevail in the border. She also summarized the Commission’s main achievements in three main strategic projects: 1) disease prevention and health promotion, 2) research and training, and 3) communication, collaboration and engagement focused on health issues such as TB, obesity, diabetes, infectious diseases, public health emergencies, research and strategic planning, and academic engagement. She talked about challenges ahead: Our main goal will be to continue focusing on areas identified in Healthy Border 2020 which is about to conclude, and those areas that we will need to identify as priorities in Healthy Border 2030. Healthy Border 2030 will be a challenging task as it must include not only the public health threats of border residents but will also need to address those specific public health priorities that may affect a migrant and transitory population. As we advance, the Mexican government is committed to the Commission’s goals and stakeholders to continue supporting and providing leadership to improve health and quality of life along the border. Dr. Alcocer is fully confident that the USMBHC will continue providing leadership, focusing on strategic issues that will impact and improve health and quality of life in the border region. Finally, Dr. Alcocer, recognizes all the work that the Commission has carried out over the past 19 years and sends his best wishes for a mutual learning experience during this annual meeting. Tom Alexander and Dr. Rangel presented the United States- Mexico Border Health Commission (USMBHC) mission, vision, functions and structure for the benefit of all new members and delegates. When discussing the specific function of “Conduct or support the establishment of an extensive and coordinated system, that uses advanced technologies to the extent possible, for gathering healthrelated data and monitoring health problems in the United States-Mexico border area,” Dr. Rangel highlighted that several years ago there was an attempt by the USMBHC to develop such an information system with the help of the National Institutes of Health. She was not at the Commission at the time and is not aware if this project was ever completed, but the data system seems to have been in place for two TX-DSHS-19-1309-A-0024883 to three years with several health indicators and in use by all 10 states. She thinks it worthwhile to reconsider this topic for discussion given the work that apparently went into the project. After this presentation all members, delegates and OGA leadership posed for a group photo. Dr. Gloria Molina requested and was granted the opportunity to present on this day her state’s best practice. Dr. Molina began by recognizing the work of Dr. Svarch for all the support given during the migrant influx situation, including Dr. Rangel and Dr. Maria de la Luz Vazquez Saavedra. Dr. Molina shared a video presenting the Tam Te Cuida campaign which brings primary health care services through mobile health squads to those who cannot come to the services by themselves. R.J. Dutton recognized Dr. Molina’s work and coordination with the state of Texas. During Question and Answers, after Dr. Molina’s presentation, Dr. Dora Elia Cortez congratulated her for the initiative, and added that a project like Tam Te Cuida from Tamaulipas could very well be implemented throughout the border. Plenary Session Garrett Grigsby led the National Anthems ceremony. Dr. Karen Smith, Director and State Health Officer for California offered opening remarks for this public session of the Commission. In her remarks, Dr. Smith welcomed the Commission and guests from the private sector. She went on to present the breadth and scope of the Department of Health in California which touches the lives of over 39 million people in the state, and the work of the Office of Binational Border Health in San Diego which was established in 1999 to facilitate the cooperation between California and Mexico’s public health officials and health professionals to reduce the risk of disease in the California border region and in binational communities throughout the state. She highlighted that a primary focus of this office is working in tandem with the Department Center for Infectious Diseases programs and their collaborative partners in Baja California, including surveillance and monitoring of infectious disease to help develop and maintain communication protocols. This has been an extremely helpful ongoing method of communicating in the past to inform the communities on both sides of the border what is happening in terms of public health. This is possible only because of the commitment of public health officials and professionals on both sides of the border facilitating through communication, cooperation and collaboration. Mexico Initiatives - Dr. Rangel took the floor to provide her annual report in this public forum. The projects she reported on were: Border Health Month, Ama tu Corazón, Ventanillas de Salud, Mobile Health Units, Border Health Binational Network, COBINAS and Leaders across Borders, Mental Health Initiative (mhGAP) and Migrant Health Modules. Dr. Dora Elia Cortez added detail to the report on the Border Health Binational Network (Red Binacional) which was funded through Mexico’s National Science and Technology Council (CONACYT) but has kept a binational focus in its research. Dr. Cortez explained the structure, scope and work approach. The results for the 2015-2017 period included 46 short stays for participating researchers and a special issue of Frontiers in Public Health, https://www.frontiersin.org/research-topics/5417/the-us-mexico-border-a-unique-tapestry-ofhealth#articles with 12 articles published and a large number of the Binational Network researchers who authored these articles. In addition, the support for Leaders across Borders (LaB) was substantial for the continuation of this leadership development project this year. U.S. Initiatives – Tom Alexander presented his report before the public forum. He stated that Secretary Azar has encouraged the Commission to play a critical role in identifying border issues that can impact national health security and serve as a key body to gain local, state and federal stakeholders. Secretary Azar believes the commission is well-positioned to find solutions and has focused all border funds to infectious disease, specifically to the Border Infectious Disease Surveillance System (BIDS). The details of the 18 projects were: Arizona, MEDSIS- State Surveillance System, Captures Binational Cases of TX-DSHS-19-1309-A-0024894 Communicable Illnesses; New Mexico, US-Mexico Tuberculosis ECHO Program, Partner with University of New Mexico and Mexican National Respiratory Institute (INER); Texas, Communication and Response in the Paso del Norte Region, Influenza Surveillance Expansion; California, Flu Surveillance at five border sites, Statewide Identification of Binational Cases of disease, Expanded use of Queso Fresco Questionnaire. Tom Alexander mentioned that these border state activities define the actions that the U.S. government is willing to take and will continue to take to prevent, detect and respond to infectious disease threats. This approach represents the whole-of-government approach whereby leveraging all resources to combat infectious disease. Dr. Rangel led a brief question-and-answer session after the presentations. Dr. Kline commented that he is flabbergasted by what Mexico has accomplished. In particular, he mentions that a small amount of money can have a great impact with a program such as Leaders across Borders. He believes that if we want to improve border health, we need to improve health leadership in the border. Dr. Filiberto Perez seconds Dr. Kline’s thoughts and congratulates Dr. Rangel for the work being done in Mexico, highlighting the work of the Border Health Binational Network and the publications the network has issued in Health Frontiers. He also congratulated Tom Alexander for the work that has been carried out in his short term. Dr. Alfonso Valenzuela congratulated Dr. Rangel for bringing clear measurements into the results of the Commission. Having a clear direction, with clear objectives is securing the future of the Commission. From the public, Chuck Matthews, one of three local directors for Health and Human Services in San Diego said he was thankful and appreciative of the investments the Commission is doing along the border. Whether it is surveillance or any other area, it is exciting locally and motivates everyone to continue working. Intention to renew Joint Declaration Agreement in 2020 Dr. Rangel began this discussion in representation of Dr. Alcocer and read a memo sent to the Commission on his behalf regarding the intention to renew the joint declaration agreement in 2020. Thanks to the binational joint efforts in the past 19 years the Commission has distinguished itself as a leader which has facilitated the identification of relevant mutual border public health issues. It supports health studies and research along the border and it gathers federal, state and local funds, public and private, effective funds, building alliances and dynamic partnerships to improve health and the lives of the people living through a creative multi-sectorial approach, and as such, it becomes necessary to have a strategic plan. In April 2014, both sections of the Commission met to develop a joint strategic plan. As a result of this meeting, a strategic map was defined which has four major priority areas: 1) impact on common public health issues, 2) maximize communication, coordination, collaboration and commitment, 3) manage public and private resources, and 4) strengthen the infrastructure of the commission to obtain results. Dr. Jorge Alcocer, Commissioner of the Mexico Section of the Commission, met in Tijuana on June 9 with all the border state health officers. He reiterated his commitment to the work of the Commission, and he instructed me to continue with the activities of greatest impact and priority for the U.S.-MEXICO region. He asked me to please ratify on his behalf and share with you the intention to continue such an important mission and to renew the joint declaration in the 20th anniversary of the Commission, which manifests the interest of the Mexican government for the USMBHC to continue to act as a leader in the TX-DSHS-19-1309-A-0024905 identification and assessment of border health issues impacting its population as well as to facilitate the actions for care of this population through the exchange of resources and the joining of talents between the two countries. He thanks everyone who works for the Commission because through your work, you have made a difference throughout these 19 years, you have made possible constant and determined actions, gathering all the resources, both public and private to meet all established goals and join the binational effort for the benefit of the border population. Dr. Rangel said that these were the words of Dr. Jorge Alcocer where he instructed her to share with the Commission the intention to continue and renew the joint declaration in the 20th anniversary of the Commission. Garrett Grigsby stated that the 20th anniversary is fast approaching and the declaration and memorandum of understanding (MOU) between the two countries that brought the Commission into existence on July 14, 2000, have withstood the test of time. The review and ratification process within HHS of these documents has already begun. Given that the MOU has the legal status of a treaty, the documents must be reviewed by the Department of State on top of all other internal reviews at HHS. The attorneys have indicated the review process will go through several offices and will take several months. It is assumed that Mexico will begin a similar review and ratification process as Dr. Rangel has stated today. HHS legal offices have indicated that the documents will be ready for the signing of the declaration and the ceremonial signing would take place approximately one year from now at our binational meeting during the celebrations of the 20th anniversary. As a symbol of our commitment to the declaration it is now my privilege to read a statement by our statutory Commissioner of the US Section, HHS Secretary, Alex Azar. As statutory commissioner of the US Section of the USMBHC, I welcome you to the first Commission meeting since 2016 and the first of the Trump administration. Since the Commission was established through a Memorandum of Understanding on July 14, 2000, bilateral health collaboration between the US and MEXICO and our 10 border states has been a key component of our relationship as we address the unique public health challenges of the U.S.-MEXICO border region. The US is committed to continuing our mutual work in the border area. As the esteemed health professionals in this room know, viruses and bacteria do not stop at borders and only through bilateral cooperation can we successfully combat common public health threats. To this end I thank members of the U.S. Section for your support of the recent alignment of the Commission activities with the administration’s infectious disease priorities. Through the CDC’s global health security and antimicrobial resistance projects in the US border region we have been able to make tangible difference in global health security. I know that both the US and MEXICO have both approved national antimicrobial resistance plans. These plans are critical foundations for ongoing work to prevent and control anti-microbial resistance. Moreover, I thank Mexico for supporting the AMR resolution at the World Health Assembly last month that urges member states to strengthen infection, prevention and control measures. Our nations have also worked together on binational infectious disease surveillance, BIDS projects. As you know the critical work of BIDS is the integration of binational reporting criteria and to border-wide investigations, the implementation of operational protocol for the U.S.-Mexico Commission and coordination guidelines and the enhancement of disease surveillance. TX-DSHS-19-1309-A-0024916 Binational collaboration is critical for global health security. As president Trump reaffirmed on May 9th, 2019 in releasing the administration’s global health security strategy. Global Health Security remains a top priority for the US because infectious disease epidemics pose not only a local health risk but also an international health security threat. Last year we marked the 100th anniversary of the 1918 influenza pandemic which killed more than 50 million people. The following year, 1919 saw the beginning of another significant outbreak of typhus in Europe, which lead health ministers to gather in London to plan the health component of the League of Nations even before the league had its first official meeting in Geneva. While we have made much progress since then, this is also the 10-year anniversary of the 2009 H1N1 flu pandemic which killed an estimated 284,000 people globally in the first year. Mexico was at the center of that epidemic and did an outstanding job responding to the outbreak in a timely and effective manner. Mexico’s response serves as an example for all in global health. The US and MEXICO worked together closely then and will continue to work in partnership for years to come. We are reminded about the ongoing nature of this threat by the current Ebola outbreak in the Democratic Republic of the Congo which has killed more than 2,000 Congolese and shows no sign of slowing, or the reemergence of vaccine preventable diseases in South America where because of migrants and refugees fleeing the chaos in Venezuela and the collapse of that country’s health care system, measles has reemerged with a vengeance. Because of migration from Central America we must also be prepared to face the threats of dengue, measles, influenza and antimicrobial resistance. The situations in the DRC and Venezuela are tragic reminders of why global health security is a top priority. This is not a theoretical exercise; the threat is real and ongoing and demands constant vigilance. Therefore, I encourage the Commission to continue to convene state, local and national health leaders to discuss health security as a binational priority. It is essential that we continue to coordinate with partner governments, NGOs and the private sector to promote health security capacity. By increasing international support, we will also be able to enhance preparedness and response mechanisms to combat infectious diseases at home and abroad. In doing so, the Commission will continue to remain true to its statutory mandate and to the terms of the MOU which binds our two countries together. It will remain faithful to the vision of Dr. Lawrence Nicky and our Mexican section and colleagues who advocated that the role of the Commission is to be a convener intended to synthesize the work of agencies operating in the border region in order to produce measurable health results. Next year will mark the 20th anniversary of the USMBHC. I look forward to reaffirming the importance of the Commission at the signing of the 2020 joint declaration next summer. I commend you, the members, for your admirable leadership and commitment to do all within your power to address and mitigate the infectious disease health threats faced by our nations and by the 18 million inhabitants of the US- MEXICO border region. Dr. Rangel closed the meeting by thanking all members, delegates and special guests and said: “For those of us who reside in the border this is more than just about resources, there is a commitment in TX-DSHS-19-1309-A-0024927 each one of us to continue working binationally. I want to reaffirm my commitment to working not only with the Mexican Section but with all 10 states.” DAY TWO Dr. Rangel began day two by explaining the relevance of the morning’s presentations. Many of the initiatives were not born within the Commission but came through our partners. The Commission has participated in them and taken them to a different level. Local initiatives may be replicable along the border region. Our role as a Commission is to support and promote those initiatives that may benefit our border populations. Therefore, all the initiatives presented by the Mexico Section today are partner initiated. Some by one of our states, another one by NIH, another one by the Department of State of the Mexican government; but in all cases, without the support and promotion of the Mexican Section, they would not have the level that they have now. The initiatives presented were:     Binational Campaign Ama tu Corazón, by Barbara Jimenez, Director of Regional Operations, Department of Health in San Diego and Dr. Melisa Machado, Coordinator, Border Health Office in Baja California. Meta Salud, Diabetes, by Dr. Filiberto Pérez Duarte and Dr. Cecilia Rosales, academician, University of Arizona, ex-member of the USMBHC Ventanillas de Salud, by Dr. Cecilia Rosales Tam Te Cuida, by Dr. Gloria Molina, Secretary of Health of the State of Tamaulipas (presented the day before) Tom Alexander praised the work of the Ventanillas de Salud project. Several other members, delegates and coordinators commented on the success of VDS. Dr. Rangel introduced the COBINAS or Binational Health Councils, a binational initiative that again, was not born in the Commission, but has always been supported by the Commission. Dr. Gloria Molina, Dr. Jesus M. Flores and RJ Dutton shared their state experience with COBINAS. Garrett Grigsby introduced the U.S. best practices:     Overview of California’s Best Practices, by April Fernandez, Chief, Binational Border Health Office New Mexico’s Operation Cascarones, by Travis Leyva, Director, New Mexico’s Border Health Office Overview of Texas Border/Binational Initiatives, by RJ Dutton, Director, Texas Border Health Office Arizona’s Best Practices with Sonora, by Robert Guerrero, Chief, Arizona Border Health Office. Tom Alexander introduced the discussion on future binational collaboration: Healthy Border 2020 - Dr. Eduardo González-Fagoaga and Robert Guerrero provided a brief presentation and led the discussion. ₋ ₋ ₋ ₋ Alfonso Valenzuela (Baja California) believes it is very important to have a unified data system and supports the Commission to continuing to develop such a system. Dr. Karen Smith (California) says the four states do not have a unified data system and believes Mexico’s system is far superior to the US at this time. Following the discussion among all attendees regarding next steps for Healthy Border 2020, both Dr. Rangel and Tom Alexander, along with a few members proposed to close out HB2020 through the creation of a timeline and next steps to complete the study and continue with a HB2030 project. Nestor Hernandez, (Secretary of Health, Baja California) talked about the need to include environmental health in the Baja California and California region as a priority in 2030. TX-DSHS-19-1309-A-0024938 ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ Dr. Dora Elia Cortez believes there is a definite need to have a unified data system and that it is very important that the Commission find alternative ways to work on an observatory following the vision of the Commission. Robert Guerrero (Arizona) said that before talking about data as it pertains to Healthy Border, there is a basic question that needs to be answered and that is “Does the Binational Commission want to develop HB2030?” If neither federal government supports it, “then we are just having a nice academic discussion,” he added. Dr. Filiberto Perez also supports environmental health to be included as a priority for 2030. Dr. de la Rosa expressed his support for carrying out HB2030. Dr. Kline supports the idea stating that many institutions use HB2020 as a research document – not having anything is not an option – the question is whether the Commission will have federal support. Dr. Rangel stated that she and Tom Alexander both believe that there is a commitment to conclude HB2020. She said, “We need to create a timeline and commit to the completion of HB2020 and would agree to continue with HB2030.” Dr. Rangel requested a show of hands to close 2020 and to continue with a new HB2030 project. R. Guerrero explained that environmental health is included in the HB2020 document. T. Alexander stated he fully seconds what Dr. Rangel has stated, and that the federal government supports the completion of HB2020 and the start of a HB2030 project. Dr. de la Rosa said there must be a disclosure which indicates the HB2030 document is an exercise in measurement, in tracking and nothing else to intervene or change health outcomes. Dr. K Smith said she will participate sharing data but cannot commit any resources as her Border Health Office is currently only state funded. T. Alexander said he has reached out to the Office of the Assistant Secretary (OASH) for help. They are responsible for publishing Healthy People 2030 – and on a preliminary basis have offered to work with the Commission to share the data they have. Although not definitive, they have offered to produce a companion document, subject to agreement by the Commission. Dr. Rangel states the Mexican federal government fully supports the completion of HB2020 and T. Alexander and herself would work on next steps for HB2030. This action is included in the Mexico Section work plan for 2019. When asked to vote, the majority vote yes to completion of HB2020 and yes to move on to HB2030 with T. Alexander and Dr. Rangel working on next steps and keeping the members informed of the steps. Infectious diseases ₋ ₋ ₋ ₋ ₋ ₋ The Commission had a lengthy discussion on infectious diseases: TB and DRTB, HIV, vector borne and to include STDs to the list of infectious diseases. Dr. Rangel mentioned the multitude of infectious diseases that have been part of various project of the Commission such as TB, HIV, vector borne, etc. R. Guerrero requests to include STDs to the list of infectious diseases and to include Drug resistant TB (DRTB). T. Alexander mentions the Ovitrap project that was very successful to which R. Guerrero cautions that the Commission is not an operations organization but rather a policymaking entity. We are not to issue services of any kind because it is confusing for the existing group. Dr. Kline also reminds people of the danger to get into operations. We can advocate and we can encourage other agencies to do it but when we start doing it, it becomes confusing. Dr. Hellerstedt says not to let the perfect be the enemy of the good. In the Ovitrap project, it was a perfect opportunity for Texas to learn from Mexico – the value of that particular project focused on an immediate threat. If both sides have the funds and the opportunity, he would totally support the project. TX-DSHS-19-1309-A-0024949 ₋ ₋ ₋ ₋ ₋ Dr. Kline sees Dr. Hellerstedt’s view and would support unique situations such as the Ovitrap. T. Alexander explains the specific situation was unique in nature. Dr. Maria de la Luz Vazquez stated that for Tamaulipas, specific situation where the binational Commission was able to support was excellent but sees the Commission bringing together many groups, not to engage in operations but rather bringing strategic support, getting together those who can help. Dr. Rangel states that she also believes we should not go into operations especially because the Commission could never match or even come close to having the resources of any of the states; however, there are a lot of activities in regards to infectious diseases in terms of convening where the Commission can do a great job. Dr. K. Smith seconds what Dr. Rangel says but also adds that she would have several areas in California where she could have the Commission participate in operational areas. Dr. Kline and Dr. San Filippo presented Dr. Rangel with a certificate of recognition for what she has done over the years, “doing small deeds with great love,” presenting her with a symbol of appreciation from the U.S. Section. ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ ₋ Dr. Molina asks to include measles, which also comes through the COBINAS, plus sharing systems and communication channels for the promotion of vaccinations along the border. Dr. Dora Elia Cortez proposed to have projects such as EWIDS or BIDS using the COBINAS, Consortium, the Commission and all local infrastructure in an epidemiological surveillance system stating this is a critical issue. She puts it on the table for consideration. Dr. K. Smith says even though the California systems are very robust, currently there is a lot of data that is not being captured. There’s a huge influx of people coming into our areas yet we’re not capturing all that data, on either side. She mentions chicken pox as an example. Dr. A. Valenzuela states that there’s already been some support in the past from EWIDS or BIDS in terms of laboratories and technical support – he believes something like this would also be very beneficial. For example, there is data being generated on the migrants coming through but it is not unified. R. Guerrero reminds everyone that the Commission used to be involved in immunization programs, including chicken pox. Dr. Smith states that CA does have some immunization programs but with migrants the health needs are much more urgent and difficult, sometimes as basic as providing water. Dr. Hellerstedt says that he would like the Commission to back immunization preventable diseases. He says that a lot of data that is captured of migrants is not reaching the state level. There is a huge population that is being released into the civil society and it is the perfect storm that could hit. The concept of health security includes treating these people with dignity and doing health screening that would benefit both migrants and the communities that are receiving them. Dr. Hellerstedt would like the federal government and other authorities to understand the Global Health Security Agenda and to implement appropriate screenings for humanitarian health support and also for the safety of the communities. Also, to include training for these individuals who are doing the screenings. Dr. Karen Smith says to also have data from all the screenings happening at the border. Kathy Moser (CDC) suggests that we may ask the Department of Homeland Security to see who is doing the screenings. The reason that we are getting different answers is because the situation has been evolving. She states surveillance is one thing and that is what BIDS is doing and knowing what is binational and not binational; but what is needed is rapid reporting. USM-U Notify is a rapid-reporting system. Currently what is not operational is the definitions that exist even with a rapid-reporting system. 10 TX-DSHS-19-1309-A-002495 ₋ Barbara Jimenez (Department of Health, San Diego) states that she has data she can share with the Commission on California’s shelters. Migrant Health Martha Romero, delegate for the Secretary of the Health State Officer in Coahuila and Dr. Nestor Hernandez, director of services in Baja California, provided a thorough and informative presentation addressing migrant health in Coahuila and in Baja California and their states’ response. Mental Health Given the time constraints, Mexico offered to defer the topic of mental health to be discussed at a later time. Regarding Committee Structures A proposal by Dr. Bruce San Filippo and Dr. de la Rosa to change the status of the Research Committee from ad hoc or work group into a permanent standing committee was presented and discussed. The rationale behind this proposal is that an ad hoc committee may be dissolved at any time and a research committee requires permanency to move forward with the type of work it generates. Dr. Dora Elia Cortes seconds the proposal in the belief that research is an area that provides the Commission guidance as to the areas it must support. This is part of the original statutory mandate of the Commission. ₋ Dr. Kline states that we need to use the committees, if they are used, he would support it. He states that it is ok from his perspective as long as it is used and usable. ₋ Dr. Rangel says that she has no vote but only speaking on behalf of the Mexico section, states that she must be critical of the work they all do in the Commission. She sees that the research committee works only to meet, and then after that nothing happens. When Cristina Rabadán- Diehl was here there was a very good session in San Diego, researchers were selected, there was a meeting in Monterrey, with a facilitator to develop a strategic plan, which all happened in 2015, and after that nothing happened. She expressed her embarrassment with this special group that was formed as there was never any communication with them again. She said that as leader of this group, she felt embarrassed and she was putting this situation on the table for consideration. If you think that with this proposal, at the end of the day, the situation may change and become effective, then ok, but we have to be very clear about what we want to do with this expert panel group. Here in Mexico we have been working La Red Nacional and we have been very fortunate because it’s been funded and it’s working successfully. She shared this to try to help expedite a decision to move forward or not. She suggests that an apology letter be sent to the expert panel group and then move forward. ₋ Dr. Alfonso Valdez seconds Dr. Rangel’s comments. ₋ Dr. Kline states he sees that we need new energy in this committee and so that it has a feeling of permanency would support changing it to a permanent committee. ₋ Dr. de la Rosa believes the committee would change to become less of an afterthought, if it changes from ad hoc to permanent. He believes what has happened with the research committee reflects what is happening in the Commission as a whole. ₋ Dr. Hellerstedt states that he believes it is important to have a research committee but would be disappointed if nothing happened. He would want to see a plan specifying what it would do, a work plan with goals, budget needs, etc. ₋ Dr. Filiberto Perez states that he would vote to include it as possible projects at least. o Dr. Dora Elia Cortez believes the research committee would need analysis and clarification of its roles and responsibilities so that it is part of the committees, not to 11 TX-DSHS-19-1309-A-002496 o o o o o work on right now but to discuss frequently in the near future. She clarifies that the Mexico Section had to move to alternative actions to continue with the research work. Dr. de la Rosa changed his proposal for further study and discussion on the viability of a research committee within the Commission and that this study be presented in the 20th anniversary annual meeting. Dr. Hellerstedt supports studying the situation and presenting a plan, how it is supported, what activities, and to show that it can operate under the Commission. Dr. Smith says she’s been witness to two years of nothing happening with the research committee. She does not believe turning this ad hoc work group into a permanent committee would change anything, but she’d like to see the work plan, activities and budget if possible. Dr. Filiberto Perez says he’d like to see a deep reflection on this matter and include it in the list of projects to see what we can do about it. Dr. Dora Elia Cortez wants to make sure we ask ourselves if a research committee is necessary, and to see what the benefits are of having one. Should it be an evaluation organism of the Commission itself? We must reflect on this, study it and present a serious proposal. The 2019 Annual Meeting was adjourned after reading the two proposed action Items: The following were proposed and agreed on by consensus or majority of the members of both sections of the U.S.-Mexico Border Health Commission: Regarding Healthy Border 2020 (HB2030) Following the discussion regarding next steps for Healthy Border 2020, several members proposed to close out HB2020 through the creation of a timeline and next steps to complete the study and begin the HB2030 project. The members in both sections of the Commission voted and agreed to close out HB2020 and then begin with a HB2030 project. Regarding Committee Structure Dr. J. Manuel de la Rosa proposed the creation of a study regarding the viability of a permanent standing research committee within the Commission and that this study be presented in the Commission’s 20th Anniversary annual meeting in 2020. The members in both sections of the Commission voted and agreed to the study on the viability of a permanent research committee. In addition, the Intention to renew the Joint Declaration Agreement in 2020 was approved by both federal governments as read by Dr. Gudelia Rangel and Garrett Grigsby on statements on behalf of their respective Secretaries of Health. 12 TX-DSHS-19-1309-A-002497 From: Reyes, Monica (OS/OGA) Sent: Thursday, September 05, 2019 4:44 PM EDT To: Alexander, Thomas (OS/OGA) ; Hellerstedt,John W (DSHS) ; De La Rosa, Jose (OS/OGA) ; Benavides, Luis (OS/OGA) ; Dutton,RJ (DSHS) ; Kunkel, Kathy, DOH ; San Filippo, Bruce (OS/OGA) ; Forster-Cox, Susan (HHS/OS/OGA) ; Leyva, Travis, DOH ; cara.christ@azdhs.gov ; Torres, Emma (OS/OGA) ; Robert Guerrero ; Kline, Lawrence (OS/OGA) ; Rodiles, Horacio (OS/OGA) ; Fernandez, April@CDPH CC: Darrow, Juliana (HHS/OS/OGA) ; Baker, Nicole (OS/OGA) ; Albertorio, Juan R. (CDC/DDPHSS/NCHS/OD) ; Notzon, Sam (CDC/DDPHSS/NCHS/OD) ; Fowler, Erin (HRSA) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) Subject: RE: US Section Call - 09.06.19 - 8:00 AM PDT 9:00 AM MDT 10:00 AM CDT 11:00 AM EDT Attachment(s): "BHC BIDS overview 9.6.19.pptx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon all, Please find attached Kathy’s PowerPoint for her presentation on tomorrow’s call. Wishing you the best, Monica Monica Reyes, PhD, MPH Global Health Officer U.S. Section, U.S.-Mexico Border Health Commission Office of the Secretary, Office of Global Affairs U.S. Department of Health and Human Services P: (915) 532-1006 Ext. 121 W: www.HHS.gov/borderhealth _____________________________________________ From: Reyes, Monica (OS/OGA) Sent: Friday, August 30, 2019 12:13 PM To: Alexander, Thomas (OS/OGA) ; john.hellerstedt@dshs.texas.gov; De La Rosa, Jose (OS/OGA) ; Benavides, Luis (OS/OGA) ; Dutton,RJ (DSHS) ; Kunkel, Kathy, DOH ; San Filippo, Bruce (OS/OGA) ; Forster-Cox, Susan (HHS/OS/OGA) ; Leyva, Travis, DOH ; cara.christ@azdhs.gov; Torres, Emma (OS/OGA) ; Robert Guerrero ; Kline, Lawrence (OS/OGA) ; Rodiles, Horacio (OS/OGA) ; Fernandez, April@CDPH Cc: Darrow, Juliana (HHS/OS/OGA) ; Baker, Nicole (OS/OGA) ; Albertorio, Juan R. (CDC/DDPHSS/NCHS/OD) ; Notzon, Sam (CDC/DDPHSS/NCHS/OD) ; Fowler, Erin (HRSA) ; Moser, Kathleen (CDC/DDID/NCEZID/DGMQ) ; Rodriguez Lainz, Alfonso (CDC/DDID/NCEZID/DGMQ) Subject: US Section Call - 09.06.19 - 8:00 AM PDT 9:00 AM MDT 10:00 AM CDT 11:00 AM EDT Good afternoon all, hope this note finds you well. In preparation for our September call next week, please find four embedded attachments in the body of the email that will be utilized during our call. If you have any questions or suggestions, let us know. • • • • US Section TC Agenda – 09.06.19 Official FINAL 2019 Annual Meeting Minutes and Action Items - please note three action items/agreements on final page (p.12) Unofficial Transcript 2019 Annual Meeting Minutes and Action Items US Section TC Minutes – 08.02.19 << File: Offical_MINUTES AND ACTION ITEMS_2019 Annual Meeting_XD.pdf >> << File: Transcript_MINUTES AND ACTION ITEMS_2019 Annual Meeting_FINALFINAL_XD.pdf >> << File: M_USS TC_080219 Final.pdf >> << File: A_USS TC_090619.pdf >> Have a safe and joyful Labor Day weekend, TX-DSHS-19-1309-A-002498 Monica Conference Line: 1-877-932-3364 Participant Code: 3490650 Monica Reyes, PhD, MPH Global Health Officer U.S. Section, U.S.-Mexico Border Health Commission Office of the Secretary, Office of Global Affairs U.S. Department of Health and Human Services P: (915) 532-1006 Ext. 121 W: www.HHS.gov/borderhealth TX-DSHS-19-1309-A-002499 Binational Border Infectious Disease Surveillance (BIDS) BIDS Programmatic Goals § Improve surveillance and control of infectious diseases of border/binational importance § Disease prioritization: (TB, Aedes-borne viral illness, Tick-borne rickettsial illness, enterics (listeria, brucellosis, salmonella, vibriosis) § Anti-microbial resistance § Improve border/binational response to infectious diseases of border/binational importance § Use/revise existing protocols: United States- Mexico Guidance § Use tabletops to identify gaps and strengthen response pathways TX-DSHS-19-1309-A-002501 2 greemen , i----:; -;a.: 0: -,_: ~ ----------------------====== =t Strategy 1a. Sustain/enhance infonnation system through integration of binational variable (BV) • Assess current use of BV • Train staff (local/state) on how to use. • Integrate BV into state surveillance systems and into NNDSS (federal). • Notify as per Ops Protocol. • Participate in CDC-facilitated evaluation. Strategy 1b. Enhance investigation and outbreak response. • Conduct enhanced human surveillance for 2018 prioritized diseases or refine sharing protocols. binatior.al i11fo1111alion • Test and refine binational communication (tabletops, etc). Strategy 1c. Improve surveillance and reporting • Enhance data collection or explore cross-border access to care survey/mobility • Share best practices with colleagues • Assist partners in outbreak response/epi training TX-DSHS-19-1309-A-002502 3 BIDS Sites ----, Cal~fornia • lnf rease/evaluate use of BV • ILl/~ ARI Surveillance • Binational TB Contact Surveiil'aq__ ce • f=xercise_oi~ational com~ unica~0n protocol • Healtll t are ~ ssociated lnfectio ns( HAI) and vectorborne illness awareness New Mexico • Increase/evaluate use of BV • ILi SUNeillance • TB ECHO Arizona • Refine/ valuate use of BV Identify border/binational enteric cluster (WGS) • Tableto for vaccineprevent ble disease outbreak = .J.U.Cl wu additional MEDSIS sites Texa~ Tableau dashboard • Increase/evaluate use of BV • Enteric suNeillance Regio 9 • ILi SUNeillance • Develop communication Ii tocols for Regions 8/11 • Enhance arboviral surveill9 RG in Regions 8/11 I • TX-DSHS-19-1309-A-002504 5 $1,40 ,ooo. ce1DS Funding by Year $400,000.00 $200,000.00 $0.00 2013 2014 2015 2016 TX-DSHS-19-1309-A-002505 6 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Monday, September 09, 2019 4:29 PM EDT CC: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L. (CDC/DDID/NCEZID/DPEI) ; Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) Subject: ELC CK14-401 Closeout Report Now in REDCap WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, All jurisdictions have been given access to the ELC CK14-401 Closeout Reports project in REDCap. If you had access to the ELC Application Portal 2019-2020, you also have access to the ELC CK14-401 Closeout Reports Project. This project has three pages: · BP5 Report Templates [where you download your report templates] · BP5 Completed Templates [where you upload all complete report templates] · ELC CK14-401 Closeout Report [where you enter the high-level summary report information for all five years of the cooperative agreement. This information will be entered directly into REDCap, and is NOT contained in a downloadable template] All Closeout Reports are due on Wednesday, October 30, 2019. Please remember after you have completed each page, please select “complete and save”. Please note: 1. Final FFRs are also due October 30th, and will be submitted directly to GrantSolutions. Please send any questions to your Grants Management Specialist in OGS. 2. The ELC Kick-off Webinar slides (and more detailed guidance on the closeout report) are located in the File Repository in the ELC CK14-401 Closeout Reports project. 3. Ebola project information is only collected for the entire period of performance on the third page, on the ELC CK14-401 Closeout Report (includes: Ebola-Associated Supplement Healthcare Infection Control Assessment and Response, Ebola Laboratory Biosafety, and Ebola-Associated Supplement for Global Migration, Border Interventions and Migrant Health). 4. Recipients are only required to complete reports for funded projects. Please disregard any BP5 templates for unfunded projects. 5. If you are missing any BP5 templates, please let us know ELC@cdc.gov. ELC is completing a final reconciliation on BP5 templates, and will upload any missing templates in the next few days. Thanks, ElC Team TX-DSHS-19-1309-A-002507 From: Centers for Disease Control and Prevention Sent: Tuesday, September 10, 2019 4:37 PM EDT To: Garcia,Imelda M (DSHS) Subject: Global HIV and TB News Fighting HIV and TB: CDC's Successes in One Country Serves as a Catalyst for Others WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Fighting HIV and TB: CDC’s Successes in One Country Serves as a Catalyst for Others Tuberculosis (TB) is the leading cause of death for adults and children living with HIV. However, there is life-saving treatment that can prevent people living with HIV from dying of TB: TB Preventive Treatment ( or TPT). Building on the President’s Emergency Plan for AIDS Relief’s (PEPFAR) platforms around the world, CDC is aggressively scaling up TPT for the millions who need it. One country – Kenya – has made extraordinary progress in just two years, increasing by 60-fold the number of people living with HIV receiving TPT. They now work hand-inhand with neighboring countries to share solutions to make TPT available immediately to those who need it most. Read the full story here >> Video: Kenya’s Dr. Katana on Controlling HIV and TB CDC Study on Reducing HIV Misdiagnoses New CDC Exhibit To Be Unveiled at Atlanta Airport “HIV and Tuberculosis (TB) are the two most deadly infectious diseases worldwide. These two epidemics are interconnected as TB is the leading cause of death for people living with HIV, says Dr. Abraham Katana, HIV Care and Treatment Chief for CDC-Kenya.” In this episode of "Experts in Action”, Dr. Katana explains how CDC is addressing these syndemics in Kenya. In more than 45 countries and regions around the world, CDC experts, like Dr. Katana, are working on the frontlines to help accelerate countries’ efforts to control HIV and eliminate TB. With our partners, they are changing the trajectory of these global epidemics and keeping people safe at home and abroad. Read more >> The World Health Organization urges immediate initiation of HIV treatment for all persons who receive a HIV-positive diagnosis. Globally, studies report that HIV misdiagnoses rates range from less than 1 percent to more than 10 percent, with significant social and financial costs for such misdiagnoses. A recent CDC study published in the PLOS One journal suggests that a second test to verify the initial diagnosis can eliminate or reduce HIV misdiagnoses and prevent unnecessary initiation of treatment. The modelling study estimates about 240,000 positive misdiagnoses may occur in Africa over 10 years, in the absence of retesting. Read more >> In September 2018, CDC and world-renowned photographer, Thom Pierce, traveled to the epicenter of the global HIV epidemic in South Africa to capture the faces and stories of those at the forefront of CDC’s global response against HIV and TB. From September 16 – October 16, an exhibit of these images, “Faces from the Frontlines” will be on display in Atlanta’s Hartsfield-Jackson Airport’s International Terminal, Concourse F. The exhibit highlights individuals whose innovations and efforts are helping to transform these epidemics – and offers a snapshot into the work CDC and PEPFAR are leading around the world. These are their voices. See More >> News You Can Use: Global HIV & TB Resources for You! CDC offers a range of compelling and easily-downloadable resources you can use on your own platforms to highlight the urgency and impact of fighting HIV and TB around the world. This quarter, we are excited to share with you a suite of photo-centric HIV and TB social media data cards celebrating those at the forefront of the global response against these epidemics and highlighting our shared impact. We also have available, this quarter, our 2019 country profiles. The profiles provide an overview of the HIV and TB epidemics of more than 45 countries and regions CDC serves and outlines the impact of global efforts in each country. Feel free to share broadly with your networks! TX-DSHS-19-1309-A-002508 From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 11, 2019 5:14 PM EDT To: Zion, Karen (CDC/OCOO/OFR/OGS) CC: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Golden,Sharon (DSHS) ; Garcia,Imelda M (DSHS) Subject: My Grants List in GrantSolutions Attachment(s): "The Grant for Texas Department of State Health Services (6 NU50CK000501-01-01) has been awarded..msg" Hi Karen, Could you please allow me to the new 6 NU50CK000501-01-01 project in GrantSolutions? I am not able to access the portal for the new awards/award actions that have been added. Please let me know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov TX-DSHS-19-1309-A-002509 From: (Grantsolutions) Sent: Wednesday, September 11, 2019 7:12 AM EDT To: Aldridge,Tiffany (DSHS) Subject: The Grant for Texas Department of State Health Services (6 NU50CK000501-01-01) has been awarded. WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. The Grant/Cooperative Agreement for Grant# 6 NU50CK000501-01-01 has been awarded and released. Organization: Texas Department of State Health Services Grant#: 6 NU50CK000501-01-01 Application#: NU50CK2019002533 Application Type: Post Award Amendment Amendment Type: Supplement Program Office: National Center for Emerging and Zoonotic Infectious Diseases [CK] (NCEZID) Grant Program: CDC-RFA-CK19-1904.NU50 2019 Epidemiology and Laboratory Capacity (ELC) for Preve Project Title: CK19-1904 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Agency: Centers for Disease Control and Prevention To view the award in GrantSolutions, please click the grant number below or use the following URL (https://www.grantsolutions.gov/gs/ws/process/award/6+NU50CK00050101-01). If you do not have a Grantee account, please complete the Grantee Account Registration form and submit it to the HelpDesk. After verification with the Grants Service Office associated with this award, the HelpDesk will inform you of your new account information. Please follow the instructions provided in the form. Grantee Account Registration Form -------This message has been sent by GrantSolutions (https://www.grantsolutions.gov) TX-DSHS-19-1309-A-002510 From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 11, 2019 5:33 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: TX Supplement Award Attachment(s): "ELC Supplment_NGAprintPdf.do.pdf" Hi De’Lisa, In the attached NoA, Texas was awarded $781,545 in additional funding for Year 1 of the ELC project (issued 09/10/19). The awards were listed as they are below: • A2.Cross-Cutting: Laboratory Capacity:$ 11,022 • C. Health Information Systems Capacity:$ 233,208 • E. Cross-Cutting Emerging Issues:$ 515,706 • Q. Influenza Surveillance and Diagnostic Testing:$ 21,609 We have not been contacted by either of the CDC program staff to explain what the funding should cover. Is this to cover IDC rates for ELC that was short? If so, does it cover all of the IDC or do you have any additional information on what the above amounts should cover? Thanks for your help and the additional assistance you all have provided us. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov TX-DSHS-19-1309-A-002511 1. DATE ISSUED 1a. SUPERSEDES AWARD NOTICE dated 07/10/2019 except that any additions or restrictions previously imposed remain in effect unless specifically rescinded MM/DD/YYYY 09/10/2019 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention I 2. CFDA NO. 93.323 - Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) CDC Office of Financial Resources 3. ASSISTANCE TYPE Cooperative Agreement 4. GRANT NO. 6 NU50CK000501-01-01 Formerly 4a. FAIN 5a. ACTION TYPE Post Award Amendment NU50CK000501 6. PROJECT PERIOD 2939 Brandywine Road Atlanta, GA 30341 5. TYPE OF AWARD Demonstration MM/DD/YYYY From 7. BUDGET PERIOD AUTHORIZATION (Legislation/Regulations) 301(A)AND317(K)(2)PHS42USC241(A)247B(K)2 07/31/2024 MM/DD/YYYY From NOTICE OF AWARD MM/DD/YYYY Through 08/01/2019 MM/DD/YYYY Through 08/01/2019 07/31/2020 8. TITLE OF PROJECT (OR PROGRAM) CK19-1904 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) 9b. GRANTEE PROJECT DIRECTOR 9a. GRANTEE NAME AND ADDRESS State Health Services, Texas Department of Dr. Imelda M. Garcia 1100 W 49th St Texas Department of State Health Services Austin, TX 78756-3101 1100 W. 49th Street Mail Code 1923 Austin, TX 78756 10a. GRANTEE AUTHORIZING OFFICIAL 10b. FEDERAL PROJECT OFFICER Ms. Amanda Hudson De'Lisa Simpson PO BOX 149347 1600 Clifton Rd MC 1935 Atlanta, GA 30333 Department of State Health Services Phone: 404-639-3629 Austin, TX 78714-9347 ALL AMOUNTS ARE SHOWN IN USD 11. APPROVED BUDGET (Excludes Direct Assistance) 12. AWARD COMPUTATION I Financial Assistance from the Federal Awarding Agency Only II Total project costs including grant funds and all other financial participation □ Salaries and Wages ……………….................. 1,757,201.00 b. Fringe Benefits ……………….................. 643,050.00 .…...….…… 2,400,251.00 Total Personnel Costs d. Equipment ……………………………. 175,890.00 e. Supplies ……………………………. 999,621.00 f. Travel ……………………………. 203,155.00 g. Construction ……………………………. 0.00 h. Other ……………………………. 106,158.00 i. Contractual …………………….……… 972,626.00 j. TOTAL DIRECT COSTS k. INDIRECT COSTS l. TOTAL APPROVED BUDGET 5,625,384.00 m. Federal Share 5,625,384.00 n. Non-Federal Share REMARKS c. Less Cumulative Prior Award(s) This Budget Period 767,683.00 0.00 (Other Terms and Conditions Attached - Yes 4,843,839.00 d. AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION 13. Total Federal Funds Awarded to Date for Project Period I I 781,545.00 5,625,384.00 14. RECOMMENDED FUTURE SUPPORT (Subject to the availability of funds and satisfactory progress of the project): YEAR TOTAL DIRECT COSTS YEAR a. 2 d. 5 b. 3 e. 6 c. 4 f. 7 TOTAL DIRECT COSTS 15. PROGRAM INCOME SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING ALTERNATIVES: a. b. c. d. e. 4,857,701.00 ~ 0.00 b. Less Unobligated Balance From Prior Budget Periods a. c. 5,625,384.00 a. Amount of Federal Financial Assistance (from item 11m) I □ DEDUCTION ADDITIONAL COSTS MATCHING OTHER RESEARCH (Add / Deduct Option) OTHER (See REMARKS) b 16. THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY, THE FEDERAL AWARDING AGENCY ON THE ABOVE TITLED PROJECT AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a. b. c. d. The grant program legislation . The grant program regulations. This award notice including terms and conditions, if any, noted below under REMARKS. Federal administrative requirements, cost principles and audit requirements applicable to this grant. In the event there are conflicting or otherwise inconsistent policies applicable to the grant, the above order of precedence shall prevail. Acceptance of the grant terms and conditions is acknowledged by the grantee when funds are drawn or otherwise obtained from the grant payment system. No) GRANTS MANAGEMENT OFFICIAL: Erica Stewart, Grants Management Officer 2939 Flowers Rd TV-2 Atlanta, GA 30341 Phone: 770-488-2769 17.OBJ CLASS 41.51 18a. VENDOR CODE FY-ACCOUNT NO. 1320113643A2 18b. EIN DOCUMENT NO. 320113643 19. DUNS ADMINISTRATIVE CODE 807391511 20. CONG. DIST. AMT ACTION FIN ASST 10 APPROPRIATION 21. a. 9-939ZSCE b. 19NU50CK000501 c. CK d. $21,609.00 e. 75-19-0951 22. a. 9-939ZVJC b. 19NU50CK000501 c. CK d. $2,500.00 e. 75-19-0949 23. a. 9-9390C0K b. 19NU50CK000501 c. CK d. $498,206.00 e. 75-X-0943 TX-DSHS-19-1309-A-002512 PAGE 2 of 3 DATE ISSUED 09/10/2019 NOTICE OF AWARD (Continuation Sheet) GRANT NO. FY-ACCOUNT NO. 24.a. 9-93902YZ 25.a. 9-939ZLBF b. b. DOCUMENT NO. 19NU50CK000501 19NU50CK000501 c. c. ADMINISTRATIVE CODE CK CK d. d. 6 NU50CK000501-01-01 AMT ACTION FIN ASST $244,230.00 $15,000.00 e. e. APPROPRIATION 75-1519-0943 75-19-0951 Direct Assistance BUDGET CATEGORIES PREVIOUS AMOUNT (A) AMOUNT THIS ACTION (B) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Personnel Fringe Benefits Travel Equipment Supplies Contractual Construction Other Total 2 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL (A + B) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TX-DSHS-19-1309-A-002513 PAGE 3 of3 NOTICE OF AWARD (Continuation Sheet) GRANT NO. I DATE ISSUED 09/10/2019 6 NU50CK000501-01-01 Federal Financial Report Cycle Reportiflg Period Start Date Reportiflg Period Efld Date Reportiflg Type Reportiflg Period Due Date 08/01/2019 07/31/2020 Aflflual 10/29/2020 08/01/2020 07/31/2021 Aflflual 10/29/2021 08/01/2021 07/31/2022 AflflUal 10/29/2022 08/01/2022 07/31/2023 Aflflual 10/29/2023 08/01/2023 07/31/2024 Aflflual 10/29/2024 TX-DSHS-19-1309-A-002514 AWARD ATTACHMENTS Texas Department of State Health Services 6 NU50CK000501-01-01 1. Terms and Conditions TX-DSHS-19-1309-A-002515 TERMS AND CONDITIONS OF AWARD Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms and Conditions for Non-research awards at https://www.cdc.gov/grants/federalregulationspolicies/index.html, the Centers for Disease Control and Prevention (CDC) hereby incorporates Notice of Funding Opportunity (NOFO) number CK19-1904, titled Epidemiology and Laboratory Capacity (ELC), which is hereby made a part of this Non-research award, hereinafter referred to as the Notice of Award (NoA). Supplemental Funding: Supplemental funding in the amount of $781,545 is approved for the Year 01 budget period, which is August 1, 2019 through July 31, 2020 for the following activity or activities: • • • • A2.Cross-Cutting: Laboratory Capacity:$ 11,022 C. Health Information Systems Capacity:$ 233,208 E. Cross-Cutting Emerging Issues:$ 515,706 Q. Influenza Surveillance and Diagnostic Testing:$ 21,609 NOFO Funding Non-PPHF Ebola Amount $ 537,315 $ 244,230 PAYMENT INFORMATION The HHS Office of the Inspector General (OIG) maintains a toll-free number (1-800-HHS-TIPS [1-800-447-8477]) for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. Information also may be submitted by e-mail to hhstips@oig.hhs.gov or by mail to Office of the Inspector General, Department of Health and Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington DC 20201. Such reports are treated as sensitive material and submitters may decline to give their names if they choose to remain anonymous. Payment Management System Subaccount: Funds awarded in support of approved activities have been obligated in a subaccount in the PMS, herein identified as the “P Account”. Funds must be used in support of approved activities in the NOFO and the approved application. The grant document number identified on the bottom of Page 1 of the Notice of Award must be known in order to draw down funds. Component: Non-PPHF Document Number: NU50CK000501 Component: Ebola Document Number: NU50CK00050119EBLA Stewardship: The recipient must exercise proper stewardship over Federal funds by ensuring that all costs charged to your cooperative agreement are allowable, allocable, and reasonable and that they address the highest priority needs as they relate to this program. TX-DSHS-19-1309-A-002516 All the other terms and conditions issued with the original award remain in effect throughout the budget period unless otherwise changed, in writing, by the Grants Management Officer. CDC, Office of Grants Services Tonya Jenkins, Grants Management Specialist Centers for Disease Control and Prevention Infectious Disease Services Branch 2939 Flowers Road, MS-TV-2 Atlanta, GA 30341 Telephone: 404-498-2399 Email: pjo6@cdc.gov TX-DSHS-19-1309-A-002517 From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 11, 2019 5:33 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,Imelda M (DSHS) ; Golden,Sharon (DSHS) Subject: TX Supplement Award Attachment(s): "ELC Supplment_NGAprintPdf.do.pdf" Hi De’Lisa, In the attached NoA, Texas was awarded $781,545 in additional funding for Year 1 of the ELC project (issued 09/10/19). The awards were listed as they are below: • A2.Cross-Cutting: Laboratory Capacity:$ 11,022 • C. Health Information Systems Capacity:$ 233,208 • E. Cross-Cutting Emerging Issues:$ 515,706 • Q. Influenza Surveillance and Diagnostic Testing:$ 21,609 We have not been contacted by either of the CDC program staff to explain what the funding should cover. Is this to cover IDC rates for ELC that was short? If so, does it cover all of the IDC or do you have any additional information on what the above amounts should cover? Thanks for your help and the additional assistance you all have provided us. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov TX-DSHS-19-1309-A-002518 1. DATE ISSUED 1a. SUPERSEDES AWARD NOTICE dated 07/10/2019 except that any additions or restrictions previously imposed remain in effect unless specifically rescinded MM/DD/YYYY 09/10/2019 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention I 2. CFDA NO. 93.323 - Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) CDC Office of Financial Resources 3. ASSISTANCE TYPE Cooperative Agreement 4. GRANT NO. 6 NU50CK000501-01-01 Formerly 4a. FAIN 5a. ACTION TYPE Post Award Amendment NU50CK000501 6. PROJECT PERIOD 2939 Brandywine Road Atlanta, GA 30341 5. TYPE OF AWARD Demonstration MM/DD/YYYY From 7. BUDGET PERIOD AUTHORIZATION (Legislation/Regulations) 301(A)AND317(K)(2)PHS42USC241(A)247B(K)2 07/31/2024 MM/DD/YYYY From NOTICE OF AWARD MM/DD/YYYY Through 08/01/2019 MM/DD/YYYY Through 08/01/2019 07/31/2020 8. TITLE OF PROJECT (OR PROGRAM) CK19-1904 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) 9b. GRANTEE PROJECT DIRECTOR 9a. GRANTEE NAME AND ADDRESS State Health Services, Texas Department of Dr. Imelda M. Garcia 1100 W 49th St Texas Department of State Health Services Austin, TX 78756-3101 1100 W. 49th Street Mail Code 1923 Austin, TX 78756 10a. GRANTEE AUTHORIZING OFFICIAL 10b. FEDERAL PROJECT OFFICER Ms. Amanda Hudson De'Lisa Simpson PO BOX 149347 1600 Clifton Rd MC 1935 Atlanta, GA 30333 Department of State Health Services Phone: 404-639-3629 Austin, TX 78714-9347 ALL AMOUNTS ARE SHOWN IN USD 11. APPROVED BUDGET (Excludes Direct Assistance) 12. AWARD COMPUTATION I Financial Assistance from the Federal Awarding Agency Only II Total project costs including grant funds and all other financial participation □ Salaries and Wages ……………….................. 1,757,201.00 b. Fringe Benefits ……………….................. 643,050.00 .…...….…… 2,400,251.00 Total Personnel Costs d. Equipment ……………………………. 175,890.00 e. Supplies ……………………………. 999,621.00 f. Travel ……………………………. 203,155.00 g. Construction ……………………………. 0.00 h. Other ……………………………. 106,158.00 i. Contractual …………………….……… 972,626.00 j. TOTAL DIRECT COSTS k. INDIRECT COSTS l. TOTAL APPROVED BUDGET 5,625,384.00 m. Federal Share 5,625,384.00 n. Non-Federal Share REMARKS c. Less Cumulative Prior Award(s) This Budget Period 767,683.00 0.00 (Other Terms and Conditions Attached - Yes 4,843,839.00 d. AMOUNT OF FINANCIAL ASSISTANCE THIS ACTION 13. Total Federal Funds Awarded to Date for Project Period I I 781,545.00 5,625,384.00 14. RECOMMENDED FUTURE SUPPORT (Subject to the availability of funds and satisfactory progress of the project): YEAR TOTAL DIRECT COSTS YEAR a. 2 d. 5 b. 3 e. 6 c. 4 f. 7 TOTAL DIRECT COSTS 15. PROGRAM INCOME SHALL BE USED IN ACCORD WITH ONE OF THE FOLLOWING ALTERNATIVES: a. b. c. d. e. 4,857,701.00 ~ 0.00 b. Less Unobligated Balance From Prior Budget Periods a. c. 5,625,384.00 a. Amount of Federal Financial Assistance (from item 11m) I □ DEDUCTION ADDITIONAL COSTS MATCHING OTHER RESEARCH (Add / Deduct Option) OTHER (See REMARKS) b 16. THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY, THE FEDERAL AWARDING AGENCY ON THE ABOVE TITLED PROJECT AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a. b. c. d. The grant program legislation . The grant program regulations. This award notice including terms and conditions, if any, noted below under REMARKS. Federal administrative requirements, cost principles and audit requirements applicable to this grant. In the event there are conflicting or otherwise inconsistent policies applicable to the grant, the above order of precedence shall prevail. Acceptance of the grant terms and conditions is acknowledged by the grantee when funds are drawn or otherwise obtained from the grant payment system. No) GRANTS MANAGEMENT OFFICIAL: Erica Stewart, Grants Management Officer 2939 Flowers Rd TV-2 Atlanta, GA 30341 Phone: 770-488-2769 17.OBJ CLASS 41.51 18a. VENDOR CODE FY-ACCOUNT NO. 1320113643A2 18b. EIN DOCUMENT NO. 320113643 19. DUNS ADMINISTRATIVE CODE 807391511 20. CONG. DIST. AMT ACTION FIN ASST 10 APPROPRIATION 21. a. 9-939ZSCE b. 19NU50CK000501 c. CK d. $21,609.00 e. 75-19-0951 22. a. 9-939ZVJC b. 19NU50CK000501 c. CK d. $2,500.00 e. 75-19-0949 23. a. 9-9390C0K b. 19NU50CK000501 c. CK d. $498,206.00 e. 75-X-0943 TX-DSHS-19-1309-A-002519 PAGE 2 of 3 DATE ISSUED 09/10/2019 NOTICE OF AWARD (Continuation Sheet) GRANT NO. FY-ACCOUNT NO. 24.a. 9-93902YZ 25.a. 9-939ZLBF b. b. DOCUMENT NO. 19NU50CK000501 19NU50CK000501 c. c. ADMINISTRATIVE CODE CK CK d. d. 6 NU50CK000501-01-01 AMT ACTION FIN ASST $244,230.00 $15,000.00 e. e. APPROPRIATION 75-1519-0943 75-19-0951 Direct Assistance BUDGET CATEGORIES PREVIOUS AMOUNT (A) AMOUNT THIS ACTION (B) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Personnel Fringe Benefits Travel Equipment Supplies Contractual Construction Other Total 2 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TOTAL (A + B) $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 TX-DSHS-19-1309-A-002520 PAGE 3 of3 NOTICE OF AWARD (Continuation Sheet) GRANT NO. I DATE ISSUED 09/10/2019 6 NU50CK000501-01-01 Federal Financial Report Cycle Reportiflg Period Start Date Reportiflg Period Efld Date Reportiflg Type Reportiflg Period Due Date 08/01/2019 07/31/2020 Aflflual 10/29/2020 08/01/2020 07/31/2021 Aflflual 10/29/2021 08/01/2021 07/31/2022 AflflUal 10/29/2022 08/01/2022 07/31/2023 Aflflual 10/29/2023 08/01/2023 07/31/2024 Aflflual 10/29/2024 TX-DSHS-19-1309-A-002521 AWARD ATTACHMENTS Texas Department of State Health Services 6 NU50CK000501-01-01 1. Terms and Conditions TX-DSHS-19-1309-A-002522 TERMS AND CONDITIONS OF AWARD Incorporation: In addition to the federal laws, regulations, policies, and CDC General Terms and Conditions for Non-research awards at https://www.cdc.gov/grants/federalregulationspolicies/index.html, the Centers for Disease Control and Prevention (CDC) hereby incorporates Notice of Funding Opportunity (NOFO) number CK19-1904, titled Epidemiology and Laboratory Capacity (ELC), which is hereby made a part of this Non-research award, hereinafter referred to as the Notice of Award (NoA). Supplemental Funding: Supplemental funding in the amount of $781,545 is approved for the Year 01 budget period, which is August 1, 2019 through July 31, 2020 for the following activity or activities: • • • • A2.Cross-Cutting: Laboratory Capacity:$ 11,022 C. Health Information Systems Capacity:$ 233,208 E. Cross-Cutting Emerging Issues:$ 515,706 Q. Influenza Surveillance and Diagnostic Testing:$ 21,609 NOFO Funding Non-PPHF Ebola Amount $ 537,315 $ 244,230 PAYMENT INFORMATION The HHS Office of the Inspector General (OIG) maintains a toll-free number (1-800-HHS-TIPS [1-800-447-8477]) for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. Information also may be submitted by e-mail to hhstips@oig.hhs.gov or by mail to Office of the Inspector General, Department of Health and Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington DC 20201. Such reports are treated as sensitive material and submitters may decline to give their names if they choose to remain anonymous. Payment Management System Subaccount: Funds awarded in support of approved activities have been obligated in a subaccount in the PMS, herein identified as the “P Account”. Funds must be used in support of approved activities in the NOFO and the approved application. The grant document number identified on the bottom of Page 1 of the Notice of Award must be known in order to draw down funds. Component: Non-PPHF Document Number: NU50CK000501 Component: Ebola Document Number: NU50CK00050119EBLA Stewardship: The recipient must exercise proper stewardship over Federal funds by ensuring that all costs charged to your cooperative agreement are allowable, allocable, and reasonable and that they address the highest priority needs as they relate to this program. TX-DSHS-19-1309-A-002523 All the other terms and conditions issued with the original award remain in effect throughout the budget period unless otherwise changed, in writing, by the Grants Management Officer. CDC, Office of Grants Services Tonya Jenkins, Grants Management Specialist Centers for Disease Control and Prevention Infectious Disease Services Branch 2939 Flowers Road, MS-TV-2 Atlanta, GA 30341 Telephone: 404-498-2399 Email: pjo6@cdc.gov TX-DSHS-19-1309-A-002524 From: Centers for Disease Control and Prevention Sent: Wednesday, September 18, 2019 12:16 PM EDT To: Garcia,Imelda M (DSHS) Subject: Emerging Infectious Diseases Journal - Volume 25, Issue 10 - October 2019 Issue Now Online WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online TABLE OF CONTENTS Ahead of Print Current Cover Podcasts Synopsis Contact EID Announcements CDC Global Epidemiology of Diphtheria, 2000– 2017 K. Clarke et al. cont. Bidirectional Human-Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018 Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016– 2017 A. Chastagner et al. W. Liu et al. Tick-Borne Encephalitis in AuvergneRhône-Alpes Region, France, 2017–2018 Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018 EID Podcasts Dispatches, J. Weese et al. Medscape CME Activity Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018 A. M. Kjemtrup et al. E. Botelho-Nevers et al. Factoring Prior Treatment into Tuberculosis Prevalence Estimates, United States, 2011–2012 L. A. Vonnahme et al. A. Dernoncourt et al. Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018 Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015 G. N. Hartmeyer et al. M. D. Van Kerkhove et al. Medscape CME Activity Edwardsiella tardaEdwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 S. Kamiyama et al. Research Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013 N. Ouhoummane et al. Medscape CME Activity Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 E. Mosites et al. Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015 A. Chrdle et al. Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China Y. Hu et al. Sensitive and Specific Detection of LowLevel Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections N. Okba et al. Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus R. Harvey et al. Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia M. Wille et al. VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns A. Fonseca et al. Sporotrichosis in the Highlands of Madagascar, 2013–2017 T. Rasamoelina et al. Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines K. O. Murray et al. Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico R. R. Hemme et al. Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018 R. Bai et al. Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit A. Chamieh et al. Research Letters Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission L. Zhou et al. Emergence of Influenza A(H7N4) Virus, Cambodia D. Vijaykrishna et al. Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018 A. van Schalkwyk and M. Romito Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010– 2017 M. Rogers et al. Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS S. M. Michienzi et al. Mycobacterium marseillense Infection in Human Skin, China, 2018 B. Xie et al. Lassa Virus in Pygmy Mice, Benin, West Africa, 2016–2017 A. Yadouleton et al. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran F. Sakhaee et al. Letters TX-DSHS-19-1309-A-002525 Databases for Research and Development K. O. Murray et al. Dispatches Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir V. P. Mishin et al. Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis J. Allgaier et al. Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017 I. Guendel et al. Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018 A. Pohlmann et al. Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018 A. J. Henningsson et al. Databases for Research and Development M. G. Head Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission C. E. Styles et al. Etymologia Etymologia: Edwardsiella tarda R. Henry About the Cover A Study in Stillness and Symmetry B. Breedlove Books and Media Flu Hunter: Unlocking the Secrets of a Virus S. W. Boktor and S. Ostroff Corrections Correction: Vol. 25, No. 3 Correction: Vol. 25, No. 9 Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002526 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Wednesday, September 18, 2019 4:50 PM EDT CC: O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) Subject: Updated Budget Markups and Funding Summaries WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, The ELC has been able to work across the agency to secure additional end of year and/or recovered funds to support previously approved but unfunded priorities included in your application. The specific details are reflected in your budget markups and the funding summary spreadsheet; both may be found on REDCap by the end of the week. These funds should be considered one-time and not sustainable beyond this budget period. Because a number of priorities were identified and addressed with these end of year resources, please be sure to reference the “CDC Program Notes” column in your budget markup for additional context. Some recipients may have received funds on a separate subaccount marked as, “Ebola”; these recovered funds were applied to previously approved but unfunded requests that align to the shared mission of ELC and LRN. If you have any questions now or as you begin to review your amended award, you may reach out to your ELC Project Officer. All the best, The ELC Team TX-DSHS-19-1309-A-002527 From: Centers for Disease Control and Prevention Sent: Wednesday, September 18, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Latest CME Articles - Emerging Infectious Diseases Journal - October 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online LATEST CME ARTICLES Ahead of Print Current Cover Podcasts Medscape CME Activity Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults Contact EID A. Dernoncourt et al. Announcements CDC Medscape CME Activity Edwardsiella tardaEdwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 Medscape CME Activity Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 E. Mosites et al. S. Kamiyama et al. EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002528 From: CDC HAI AR (CDC) Sent: Thursday, September 19, 2019 8:29 AM EDT To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) CC: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) ; Merengwa,Enyinnaya (DSHS) Subject: RE: HAI/AR Meeting Thanks, Tiffany. Please note that we do see funds approved under G1 for this meeting: • • • • Item: “Annual ELC Grantee Meeting” Justification: “To fullfill ELC required deliverable, the attendance and participation in the HAI/AR ELC Grantee's Meeting. Date and Location TBD.” Requested: $2,893 Approved: $2,893 The budget item doesn’t specify, but it seems to be a request for two travelers. If the program has G1 dollars available for redirection due to lower indirect and fringe rates, and can thus afford a third traveler, we’re in support of that. And if there are any other redirections you’d like to propose for G1, please let us know. Michael Ashley Field Support Team Prevention and Response Branch Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 18, 2019 4:52 PM To: CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) ; Merengwa,Enyinnaya (DSHS) Subject: RE: HAI/AR Meeting Hello, I spoke with our Program staff regarding the HAI AR/AS Meeting and we noticed there was no travel requested for this conference in the ELC BP1 application. DSHS has just received new Indirect Cost (IDC) and Fringe rates and both rates have decreased. This has opened up funds which can be used to redirect to other activities unfunded in the G1 project. We are currently working on a redirection to submit to CDC but would like to request to use part of the funding from the IDC and Fringe decrease to cover the travel for the three staff to attend the HAI AR/AS Meeting. Please let me know if you have any further questions for me. Thank you for your consideration. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov -----Original Message----From: CDC HAI AR (CDC) [mailto:HAIAR@cdc.gov] Sent: Wednesday, September 18, 2019 2:26 PM To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) Subject: RE: HAI/AR Meeting Hello, Please see the following response below, from an appropriate subject matter expert. "On the epi side, we would prefer representation for the HAI Coordinator and the AR/AS Expert from each jurisdiction, as that will be TX-DSHS-19-1309-A-002529 the primary audience for our agenda. If a jurisdiction is interested in redirecting funds to travel a third epi participant, we'll need to know specifically where those funds would be coming from. It's still early in the budget period, and we want to make sure that funds are not being pulled from priority areas." Kind Regards, Janine Taylor, MPH Public Health Analyst Field Support Team HHS Regions 3, 5, 7, 9 Northrop Grumman CIMS Subcontractor to Cadence Group Division of Healthcare Quality Promotion National Center for Emerging Zoonotic Infectious Disease Centers for Disease Control and Prevention LDQ0@CDC.gov 404-718-8971 Telework: Monday & Thursday -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 18, 2019 11:03 AM To: CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: RE: HAI/AR Meeting Good Morning, I just wanted to follow-up regarding the question below regarding the number of staff we are able to send to the HAI/AR Meeting (see below). We would like to send 3 staff to the meeting, if possible. One being the HAI Manager and the others are HAI Epi's. Question: Also, if more than currently funded by CDC, could we move funding around to cover additional travel costs for staff to attend the meeting? Please let me know if you have any questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov -----Original Message----From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Monday, September 9, 2019 10:13 AM To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) Subject: RE: HAI/AR Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning, I will let HAI respond to the first question. Only staff funded by the cooperative agreement are allowed to travel. De'Lisa -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Thursday, September 5, 2019 8:38 AM To: CDC HAI AR (CDC) Cc: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Garcia,Imelda M (DSHS) Subject: HAI/AR Meeting Good Morning, Could you tell us the maximum amount of staff allowed to attend the HAI/AR meeting as part of the G1 Project in November? TX-DSHS-19-1309-A-002530 Also, if more than currently funded by CDC, could we move funding around to cover additional travel costs for staff to attend the meeting? Thank You, Tiffany Aldridge Sent from my iPhone *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002531 From: Aldridge,Tiffany (DSHS) Sent: Thursday, September 19, 2019 9:03 AM EDT To: CDC HAI AR (CDC) CC: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) ; Merengwa,Enyinnaya (DSHS) Subject: RE: HAI/AR Meeting Attachment(s): "New Information about the 2020 ELC Annual Meeting.msg" Good Morning, It seems our Program is confusing the ELC Grantee Meeting with a separate meeting specific to HAI/AR (November 2019). This helps a lot to understand. Per a previous email with CDCs guidance (attached), we were only to send staff who are part of the ELC Governance Team to the ELC Grantee Meeting. This will change the guidance we received and we will have to work some things out here for who will be attending and who will not. In this case, I don’t think three staff from this one area will be attending because it will mean we cannot send a Governance Team member. At this time, the team is reviewing the Technical Review for recommendations from CDC on how the money could better support the suggested activities from the review. We will reach out if we have any additional questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: CDC HAI AR (CDC) [mailto:HAIAR@cdc.gov] Sent: Thursday, September 19, 2019 7:29 AM To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) ; Merengwa,Enyinnaya (DSHS) Subject: RE: HAI/AR Meeting Thanks, Tiffany. Please note that we do see funds approved under G1 for this meeting: • • • • Item: “Annual ELC Grantee Meeting” Justification: “To fullfill ELC required deliverable, the attendance and participation in the HAI/AR ELC Grantee's Meeting. Date and Location TBD.” Requested: $2,893 Approved: $2,893 The budget item doesn’t specify, but it seems to be a request for two travelers. If the program has G1 dollars available for redirection due to lower indirect and fringe rates, and can thus afford a third traveler, we’re in support of that. And if there are any other redirections you’d like to propose for G1, please let us know. Michael Ashley Field Support Team Prevention and Response Branch Division of Healthcare Quality Promotion National Center for Emerging and Zoonotic Infectious Diseases Centers for Disease Control and Prevention -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 18, 2019 4:52 PM To: CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) ; Merengwa,Enyinnaya (DSHS) TX-DSHS-19-1309-A-002532 Subject: RE: HAI/AR Meeting Hello, I spoke with our Program staff regarding the HAI AR/AS Meeting and we noticed there was no travel requested for this conference in the ELC BP1 application. DSHS has just received new Indirect Cost (IDC) and Fringe rates and both rates have decreased. This has opened up funds which can be used to redirect to other activities unfunded in the G1 project. We are currently working on a redirection to submit to CDC but would like to request to use part of the funding from the IDC and Fringe decrease to cover the travel for the three staff to attend the HAI AR/AS Meeting. Please let me know if you have any further questions for me. Thank you for your consideration. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov -----Original Message----From: CDC HAI AR (CDC) [mailto:HAIAR@cdc.gov] Sent: Wednesday, September 18, 2019 2:26 PM To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Joseph, Gregory (CDC/DDID/NCEZID/DHQP) (CTR) Subject: RE: HAI/AR Meeting Hello, Please see the following response below, from an appropriate subject matter expert. "On the epi side, we would prefer representation for the HAI Coordinator and the AR/AS Expert from each jurisdiction, as that will be the primary audience for our agenda. If a jurisdiction is interested in redirecting funds to travel a third epi participant, we'll need to know specifically where those funds would be coming from. It's still early in the budget period, and we want to make sure that funds are not being pulled from priority areas." Kind Regards, Janine Taylor, MPH Public Health Analyst Field Support Team HHS Regions 3, 5, 7, 9 Northrop Grumman CIMS Subcontractor to Cadence Group Division of Healthcare Quality Promotion National Center for Emerging Zoonotic Infectious Disease Centers for Disease Control and Prevention LDQ0@CDC.gov 404-718-8971 Telework: Monday & Thursday -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Wednesday, September 18, 2019 11:03 AM To: CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) Subject: RE: HAI/AR Meeting Good Morning, I just wanted to follow-up regarding the question below regarding the number of staff we are able to send to the HAI/AR Meeting (see below). We would like to send 3 staff to the meeting, if possible. One being the HAI Manager and the others are HAI Epi's. Question: Also, if more than currently funded by CDC, could we move funding around to cover additional travel costs for staff to attend the meeting? Please let me know if you have any questions. TX-DSHS-19-1309-A-002533 Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov -----Original Message----From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Monday, September 9, 2019 10:13 AM To: Aldridge,Tiffany (DSHS) ; CDC HAI AR (CDC) Cc: Garcia,Imelda M (DSHS) Subject: RE: HAI/AR Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good morning, I will let HAI respond to the first question. Only staff funded by the cooperative agreement are allowed to travel. De'Lisa -----Original Message----From: Aldridge,Tiffany (DSHS) Sent: Thursday, September 5, 2019 8:38 AM To: CDC HAI AR (CDC) Cc: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Garcia,Imelda M (DSHS) Subject: HAI/AR Meeting Good Morning, Could you tell us the maximum amount of staff allowed to attend the HAI/AR meeting as part of the G1 Project in November? Also, if more than currently funded by CDC, could we move funding around to cover additional travel costs for staff to attend the meeting? Thank You, Tiffany Aldridge Sent from my iPhone *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. *Please note* My email address has changed to reflect @dshs.texas.gov domain. Please be sure to update your contact information with the new address. TX-DSHS-19-1309-A-002534 From: Epidemiology and Laboratory Capacity for Infectious Diseases \(ELC\) \(CDC\) on behalf of Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) (CDC) Sent: Thursday, September 12, 2019 11:42 AM EDT To: Aldridge,Tiffany (DSHS) Subject: New Information about the 2020 ELC Annual Meeting WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Special Edition: 2020 ELC Annual Meeting Information Contents • • • • • • Office of Grant Services Seeks Your Input New Caterer for the 2020 Annual Meeting More ELC Annual Meeting Updates CORRECTION: Governance Team members regarding 2020 meeting attendance NEW! Accepting Abstracts for ELC’s 1st Poster Session Scroll to the end of email for important meeting details Celebrating 25 years of service to U.S. Health Departments in the battle against infectious disease threats. Office of Grant Services (OGS) Seeks Your Input What's Already Planned 1 Plenary session with OGS speakers 5 Budget/Finance-specific breakout sessions. 64 30-minute sessions for each jurisdiction's financial officer to meet 1:1 with an OGS representative What Else Should Be Covered? You have a say in what OGS presents during the Budget/Finance-specific breakout sessions at our 2020 meeting. What information do you or your colleagues want presented? Here is a list of suggested topics. What else? • • • • • • • • Importance of identifying key personnel that need access to GS and the requirements for an account. APR Guidance – completing the SF424A where to report unobligated balance Expanded Authority (EA) – how EA impacts other types of prior approvals i.e. requesting a contract extension, Overview of Fact Sheet Tracking the Funds: FFR Reporting in GS for multiple document numbers (Special funds i.e. Hurricane funds) Prior Approval vs Grant Notes – when to utilize Key Personnel changes vs. notification of filling a vacancy Funding Restrictions – Indirect Costs and the importance of identifying the base amount and calculation PMS – FCTR updates and returning funds, what you see vs what we see Please click the button to send us a list of additionalBudget/Finance-specific ideas, questions, and topics of interest no later than September 27, 2019. Submit Budget/Financial Suggestions Here NEW! Caterer for 2020 Annual Meeting We are so excited to have a new caterer for our 25th Anniversary ELC Meeting next year. Meal options and costs will be available on our web page in October 2019. You'll be pleased with the new food selections and great prices! More details to come. NEW! More ELC Annual Meeting Updates TX-DSHS-19-1309-A-002535 3 3 10 1 5 Full days, March 11-13, 2020 Plenary sessions with ELC leadership Repeating breakout sessions with CDC Program speakers Pacific & Caribbean Islands meeting, 1:30-3:00pm, Day 3 Project Officers meet, by region, with Recipients, 3:00-4:45pm, Day 3 CORRECTION: Limiting Attendance at ELC Meeting to Governance Team members Due to Fire Marshall rules ELC must limit attendance at the 2020 meeting. Thus, each jurisdiction should only send their Governance Team members to the meeting. The good news is that all plenary sessions will be recorded so recipients who cannot attend in-person may still get the information. NEW! Accepting Abstracts for ELC’s 1st Poster Session at 2020 Meeting Submit Poster Abstract Here • • • • • • WHO: ELC Recipients WHAT: We’re looking for posters that showcase an activity, project or evaluation supported by ELC funding. Ideally, posters are an opportunity to share successes, concepts or best practices that other jurisdictions would be interested in and may apply to their own work. ELC encourages creativity and flexibility with your poster design, use of infographics, images, and other visually appealing features. WHERE: 2020 ELC Annual Meeting WHEN: March 11 and 12, 2020 during the afternoon breaks, 3:00-4:00pm. Posters should be in place no later than noon on Day 1 and left in place until the end of Day 2. WHY: This will be an excellent opportunity to feature ELC Recipients’ work, celebrate the 25th anniversary of ELC, and facilitate a casual networking opportunity among colleagues. HOW: Submit an abstract (max word limit 300) by 12/10/2019. You will be contacted no later than 1/10/2020 to let you know if your abstract was accepted along with poster dimensions and requirements. Please note: Up to 10 posters will be accepted. Details about hotels, food service, the 3-day agenda, and a special 25th anniversary event will be on the ELC website on or before September 27, 2019. ~------------------Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002536 From: Centers for Disease Control and Prevention Sent: Thursday, September 19, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Streptococci Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online STREPTOCOCCI ARTICLES Ahead of Print Current Cover Podcasts Medscape CME Activity Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 Contact EID E. Mosites et al. Announcements CDC EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002537 From: Centers for Disease Control and Prevention Sent: Friday, September 20, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Malaria Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online MALARIA ARTICLES Ahead of Print Current Cover Podcasts Contact EID VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018 A. Fonseca et al. G. N. Hartmeyer et al. Announcements CDC EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002538 From: VPD Surv ELC (CDC) Sent: Friday, September 20, 2019 8:57 AM EDT To: Aldridge,Tiffany (DSHS) ; Alfred DeMaria ; Amanda Metz - CDPHE ; Aragon,Antonio (DSHS) ; Arwady, Allison AA (CDC cityofchicago.org) ; Azadeh Tasslimi ; Black, Stephanie SB (CDC cityofchicago.org) ; Blog, Debra (CDC health.ny.gov) ; Burns, Meagan (DPH) ; Byron Backenson ; Cheryl Starling (cheryl.starling@cdph.ca.gov) ; DeBolt, Chas (DOH) ; Dufort, Elizabeth M (HEALTH) ; Elizabeth Negron ; Elizabeth Rausch-Phung (Elizabeth.Rausch-Phung@health.ny.gov) ; Emily Spence Davizon - CDPHE ; Fleming, Wayne S ; Garcia,Imelda M (DSHS) ; Gillian Haney ; Graff, Nicholas R (DOH) ; Hannah Volkman (Hannah.Volkman@cdph.ca.gov) ; Harit Agroia (Harit.Agroia@cdph.ca.gov) ; Herlihy, Rachel (CDC state.co.us) ; Jayne Griffith ; Jodi Morgan (Jodi.morgan@illinois.gov) ; Julie Miller ; Kathy Harriman (Kathleen.harriman@cdph.ca.gov) ; Kauerauf, Judy (CDC illinois.gov) ; Kenyon, Cynthia (MDH) ; Kristen Ehresmann (Kristen.Ehresmann@state.mn.us) ; Kuhles, Daniel J (HEALTH) ; Kumar Nalluswami ; Lam, Esther W (DOH) ; Leos,Greg (DSHS) ; Longenberger, Allison (CDC pa.gov) ; Lurie, Perrianne ; Mallory Sinner (Mallory.sinner@illinois.gov) ; Marielle Fricchione ; Maxted, Angie M (HEALTH) ; Meghan Barnes - CDPHE ; Melissa McMahon (Melissa.McMahon@state.mn.us) ; Nambiar, Atmaram ; Ramirez, Enrique (CDC cityofchicago.org) ; Reid, Heather ; Rice, Samantha K (DOH ; Sanders,Kelsey (DSHS) ; Sergey Morzunov (smorzunov@medicine.nevada.edu) ; Sharon Watkins (shawatkins@pa.gov) ; Stockman, Lauren@CDPH ; Susan Lett ; Tupy,Shawn (DSHS) ; Watt, James (CDC cdph.ca.gov) ; Wayne Turnberg (wayne.turnberg@doh.wa.gov) CC: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Pennings, Breanna (CDC/DDID/NCIRD/OD) (CTR) ; VPD Surv ELC (CDC) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) ; Patel, Manisha M. (CDC/DDID/NCIRD/DVD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) Subject: AFM Emerging Issues ELC 2019 - getting started WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. ColleaguesThe ELC Notices of Award have now been sent out for the ELC Project E "Cross-cutting Emerging Issues" and we are now able to begin working on the AFM-focused activities for which funding was awarded. Understanding that the “Cross-cutting Emerging Issues” (Project E) application was written broadly, each jurisdiction will need to submit a “work plan” that specifically addresses your proposed activities and milestones regarding for this component of AFM-related funding. There are three "buckets" or project categories into which your AFM activities may fall: 1. Communications for surveillance Increase engagement of local neurologists and other clinicians such as infectious disease specialists, front-line emergency care clinicians, or other specialties that see patients who are suspected with AFM. 0 Increase jurisdiction engagement to expand awareness of AFM and surveillance activities. 2. Surveillance data collection 0 Enhance surveillance by conducting active surveillance at select tertiary care hospitals and/or pediatric centers to identify possible patients with AFM in a more timely manner. 0 Increase completeness and timeliness of surveillance data collected and submitted. 0 Increase timeliness of collection of laboratory specimens for submission to CDC laboratories for etiological testing. 3. Surveillance data analysis 0 Review and apply data to inform epidemiologic and programmatic decisions related to AFM surveillance practice. 0 AFM-related work that focuses on communications for surveillance would likely include activities such as engaging local neurologists to conduct AFM-specific outreach with infectious disease specialists, pediatric primary care clinicians, and ER/emergency care practitioners. This work may also include increased engagement by the jurisdiction health departments TX-DSHS-19-1309-A-002539 to educate reporting facilities about the requirements and importance of AFM surveillance. Activities that focus on surveillance data collection would likely include conducting enhanced active surveillance at tertiary care hospitals or pediatric centers by connecting with neurology, infectious diseases, or hospital infection prevention/control specialists to conduct weekly searches for possible patients with AFM. This may also include improving completeness of data collected from patients suspected of having AFM and decreasing the time to specimen collection for testing to help identify a possible etiology. Finally, activities that focus on surveillance data analysis would likely include syndromic surveillance projects with statebased hospital information systems to look for AFP, and within that, AFM. These projects would support better understanding of the burden of disease for both entities, and would provide data to inform epidemiologic and programmatic decisions related to AFM/AFP surveillance practice. Certainly, these are not all of the possible or relevant activities, and we are very much looking forward to discussing any additional activities that you identify. At this time, we request that each funded jurisdiction submits a short (e.g., 1-2 page) work plan that identifies the project categories proposed by the jurisdiction and specific AFM-related activities. In addition to listing the activities being proposed, please also address staffing, timeframes, and measurement/evaluation. We ask that the work plan is submitted to VPDsurvELC@cdc.gov by close of business (COB) on September 26, 2019. We will be scheduling a call that will include representation from each of the 10 jurisdictions that were funded for these AFM emerging issues special projects. During that call, we will share proposed activities and will discuss next steps. To help us schedule that meeting, please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​. Please submit your availability by COB on Tuesday, September 24. An email including the agenda and logistics for the call will be sent after we receive availability from each funded jurisdiction. We are working with the ELC program to include this AFM Emerging Issues project within the RedCap Monitoring Portal. Remember that each jurisdiction will also need to add their project information into RedCap once the work plan is finalized. More information regarding RedCap will be provided following the call. This email is being sent broadly for information, but please feel free to forward to others if you wish. Thank you for your leadership in AFM surveillance. We are very excited to work on these activities with you! Sandy Sandra W. Roush, MT, MPH ​ Surveillance Officer National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop A-27 Building 24, Room 8212 Atlanta, Georgia 30333 phone: 404-639-8741 fax: 404-639-8616 sroush@cdc.gov TX-DSHS-19-1309-A-002540 From: Centers for Disease Control and Prevention Sent: Friday, September 20, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Parasites Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online PARASITES ARTICLES Ahead of Print Current Cover Podcasts Contact EID VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018 A. Fonseca et al. G. N. Hartmeyer et al. Announcements CDC EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002541 From: Centers for Disease Control and Prevention Sent: Sunday, September 22, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Vector-borne Infections Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online VECTOR-BORNE INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016– 2017 W. Liu et al. CDC New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018 Tick-Borne Encephalitis in AuvergneRhône-Alpes Region, France, 2017–2018 E. Botelho-Nevers et al. Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico R. R. Hemme et al. A. M. Kjemtrup et al. EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002542 From: Centers for Disease Control and Prevention Sent: Sunday, September 22, 2019 6:01 PM EDT To: Garcia,Imelda M (DSHS) Subject: Antimicrobial Resistance Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online ANTIMICROBIAL RESISTANCE ARTICLES Ahead of Print Current Cover Podcasts Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China Medscape CME Activity Edwardsiella tardaEdwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 Y. Hu et al. S. Kamiyama et al. Announcements Mycobacterium marseillense Infection in Human Skin, China, 2018 CDC B. Xie et al. Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit Contact EID Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran A. Chamieh et al. F. Sakhaee et al. EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002543 From: Centers for Disease Control and Prevention Sent: Monday, September 23, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Tuberculosis and Other Mycobacteria Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online TUBERCULOSIS AND OTHER MYCOBACTERIA ARTICLES Ahead of Print Current Cover Podcasts Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS S. M. Michienzi et al. Contact EID Announcements Mycobacterium marseillense Infection in Human Skin, China, 2018 B. Xie et al. CDC Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012 L. A. Vonnahme et al. Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines K. O. Murray et al. F. Sakhaee et al. EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002544 From: Centers for Disease Control and Prevention Sent: Monday, September 23, 2019 6:00 PM EDT To: Garcia,Imelda M (DSHS) Subject: Respiratory Infections Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online RESPIRATORY INFECTIONS ARTICLES Ahead of Print Current Cover Podcasts Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission Bidirectional Human-Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018 L. Zhou et al. A. Chastagner et al. Announcements Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir CDC V. P. Mishin et al. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran Contact EID EID Podcasts Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018 F. Sakhaee et al. A. Pohlmann et al. A Study in Stillness and Symmetry Sensitive and Specific Detection of LowLevel Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections B. Breedlove Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015 M. D. Van Kerkhove et al. N. Okba et al. Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus R. Harvey et al. Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002545 From: VPD Surv ELC (CDC) Sent: Tuesday, September 24, 2019 2:09 PM EDT To: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) Subject: AFM Emerging Issues ELC 2019 - reminders WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. AllI am re-sending this as a reminder that our meeting availability poll will endby close of business (COB) today, September 24, 2019. Please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​ Please also note we are requesting a brief(e.g., 1-2 page) workplan be submitted to VPDsurvELC@cdc.gov by COB on September 26, 2019. This workplan can still be submitted as a draft, as it will be used to inform the call. Each jurisdiction will be asked to input a finalized version on REDCap following the meeting. Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Friday, September 20, 2019 8:57 AM To: Aldridge,Tiffany (DSHS) ; Alfred DeMaria ; Amanda Metz CDPHE ; Aragon,Antonio (DSHS) ; Arwady, Allison AA (CDC cityofchicago.org) ; Azadeh Tasslimi ; Black, Stephanie SB (CDC cityofchicago.org) ; Blog, Debra (CDC health.ny.gov) ; Burns, Meagan (DPH) ; Byron Backenson ; Cheryl Starling (cheryl.starling@cdph.ca.gov) ; DeBolt, Chas (DOH) ; Dufort, Elizabeth M (HEALTH) ; Elizabeth Negron ; Elizabeth Rausch-Phung (Elizabeth.RauschPhung@health.ny.gov) ; Emily Spence Davizon - CDPHE ; Fleming, Wayne S ; Garcia,Imelda M (DSHS) ; Gillian Haney ; Graff, Nicholas R (DOH) ; Hannah Volkman (Hannah.Volkman@cdph.ca.gov) ; Harit Agroia (Harit.Agroia@cdph.ca.gov) ; Herlihy, Rachel (CDC state.co.us) ; Jayne Griffith ; Jodi Morgan (Jodi.morgan@illinois.gov) ; Julie Miller ; Kathy Harriman (Kathleen.harriman@cdph.ca.gov) ; Kauerauf, Judy (CDC illinois.gov) ; Kenyon, Cynthia (MDH) ; Kristen Ehresmann (Kristen.Ehresmann@state.mn.us) ; Kuhles, Daniel J (HEALTH) ; Kumar Nalluswami ; Lam, Esther W (DOH) ; Leos,Greg (DSHS) ; Longenberger, Allison (CDC pa.gov) ; Lurie, Perrianne ; Mallory Sinner (Mallory.sinner@illinois.gov) ; Marielle Fricchione ; Maxted, Angie M (HEALTH) ; Meghan Barnes - CDPHE ; Melissa McMahon (Melissa.McMahon@state.mn.us) ; Nambiar, Atmaram ; Ramirez, Enrique (CDC cityofchicago.org) ; Reid, Heather ; Rice, Samantha K (DOH ; Sanders,Kelsey (DSHS) ; Sergey Morzunov (smorzunov@medicine.nevada.edu) ; Sharon Watkins (shawatkins@pa.gov) ; Stockman, Lauren@CDPH ; Susan Lett ; Tupy,Shawn (DSHS) ; Watt, James (CDC cdph.ca.gov) ; Wayne Turnberg (wayne.turnberg@doh.wa.gov) Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Pennings, Breanna (CDC/DDID/NCIRD/OD) (CTR) ; VPD Surv ELC (CDC) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) ; Patel, Manisha M. (CDC/DDID/NCIRD/DVD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) Subject: AFM Emerging Issues ELC 2019 - getting started Colleagues- TX-DSHS-19-1309-A-002546 The ELC Notices of Award have now been sent out for the ELC Project E "Cross-cutting Emerging Issues" and we are now able to begin working on the AFM-focused activities for which funding was awarded. Understanding that the “Cross-cutting Emerging Issues” (Project E) application was written broadly, each jurisdiction will need to submit a “work plan” that specifically addresses your proposed activities and milestones regarding for this component of AFM-related funding. There are three "buckets" or project categories into which your AFM activities may fall: 1. Communications for surveillance Increase engagement of local neurologists and other clinicians such as infectious disease specialists, front-line emergency care clinicians, or other specialties that see patients who are suspected with AFM. 0 Increase jurisdiction engagement to expand awareness of AFM and surveillance activities. 2. Surveillance data collection 0 Enhance surveillance by conducting active surveillance at select tertiary care hospitals and/or pediatric centers to identify possible patients with AFM in a more timely manner. 0 Increase completeness and timeliness of surveillance data collected and submitted. 0 Increase timeliness of collection of laboratory specimens for submission to CDC laboratories for etiological testing. 3. Surveillance data analysis 0 Review and apply data to inform epidemiologic and programmatic decisions related to AFM surveillance practice. 0 AFM-related work that focuses on communications for surveillance would likely include activities such as engaging local neurologists to conduct AFM-specific outreach with infectious disease specialists, pediatric primary care clinicians, and ER/emergency care practitioners. This work may also include increased engagement by the jurisdiction health departments to educate reporting facilities about the requirements and importance of AFM surveillance. Activities that focus on surveillance data collection would likely include conducting enhanced active surveillance at tertiary care hospitals or pediatric centers by connecting with neurology, infectious diseases, or hospital infection prevention/control specialists to conduct weekly searches for possible patients with AFM. This may also include improving completeness of data collected from patients suspected of having AFM and decreasing the time to specimen collection for testing to help identify a possible etiology. Finally, activities that focus on surveillance data analysis would likely include syndromic surveillance projects with statebased hospital information systems to look for AFP, and within that, AFM. These projects would support better understanding of the burden of disease for both entities, and would provide data to inform epidemiologic and programmatic decisions related to AFM/AFP surveillance practice. Certainly, these are not all of the possible or relevant activities, and we are very much looking forward to discussing any additional activities that you identify. At this time, we request that each funded jurisdiction submits a short (e.g., 1-2 page) work plan that identifies the project categories proposed by the jurisdiction and specific AFM-related activities. In addition to listing the activities being proposed, please also address staffing, timeframes, and measurement/evaluation. We ask that the work plan is submitted to VPDsurvELC@cdc.gov by close of business (COB) on September 26, 2019. We will be scheduling a call that will include representation from each of the 10 jurisdictions that were funded for these AFM emerging issues special projects. During that call, we will share proposed activities and will discuss next steps. To help us schedule that meeting, please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​. Please submit your availability by COB on Tuesday, September 24. An email including the agenda and logistics for the call will be sent after we receive availability from each funded jurisdiction. We are working with the ELC program to include this AFM Emerging Issues project within the RedCap Monitoring Portal. Remember that each jurisdiction will also need to add their project information into RedCap once the work plan is finalized. More information regarding RedCap will be provided following the call. This email is being sent broadly for information, but please feel free to forward to others if you wish. Thank you for your leadership in AFM surveillance. We are very excited to work on these activities with you! Sandy Sandra W. Roush, MT, MPH ​ Surveillance Officer National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop A-27 Building 24, Room 8212 TX-DSHS-19-1309-A-002547 Atlanta, Georgia 30333 phone: 404-639-8741 fax: 404-639-8616 sroush@cdc.gov TX-DSHS-19-1309-A-002548 From: Centers for Disease Control and Prevention Sent: Wednesday, September 25, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Zoonoses Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online ZOONOSES ARTICLES Ahead of Print Current Cover Podcasts Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission Contact EID L. Zhou et al. Announcements Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir CDC V. P. Mishin et al. EID Podcasts Flu Hunter: Unlocking the Secrets of a Virus S. W. Boktor and S. Ostroff Sporotrichosis in the Highlands of Madagascar, 2013–2017 T. Rasamoelina et al. Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013 Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018 N. Ouhoummane et al. R. Bai et al. Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018 Etymologia: Edwardsiella tarda A. Pohlmann et al. R. Henry A Study in Stillness and Symmetry B. Breedlove Bidirectional Human-Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018 A. Chastagner et al. Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002549 From: Centers for Disease Control and Prevention Sent: Thursday, September 26, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Bacteria Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online BACTERIA ARTICLES Ahead of Print Current Cover Podcasts Contact EID Announcements Medscape CME Activity Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 E. Mosites et al. CDC Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015 A. Chrdle et al. Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China Y. Hu et al. EID Podcasts Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018 A. J. Henningsson et al. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran F. Sakhaee et al. Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012 L. A. Vonnahme et al. Medscape CME Activity Edwardsiella tardaEdwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 S. Kamiyama et al. Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines K. O. Murray et al. Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit S. M. Michienzi et al. A. Chamieh et al. Medscape CME Activity Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults Etymologia: Edwardsiella tarda A. Dernoncourt et al. R. Henry A Study in Stillness and Symmetry B. Breedlove Mycobacterium marseillense Infection in Human Skin, China, 2018 B. Xie et al. Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002550 From: Centers for Disease Control and Prevention Sent: Friday, September 27, 2019 5:01 AM EDT To: Garcia,Imelda M (DSHS) Subject: Viruses Articles in the October 2019 Emerging Infectious Diseases Journal WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 10 - October 2019 Issue Now Online VIRUSES ARTICLES Ahead of Print Current Cover Podcasts Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018 L. Zhou et al. J. Weese et al. Announcements Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS CDC V. P. Mishin et al. S. M. Michienzi et al. Emergence of Influenza A(H7N4) Virus, Cambodia New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018 Contact EID D. Vijaykrishna et al. Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013 N. Ouhoummane et al. EID Podcasts Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis J. Allgaier et al. Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018 A. M. Kjemtrup et al. Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia M. Wille et al. Flu Hunter: Unlocking the Secrets of a Virus S. W. Boktor and S. Ostroff Tick-Borne Encephalitis in AuvergneRhône-Alpes Region, France, 2017–2018 A. Pohlmann et al. E. Botelho-Nevers et al. Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018 Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015 A. van Schalkwyk and M. Romito M. D. Van Kerkhove et al. Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010– 2017 Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico M. Rogers et al. Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016– 2017 R. R. Hemme et al. W. Liu et al. Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018 Sensitive and Specific Detection of LowLevel Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections N. Okba et al. Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission C. E. Styles et al. R. Bai et al. A Study in Stillness and Symmetry B. Breedlove Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus R. Harvey et al. Bidirectional Human-Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018 A. Chastagner et al. Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002551 From: VPD Surv ELC (CDC) Sent: Friday, September 27, 2019 8:46 AM EDT To: Aldridge,Tiffany (DSHS) ; Alfred DeMaria ; Amanda Metz - CDPHE ; Aragon,Antonio (DSHS) ; Arwady, Allison AA (CDC cityofchicago.org) ; Azadeh Tasslimi ; Black, Stephanie SB (CDC cityofchicago.org) ; Blog, Debra (CDC health.ny.gov) ; Burns, Meagan (DPH) ; Byron Backenson ; Cheryl Starling (cheryl.starling@cdph.ca.gov) ; DeBolt, Chas (DOH) ; Dufort, Elizabeth M (HEALTH) ; Elizabeth Negron ; Elizabeth Rausch-Phung (Elizabeth.Rausch-Phung@health.ny.gov) ; Emily Spence Davizon - CDPHE ; Fleming, Wayne S ; Garcia,Imelda M (DSHS) ; Gillian Haney ; Graff, Nicholas R (DOH) ; Hannah Volkman (Hannah.Volkman@cdph.ca.gov) ; Harit Agroia (Harit.Agroia@cdph.ca.gov) ; Herlihy, Rachel (CDC state.co.us) ; Jayne Griffith ; Jodi Morgan (Jodi.morgan@illinois.gov) ; Julie Miller ; Kathy Harriman (Kathleen.harriman@cdph.ca.gov) ; Kauerauf, Judy (CDC illinois.gov) ; Kenyon, Cynthia (MDH) ; Kristen Ehresmann (Kristen.Ehresmann@state.mn.us) ; Kristen Mortz (kristen.mertz@AlleghenyCounty.us) ; Kuhles, Daniel J (HEALTH) ; Kumar Nalluswami ; Lam, Esther W (DOH) ; Leos,Greg (DSHS) ; Longenberger, Allison (CDC pa.gov) ; luann.brink@alleghenycounty.us ; Lurie, Perrianne ; Mallory Sinner (Mallory.sinner@illinois.gov) ; Marielle Fricchione ; Maxted, Angie M (HEALTH) ; Meghan Barnes CDPHE ; Melissa McMahon (Melissa.McMahon@state.mn.us) ; Nambiar, Atmaram ; Ramirez, Enrique (CDC cityofchicago.org) ; Reid, Heather ; Rice, Samantha K (DOH ; Sanders,Kelsey (DSHS) ; Sharon Watkins (shawatkins@pa.gov) ; Stockman, Lauren@CDPH ; Susan Lett ; Tupy,Shawn (DSHS) ; Watt, James (CDC cdph.ca.gov) ; Wayne Turnberg (wayne.turnberg@doh.wa.gov) CC: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) Subject: AFM Emerging Issues ELC 2019 - Call Agenda and Logistics WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. AllThank you to all who filled in the Call Poll. The AFM Emerging Issues Special Project call will be occurring onOctober 3, 2019 at 12:00 - 1:00 pm EST. Although unable to find a time in which everyone was free, this date accommodated the greatest number of jurisdictions. Meeting notes and a recording will be made available two weeks following the call. Each jurisdiction will be asked to present a brief 1-3 minute summary of their workplan to present during the call. Agenda: 1. 2. 3. 4. Welcome and Introduction AFM Project Categories Jurisdiction's workplan summaries Call Discussion Questions ThanksBreanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Tuesday, September 24, 2019 2:09 PM To: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) Subject: AFM Emerging Issues ELC 2019 - reminders TX-DSHS-19-1309-A-002552 AllI am re-sending this as a reminder that our meeting availability poll will endby close of business (COB) today, September 24, 2019. Please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​ Please also note we are requesting a brief(e.g., 1-2 page) workplan be submitted to VPDsurvELC@cdc.gov by COB on September 26, 2019. This workplan can still be submitted as a draft, as it will be used to inform the call. Each jurisdiction will be asked to input a finalized version on REDCap following the meeting. Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Friday, September 20, 2019 8:57 AM To: Aldridge,Tiffany (DSHS) ; Alfred DeMaria ; Amanda Metz CDPHE ; Aragon,Antonio (DSHS) ; Arwady, Allison AA (CDC cityofchicago.org) ; Azadeh Tasslimi ; Black, Stephanie SB (CDC cityofchicago.org) ; Blog, Debra (CDC health.ny.gov) ; Burns, Meagan (DPH) ; Byron Backenson ; Cheryl Starling (cheryl.starling@cdph.ca.gov) ; DeBolt, Chas (DOH) ; Dufort, Elizabeth M (HEALTH) ; Elizabeth Negron ; Elizabeth Rausch-Phung (Elizabeth.RauschPhung@health.ny.gov) ; Emily Spence Davizon - CDPHE ; Fleming, Wayne S ; Garcia,Imelda M (DSHS) ; Gillian Haney ; Graff, Nicholas R (DOH) ; Hannah Volkman (Hannah.Volkman@cdph.ca.gov) ; Harit Agroia (Harit.Agroia@cdph.ca.gov) ; Herlihy, Rachel (CDC state.co.us) ; Jayne Griffith ; Jodi Morgan (Jodi.morgan@illinois.gov) ; Julie Miller ; Kathy Harriman (Kathleen.harriman@cdph.ca.gov) ; Kauerauf, Judy (CDC illinois.gov) ; Kenyon, Cynthia (MDH) ; Kristen Ehresmann (Kristen.Ehresmann@state.mn.us) ; Kuhles, Daniel J (HEALTH) ; Kumar Nalluswami ; Lam, Esther W (DOH) ; Leos,Greg (DSHS) ; Longenberger, Allison (CDC pa.gov) ; Lurie, Perrianne ; Mallory Sinner (Mallory.sinner@illinois.gov) ; Marielle Fricchione ; Maxted, Angie M (HEALTH) ; Meghan Barnes - CDPHE ; Melissa McMahon (Melissa.McMahon@state.mn.us) ; Nambiar, Atmaram ; Ramirez, Enrique (CDC cityofchicago.org) ; Reid, Heather ; Rice, Samantha K (DOH ; Sanders,Kelsey (DSHS) ; Sharon Watkins (shawatkins@pa.gov) ; Stockman, Lauren@CDPH ; Susan Lett ; Tupy,Shawn (DSHS) ; Watt, James (CDC cdph.ca.gov) ; Wayne Turnberg (wayne.turnberg@doh.wa.gov) Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Pennings, Breanna (CDC/DDID/NCIRD/OD) (CTR) ; VPD Surv ELC (CDC) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) ; Patel, Manisha M. (CDC/DDID/NCIRD/DVD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) Subject: AFM Emerging Issues ELC 2019 - getting started ColleaguesThe ELC Notices of Award have now been sent out for the ELC Project E "Cross-cutting Emerging Issues" and we are now able to begin working on the AFM-focused activities for which funding was awarded. Understanding that the “Cross-cutting Emerging Issues” (Project E) application was written broadly, each jurisdiction will need to submit a “work plan” that specifically addresses your proposed activities and milestones regarding for this component of AFM-related funding. There are three "buckets" or project categories into which your AFM activities may fall: TX-DSHS-19-1309-A-002553 1. Communications for surveillance Increase engagement of local neurologists and other clinicians such as infectious disease specialists, front-line emergency care clinicians, or other specialties that see patients who are suspected with AFM. 0 Increase jurisdiction engagement to expand awareness of AFM and surveillance activities. 2. Surveillance data collection 0 Enhance surveillance by conducting active surveillance at select tertiary care hospitals and/or pediatric centers to identify possible patients with AFM in a more timely manner. 0 Increase completeness and timeliness of surveillance data collected and submitted. 0 Increase timeliness of collection of laboratory specimens for submission to CDC laboratories for etiological testing. 3. Surveillance data analysis 0 Review and apply data to inform epidemiologic and programmatic decisions related to AFM surveillance practice. 0 AFM-related work that focuses on communications for surveillance would likely include activities such as engaging local neurologists to conduct AFM-specific outreach with infectious disease specialists, pediatric primary care clinicians, and ER/emergency care practitioners. This work may also include increased engagement by the jurisdiction health departments to educate reporting facilities about the requirements and importance of AFM surveillance. Activities that focus on surveillance data collection would likely include conducting enhanced active surveillance at tertiary care hospitals or pediatric centers by connecting with neurology, infectious diseases, or hospital infection prevention/control specialists to conduct weekly searches for possible patients with AFM. This may also include improving completeness of data collected from patients suspected of having AFM and decreasing the time to specimen collection for testing to help identify a possible etiology. Finally, activities that focus on surveillance data analysis would likely include syndromic surveillance projects with statebased hospital information systems to look for AFP, and within that, AFM. These projects would support better understanding of the burden of disease for both entities, and would provide data to inform epidemiologic and programmatic decisions related to AFM/AFP surveillance practice. Certainly, these are not all of the possible or relevant activities, and we are very much looking forward to discussing any additional activities that you identify. At this time, we request that each funded jurisdiction submits a short (e.g., 1-2 page) work plan that identifies the project categories proposed by the jurisdiction and specific AFM-related activities. In addition to listing the activities being proposed, please also address staffing, timeframes, and measurement/evaluation. We ask that the work plan is submitted to VPDsurvELC@cdc.gov by close of business (COB) on September 26, 2019. We will be scheduling a call that will include representation from each of the 10 jurisdictions that were funded for these AFM emerging issues special projects. During that call, we will share proposed activities and will discuss next steps. To help us schedule that meeting, please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​. Please submit your availability by COB on Tuesday, September 24. An email including the agenda and logistics for the call will be sent after we receive availability from each funded jurisdiction. We are working with the ELC program to include this AFM Emerging Issues project within the RedCap Monitoring Portal. Remember that each jurisdiction will also need to add their project information into RedCap once the work plan is finalized. More information regarding RedCap will be provided following the call. This email is being sent broadly for information, but please feel free to forward to others if you wish. Thank you for your leadership in AFM surveillance. We are very excited to work on these activities with you! Sandy Sandra W. Roush, MT, MPH ​ Surveillance Officer National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop A-27 Building 24, Room 8212 Atlanta, Georgia 30333 phone: 404-639-8741 fax: 404-639-8616 sroush@cdc.gov TX-DSHS-19-1309-A-002554 From: VPD Surv ELC (CDC) Sent: Friday, September 27, 2019 1:53 PM EDT To: VPD Surv ELC (CDC) Subject: AFM Emerging Issues- Skype Information WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. AllFor reference I am including the Skype information shared on the meeting invite sent out this afternoon. ......................................................................................................................................... Join Skype Meeting Trouble Joining? Try Skype Web App Join by phone (404) 553-8912 (Atlanta Dial-in Conference Region) (855) 348-8390 (Atlanta Dial-in Conference Region) English (United States) English (United States) Find a local number Conference ID: 4054161 Forgot your dial-in PIN? Help [!OC([1033])!] ......................................................................................................................................... Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Friday, September 27, 2019 8:46 AM To: AFM emerging issues list serve Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) Subject: AFM Emerging Issues ELC 2019 - Call Agenda and Logistics AllThank you to all who filled in the Call Poll. The AFM Emerging Issues Special Project call will be occurring onOctober 3, 2019 at 12:00 - 1:00 pm EST. Although unable to find a time in which everyone was free, this date accommodated the greatest number of jurisdictions. Meeting notes and a recording will be made available two weeks following the call. Each jurisdiction will be asked to present a brief 1-3 minute summary of their workplan to present during the call. Agenda: 1. 2. 3. 4. Welcome and Introduction AFM Project Categories Jurisdiction's workplan summaries Call Discussion Questions ThanksBreanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Tuesday, September 24, 2019 2:09 PM To: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) Subject: AFM Emerging Issues ELC 2019 - reminders AllI am re-sending this as a reminder that our meeting availability poll will endby close of business (COB) today, September 24, 2019. Please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​ Please also note we are requesting a brief(e.g., 1-2 page) workplan be submitted to VPDsurvELC@cdc.gov by COB on September 26, 2019. This workplan can still be submitted as a draft, as it will be used to inform the call. Each jurisdiction will be asked to input a finalized version on REDCap following the meeting. Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 TX-DSHS-19-1309-A-002556 From: VPD Surv ELC (CDC) Sent: Friday, September 20, 2019 8:57 AM To: Aldridge,Tiffany (DSHS) ; Alfred DeMaria ; Amanda Metz - CDPHE ; Aragon,Antonio (DSHS) ; Arwady, Allison AA (CDC cityofchicago.org) ; Azadeh Tasslimi ; Black, Stephanie SB (CDC cityofchicago.org) ; Blog, Debra (CDC health.ny.gov) ; Burns, Meagan (DPH) ; Byron Backenson ; Cheryl Starling (cheryl.starling@cdph.ca.gov) ; DeBolt, Chas (DOH) ; Dufort, Elizabeth M (HEALTH) ; Elizabeth Negron ; Elizabeth Rausch-Phung (Elizabeth.Rausch-Phung@health.ny.gov) ; Emily Spence Davizon CDPHE ; Fleming, Wayne S ; Garcia,Imelda M (DSHS) ; Gillian Haney ; Graff, Nicholas R (DOH) ; Hannah Volkman (Hannah.Volkman@cdph.ca.gov) ; Harit Agroia (Harit.Agroia@cdph.ca.gov) ; Herlihy, Rachel (CDC state.co.us) ; Jayne Griffith ; Jodi Morgan (Jodi.morgan@illinois.gov) ; Julie Miller ; Kathy Harriman (Kathleen.harriman@cdph.ca.gov) ; Kauerauf, Judy (CDC illinois.gov) ; Kenyon, Cynthia (MDH) ; Kristen Ehresmann (Kristen.Ehresmann@state.mn.us) ; Kuhles, Daniel J (HEALTH) ; Kumar Nalluswami ; Lam, Esther W (DOH) ; Leos,Greg (DSHS) ; Longenberger, Allison (CDC pa.gov) ; Lurie, Perrianne ; Mallory Sinner (Mallory.sinner@illinois.gov) ; Marielle Fricchione ; Maxted, Angie M (HEALTH) ; Meghan Barnes - CDPHE ; Melissa McMahon (Melissa.McMahon@state.mn.us) ; Nambiar, Atmaram ; Ramirez, Enrique (CDC cityofchicago.org) ; Reid, Heather ; Rice, Samantha K (DOH ; Sanders,Kelsey (DSHS) ; Sharon Watkins (shawatkins@pa.gov) ; Stockman, Lauren@CDPH ; Susan Lett ; Tupy,Shawn (DSHS) ; Watt, James (CDC cdph.ca.gov) ; Wayne Turnberg (wayne.turnberg@doh.wa.gov) Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) ; Pennings, Breanna (CDC/DDID/NCIRD/OD) (CTR) ; VPD Surv ELC (CDC) ; Lopez, Adriana (CDC/DDID/NCIRD/DVD) ; Routh, Janell A. (CDC/DDID/NCIRD/DVD) ; Patel, Manisha M. (CDC/DDID/NCIRD/DVD) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) Subject: AFM Emerging Issues ELC 2019 - getting started ColleaguesThe ELC Notices of Award have now been sent out for the ELC Project E "Cross-cutting Emerging Issues" and we are now able to begin working on the AFM-focused activities for which funding was awarded. Understanding that the “Cross-cutting Emerging Issues” (Project E) application was written broadly, each jurisdiction will need to submit a “work plan” that specifically addresses your proposed activities and milestones regarding for this component of AFM-related funding. There are three "buckets" or project categories into which your AFM activities may fall: 1. Communications for surveillance Increase engagement of local neurologists and other clinicians such as infectious disease specialists, front-line emergency care clinicians, or other specialties that see patients who are suspected with AFM. 0 Increase jurisdiction engagement to expand awareness of AFM and surveillance activities. 2. Surveillance data collection Enhance surveillance by conducting active surveillance at select tertiary care hospitals and/or pediatric centers to identify possible patients with AFM in a more timely manner. 0 Increase completeness and timeliness of surveillance data collected and submitted. 0 Increase timeliness of collection of laboratory specimens for submission to CDC laboratories for etiological testing. 3. Surveillance data analysis 0 Review and apply data to inform epidemiologic and programmatic decisions related to AFM surveillance practice. AFM-related work that focuses on communications for surveillance would likely include activities such as engaging local neurologists to conduct AFM-specific outreach with infectious disease specialists, pediatric primary care clinicians, and ER/emergency care practitioners. This work may also include increased engagement by the jurisdiction health departments to educate reporting facilities about the requirements and importance of AFM surveillance. Activities that focus on surveillance data collection would likely include conducting enhanced active surveillance at tertiary care hospitals or pediatric centers by connecting with neurology, infectious diseases, or hospital infection prevention/control specialists to conduct weekly searches for possible patients with AFM. This may also include improving completeness of data collected from patients suspected of having AFM and decreasing the time to specimen collection for testing to help identify a possible etiology. Finally, activities that focus on surveillance data analysis would likely include syndromic surveillance projects with state-based hospital information systems to look for AFP, and within that, AFM. These projects would support better understanding of the burden of disease for both entities, and would provide data to inform epidemiologic and programmatic decisions related to AFM/AFP surveillance practice. Certainly, these are not all of the possible or relevant activities, and we are very much looking forward to discussing any additional activities that you identify. At this time, we request that each funded jurisdiction submits a short (e.g., 1-2 page) work plan that identifies the project categories proposed by the jurisdiction and specific AFM-related activities. In addition to listing the activities being proposed, please also address staffing, timeframes, and measurement/evaluation. We ask that the work plan is submitted to VPDsurvELC@cdc.gov by close of business (COB) on September 26, 2019. We will be scheduling a call that will include representation from each of the 10 jurisdictions that were funded for these AFM emerging issues special projects. During that call, we will share proposed activities and will discuss next steps. To help us schedule that meeting, please follow the doodle poll link, inputting your name and jurisdiction abbreviation (e.g., Breanna Pennings, MN) and availability: https://doodle.com/poll/5wur2x7bgt3azmsn ​. Please submit your availability by COB on Tuesday, September 24. An email including the agenda and logistics for the call will be sent after we receive availability from each funded jurisdiction. We are working with the ELC program to include this AFM Emerging Issues project within the RedCap Monitoring Portal. Remember that each jurisdiction will also need to add their project information into RedCap once the work plan is finalized. More information regarding RedCap will be provided following the call. This email is being sent broadly for information, but please feel free to forward to others if you wish. Thank you for your leadership in AFM surveillance. We are very excited to work on these activities with you! Sandy Sandra W. Roush, MT, MPH ​ Surveillance Officer National Center for Immunization and Respiratory Diseases Centers for Disease Control and Prevention 1600 Clifton Road, Mailstop A-27 Building 24, Room 8212 Atlanta, Georgia 30333 phone: 404-639-8741 fax: 404-639-8616 sroush@cdc.gov TX-DSHS-19-1309-A-002557 From: Aldridge,Tiffany (DSHS) Sent: Thursday, October 03, 2019 1:08 PM EDT To: Duggar, Christopher (CDC/DDID/NCEZID/DVBD) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) CC: Garcia,Imelda M (DSHS) Subject: RE: quick note: TX site visit report Thanks for the update Chris! I hope you all are doing well. My UT family would choke if they saw this but “GEAUXXXXX Tigers” J! Have a great week. - Tiffany Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Duggar, Christopher (CDC/DDID/NCEZID/DVBD) [mailto:cnd8@cdc.gov] Sent: Thursday, October 3, 2019 11:44 AM To: Aldridge,Tiffany (DSHS) ; Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Garcia,Imelda M (DSHS) Subject: quick note: TX site visit report Hi Tiffany! I promised we would send information on Zika testing and talk more. This is just a quick update. We have a communication in the works, APHL is meeting with us, so I haven’t forgotten you…Texas is not the only State testing for Zika and a handful of others are asking how to turn it off. Once we push this out Nga will see if you want a conference call for Texas specifically. Apologies for the delay but more to come. From your loyal LSU Fan, -Chris Chris Duggar Senior Public Health Advisor U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Emerging and Zoonotic Infectious Diseases Arboviral Diseases Branch 3156 Rampart Road Fort Collins, CO 80521 Phone: 404-639-1419 Cell: 970-219-8034 Email: cduggar@cdc.gov From: Aldridge,Tiffany (DSHS) Sent: Tuesday, September 24, 2019 8:18 AM To: Vuong, Nga (CDC/DDID/NCEZID/DVBD) Cc: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Duggar, Christopher (CDC/DDID/NCEZID/DVBD) ; Borchert, Jeff N. (CDC/DDID/NCEZID/DVBD) ; Garcia,Imelda M (DSHS) Subject: RE: TX site visit report TX-DSHS-19-1309-A-002559 Good Morning Nga, Thank you very much for sending the site visit report. I have sent the report to the team and have asked them to have the responses to me by next Wednesday. I am working to get you a final response by next Friday. We enjoyed having you and Chris here and it was great to finally meet you both face-to-face. Also, I love the pictures in the report. Please let us know if you have any further questions. Thank You, Tiffany Aldridge, CTCM Program Specialist Texas Department of State Health Services Infectious Disease Prevention Section MC 3082 Ph: (512) 776-6658 Cell: (512) 645-5030 Fax: (512) 776-7443 tiffany.aldridge@dshs.texas.gov From: Vuong, Nga (CDC/DDID/NCEZID/DVBD) [mailto:ypg2@cdc.gov] Sent: Tuesday, September 17, 2019 3:27 PM To: Aldridge,Tiffany (DSHS) ; Garcia,Imelda M (DSHS) Cc: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Duggar, Christopher (CDC/DDID/NCEZID/DVBD) ; Borchert, Jeff N. (CDC/DDID/NCEZID/DVBD) Subject: TX site visit report WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Good afternoon, Tiffany and Imelda – Thank you again for hosting us last week in Austin! We both thoroughly enjoyed spending time with the TX DSHS team. Here’s our site visit report. I’ll add this onto the REDCap portal and will let you all know when the project is ready for review based on our changes for the workplan. Please share this with your team as you see fit. Table of contents: Page 1-4 Overview of the site visit and logistics for the coag Page 3-4 Questions for the technical teams Page 4 Action Items for TX DSHS/CDC team members Page 5 Appendix 1 – Site Visit Attendees Page 6-7 Agenda for Day 1 and Day 2 Page 7-14 Photos taken during our site visit Thanks again! Nga Vuong, MAT Public Health Advisor CDC/NCEZID/DVBD/ADB 3156 Rampart Road, MS P-02, Fort Collins, CO 80521 Cubicle Location: 2-305.30 Phone: 970-494-6682 ypg2@cdc.gov TX-DSHS-19-1309-A-002560 From: Centers for Disease Control and Prevention Sent: Thursday, October 03, 2019 2:06 PM EDT To: Garcia,Imelda M (DSHS) Subject: CDC Experts Featured at IDWeek 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. CDC Work on Improving Healthcare Quality Featured at IDWeek 2019 This week, CDC science is featured extensively at IDWeek 2019, including work from the Division of Healthcare Quality Promotion (DHQP). IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medical Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS). IDWeek features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. DHQP experts are presenting work on antibiotic prescribing, antibiotic resistance in healthcare, sepsis, C. diff, deviceassociated infections, and much more. To learn more about CDC work being presented this week, visit: https://idweek.org/program/. DHQP prevents, detects, and responds to healthcare-associated infections, and drives innovation in healthcare to improve healthcare quality and protect patients. CDC experts from the Division of Healthcare Quality Promotion are presenting at #IDWeek2019 on antibiotic prescribing, antibiotic resistance, sepsis, C. diff, device-associated infections and more. Learn more @IDWeek2019 https://idweek.org/program/. Share on Twitter Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30333 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002561 From: VPD Surv ELC (CDC) Sent: Friday, October 04, 2019 10:07 AM EDT To: VPD Surv ELC (CDC) CC: Roush, Sandra (CDC/DDID/NCIRD/OD) Subject: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET Attachment(s): "For Jurisdictions - QSCAS Template v9 (FY18-19)-locked.docx","Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19.pdf","Summary of Measles Rubella and CRS Priorities 7 2 19.pdf","Enhanced Meningococcal Surveillance Protocol ELC VPD_v06282019.docx","Appendices for EMDS_07312018.docx","Data Collection Guidance Worksheet 06282019.pdf","Enhanced Meningococcal Disease Surveillance Supplemental Data_06282019.xlsx","Enhanced Meningococcal Disease Surveillance Shipping Spreadsheet_08132018.xls","Instructions for Completing the Varicella Outbreak Surveillance Worksheet August 2016.docx","Varicella outbreak surveillance reporting worksheet_Aug 2016.xlsx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. AllPlease save the date for the next NCIRD Quarterly All-Jurisdiction Vaccine Preventable Disease (VPD) Surveillance Call, which will take place on October 15, 2019 from 3:00-4:30pm ET. Call-in information and preliminary agenda are below. Additional attachments/slide sets may be forthcoming. Toll Free Number: 800-779-5184 Participant Passcode: 6296401 Following the entry of the passcode, please provide the requested details when prompted. Agenda for October 15, 2019 Quarterly All-Jurisdiction VPD Surveillance Call Time Topic I Speaker Information General Surveillance Updates FY19 ELC CoAg Surveillance Indicators Recent communications Conferences Announcements/Reminders Action Item Surveillance Coordination Activity Summary deadlines (ELC CoAg) • • • 3:00 – 3:10 3:10-3:30 Surveillance Coordination Implementation of HL7 message mapping guide • • • • • Information Presentation: New Jersey’s activities to prepare for HL7 MMG implementation. Presentation: MMG implementation in NBS jurisdictions. Information Project Updates Action Item Meningococcal Disease: Supplemental data and isolates due to CDC on 15th of designated month (ELC CoAg) Pertussis: Tier 2 data and isolates due January 2020 (ELC CoAg) H flu: Tier 2 data and isolates due October 2019 (ELC CoAg) • • • Sandy Roush • • 3:30-3:35 ' • Amy Blain • • • Information Updates Varicella Action Items Varicella outbreak report deadline: October 10, 2019 (ELC CoAg) Varicella completeness report: due at the end of December (ELC CoAg) Adriana Lopez Measles Information Presentation: Elimination status Nakia Clemmons & Jessica Anderson 4:05-4:20 Mumps Action Items Mumps Tier 2 data due in October (ELC CoAg) Presentation: CDC Guidance for mump outbreaks at universities Mariel Marlow 4:20-4:30 Q&A 3:50-3:55 • • • • • Enhanced Meningococcal Surveillance Protocol ELC VPD_v06282019.docx Appendices for EMDS_07312018.docx Data Collection Guidance Worksheet 06282019.pdf Enhanced Meningococcal Disease Surveillance Supplemental Data_06282019.xls Enhanced Meningococcal Disease Surveillance Shipping Spreadsheet_08132018.xls Adriana Lopez • • 3:55-4:05 • • • • Acute Flaccid Myelitis 3:35-3:50 For Jurisdictions - QSCAS Template v9locked.docx Data element Priorities for Implementation of the Mumps, Pertussis, and Varicella Massage Mapping Guides: https://wwwn.cdc.gov/nndss/casenotification/message-mapping-guides.html Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19 Summary of Measles Rubella and CRS Priorities 7 2 19 Elizabeth Zaremski (NJ) & Michael Wodajo • Meningococcal Disease Pertussis Haemophilus influenzae Notes/Attachments • Instructions for Completing the Varicella Outbreak Surveillance Worksheet August 2016.docx Varicella outbreak surveillance reporting worksheet_Aug 2016.xlsx Jurisdictions Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 TX-DSHS-19-1309-A-002562 Appendices for Enhanced Meningococcal Disease Surveillance for the ELC VPD Surveillance Coordination Jurisdictions Contents Appendix 1. NNDSS Data Use Agreement .....................................................................................................2 Appendix 2. Sample template for a data sharing agreement ........................................................................11 TX-DSHS-19-1309-A-002563 Appendix 1. NNDSS Data Use Agreement Division of Health Informatics and Surveillance (DHIS) Data Use and Access Plan for DHIS Nationally Notifiable Diseases Data Center for Surveillance, Epidemiology and Laboratory Services (CSELS) Centers for Disease Control and Prevention (CDC) Atlanta, GA 30333 Policy Last Revised: August 4, 2016 Program Contact: Umed Ajani, DHIS, CSELS Phone: (404) 498-0258 E-mail: uaa0@cdc.gov Table of Contents 1. Introduction 2. Program description 3. Nationally notifiable infectious diseases data collection 4. Privacy Act and private information in data reported to DHIS 5. Procedures for assuring data quality 6. DHIS data use 7. Procedures for maintaining security of information during data transmission and use 8. Procedures for maintaining privacy of information during publication 9. Procedures for data release (public use data sets) 10. Procedures for maintaining privacy of information in release of public use data sets 11. Sharing of DHIS nationally notifiable infectious disease data 12. Human subjects protection 1. Introduction This document summarizes the Division of Health Informatics and Surveillance (DHIS), Center for Surveillance, Epidemiology and Laboratory Services (CSELS), plan for receiving, securing, provisioning, publishing, and releasing nationally notifiable conditions data received from state, territorial and local jurisdictions for the National Notifiable Diseases Surveillance System (NNDSS) by electronic health information systems administered by DHIS. It also covers DHIS’s publishing data the Division receives from CDC programs for publication in the Morbidity and Mortality Weekly Report (MMWR (http://www.cdc.gov/mmwr/index.html) and the release of those data. DHIS receives notifiable NNDSS data from CDC programs that want DHIS to make their data available to the public through the CDC WONDER portal (http://wonder.cdc.gov/WelcomeT.html#NNDSS). The release of each of the CDC programs’ data on TX-DSHS-19-1309-A-002564 WONDER is based on guidance provided to DHIS by those programs and this document does not cover receiving, securing, and releasing those data. This plan has been developed in accordance with the CDC/ATSDR Policy on Public Health Research and Nonresearch data management and access (http://masoapplications.cdc.gov/Policy/Doc/policy385.pdf). CDC is the nation’s principal disease prevention and health promotion organization. In support of its mission, CDC collects, generates, stores, uses, and routinely provides access to public health data. Public health and scientific advancement are best served when public health data are released to, or shared with, other public health agencies, academic researchers, private researchers (if appropriate) and other partners in an open, timely, and appropriate way. CDC also recognizes the critical importance of maintaining standards of data quality; upholding individual and institutional privacy and confidentiality; protecting information based on national security concerns and law enforcement investigations and activities; supporting commitments made in data use agreements (DUAs) with organizations that provide data to CDC; protecting proprietary interests and business confidential information; protecting intellectual property rights; considering ethical matters; and ensuring impartiality in the sharing of public health data. This plan has also been developed with the recognition that CDC programs in the Center for Global Health (CGH), National Center for Chronic Disease Prevention and Control (NCCDPHP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), National Center for Environmental Health (NCEH), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), National Center for Immunization and Respiratory Disease (NCIRD), and National Institute for Occupational Safety and Health (NIOSH) have primary responsibility at CDC for surveillance of specific nationally notifiable conditions. These centers and programs also receive, secure, use, publish, and release and/or share their nationally notifiable conditions data in accord with their Centers’ guidance. In this document, the term “data release” means the dissemination of data for public-use so that CDC no longer controls the data. The term “data sharing” means granting certain individuals or organizations access to data that cannot be released publicly, for example, data that contain personally identifiable or potentially identifiable information. Office of Management and Budget (OMB) Memorandum M-07-16 defines personally identifiable information as “information that can be used to distinguish or trace an individual’s identity either alone or when combined with other personal or identifying information that is linked or associated with the individual.” The term “data provisioning” refers to DHIS’s providing conditionspecific data to the CDC programs responsible for national level surveillance, prevention and control for each condition. 2. Program Description DHIS’s receiving, securing, provisioning, publishing and releasing notifiable conditions data are components of NNDSS. NNDSS is a nationwide collaboration that enables all levels of public health—local, state, territorial, federal, and international—to share notifiable conditions-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions. Some additional information about NNDSS, including a brief description of data collection, is provided below in this document. More detailed information on NNDSS is available at: (http://wwwn.cdc.gov/nndss/). TX-DSHS-19-1309-A-002565 DHIS currently supports NNDSS by receiving, securing, processing, and provisioning nationally notifiable conditions data to specific CDC programs in CGH, NCEH, NCEZID, NCHHSTP, and NCIRD. DHIS also supports local, state, and territorial public health departments in their collection, management and submission of notifiable conditions case notification data to CDC for NNDSS. DHIS provides this support through funding, health information exchange standards and frameworks, electronic health information systems, and technical support through the NNDSS web site, tools, and training. Together, DHIS and the CDC programs prepare annual summaries of infectious and noninfectious diseases and conditions, which are published in the CDC MMWR. 3. Nationally Notifiable Diseases Data Collection A number of different legislative and regulatory decisions have authorized federal collection of notifiable disease data and given responsibility for that data collection to CDC (https://wwwn.cdc.gov/nndss/history.html). In 1961, responsibility for the collection of data on nationally notifiable diseases and deaths was transferred from the National Office of Vital Statistics to CDC. CDC is responsible for the dissemination of nationally notifiable diseases’ information, as authorized by the Public Health Service Act (42 USC 241) of January 4, 2012 Data collection for notifiable disease surveillance begins at the level of local, state, and territorial public health departments (also known as jurisdictions). Jurisdictional laws and regulations mandate reporting of cases of specified infectious and noninfectious conditions to health departments. The jurisdictions work with healthcare providers, laboratories, hospitals, and other partners to obtain the information needed to monitor, control, and prevent the occurrence and spread of these health conditions. CDC programs in CGH, NCCDPHP, NCEH, NCEZID, NCHHSTP, NCIRD, and NIOSH collaborate with the Council of State and Territorial Epidemiologists (CSTE) to determine which conditions reported to local, state, and territorial public health departments are nationally notifiable. CDC programs, in collaboration with subject matter experts in CSTE and in health departments, determine what data elements are included in national notifications. Core data elements, with common definitions, are collected for all of the conditions submitted to DHIS. The core data elements include the name of the condition; demographic data; administrative data such as the jurisdiction submitting the case; epidemiologic data; characteristics of the condition; and contact information for the person submitting the notification to CDC. For many of the conditions, the public health department may also submit data elements which are specific to the condition. The condition-specific data elements vary by condition and may include signs and symptoms, additional diagnostic data, treatment data, vaccination history, laboratory tests and results, and risk factors. Once CSTE makes a recommendation that a condition is nationally notifiable and CDC has obtained approval from the Office of Management and Budget for receipt of the data under the Paperwork Reduction Act, electronic data exchange systems are developed, and health departments participating in NNDSS may voluntarily submit notifications data to DHIS through DHIS-administered information systems or to other CDC programs responsible for those specific conditions. DHIS collaborates with CGH, NCEH, NCEZID, NCHHSTP, and NCIRD to develop and submit a request for OMB approval (OMB Control Number 09200728) for the NNDSS data submitted to CDC through DHIS systems. Jurisdiction transmission of data to DHIS is supported by several interconnected health information exchange frameworks and electronic information systems. Most case records are submitted electronically from jurisdiction information systems via automated electronic transfers through a secure network. TX-DSHS-19-1309-A-002566 Supplemental information may be received at DHIS by telephone, fax, mail, and email. Procedures for maintaining security of the data during transmission to DHIS are described in section 7 below. 4. Privacy Act and Personally Identifiable Information in Data Reported to DHIS The nationally notifiable conditions data received by DHIS contain sensitive personally identifiable health information (PII), which are subject to the Privacy Act. The Privacy Act is a Federal law that protects PII held by a federal agency in a system of records from which information is retrieved by an individual’s name, an identification number, or some other unique identifier assigned to the individual. The CDC Privacy Act System of Records Notice that covers NNDSS is 09-20-0136. This notice provides information to the public about the existence of the CDC research and surveillance systems covered by the notice, how data are used, how data are safeguarded, and how information may be disclosed (http://www.cdc.gov/SORNnotice/09-20-0136.htm/). The nationally notifiable conditions electronic records received by DHIS are stored at DHIS indefinitely. DHIS implements a number of safeguards to prevent the disclosure of PII and to prevent the identification of individuals when data are published, released or shared (Sections 7, 8, 10, and 12, below). 5. Procedures for Assuring Quality of Data A major purpose of the DHIS-administered information system is to provide mechanisms by which CDC may receive nationally notifiable conditions data submitted by local, territorial and state health departments through one organization (DHIS) and assess and assure the quality of the data. Electronic data sent to DHIS are defined by the applicable messaging, vocabulary, and programmatic standards. These data can go through validations ensuring the proper messaging structure of the data, content consistent with values identified in the Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS) code sets, and conformance to programmatically defined business rules. On a weekly basis, DHIS staff evaluate the information submitted by the jurisdictions and review case reports for missing data elements, for inconsistencies among data elements and for data values that are not consistent with the values identified in the PHIN VADS code sets. When potential errors are identified, DHIS staff works with the individuals at the state or local health department who report the data to DHIS to resolve errors. Only data that meet data quality criteria are published or released. On an annual basis, DHIS staff work with the staff in state and territorial health departments and with staff in NCEZID, NCHHSTP, NCIRD, CGH, and NCEH to finalize reports of cases for that year. Final approval is obtained from the appropriate chief epidemiologist from each state or territory. Only data that meet data quality criteria are published or released. 6. DHIS Data Use DHIS conducts a number of different activities with the NNDSS data it receives from the jurisdictions. Data receipt, processing and quality assurance As noted in section 5 above, DHIS provides information systems and procedures by which the CDC may receive NNDSS data from the jurisdictions and DHIS administers data processing systems and conducts procedures to assure data quality. TX-DSHS-19-1309-A-002567 Data Provisioning A primary DHIS activity is to provision data for specific notifiable conditions to the CDC programs responsible for the conditions so those programs’ can use the data for their national surveillance activities. Publication of Data On a weekly basis, DHIS publishes in the MMWR weekly report the numbers of provisional cases of nationally notifiable infectious diseases submitted by the jurisdictions to DHIS during the current week. DHIS also includes in the MMWR weekly report numbers of provisional cases of a few notifiable infectious conditions provided to DHIS by CDC programs that receive notifiable conditions data from jurisdictions through other information systems. Once each year in the MMWR weekly, DHIS publishes a preliminary release (which DHIS calls an “early release”) of annual finalized notifiable infectious disease case counts for that year. At a later date, DHIS collaborates with the CDC infectious disease programs to publish a more detailed annual Summary of Notifiable Infectious Diseases and Conditions, United States. Annually, DHIS also collaborates with CDC noninfectious conditions and disease outbreaks programs to publish an annual summary of information previously published by the noninfectious conditions and disease outbreaks programs. That report is entitled the Annual Summary of Notifiable Noninfectious Conditions and Disease Outbreaks, United States. (Centers for Disease Control and Prevention. [Summary of Noninfectious Conditions and Disease Outbreaks]. Published October 23, 2015 for MMWR Morb Mortal Wkly Rep 2013;26(No.54): 1-89.) Data Release On a weekly basis, DHIS releases on Data.CDC.Gov de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR (https://data.cdc.gov/browse?q=NNDSS). On a weekly basis, DHIS releases on CDC WONDER de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR. (http://wonder.cdc.gov/mmwr/mmwrmorb.asp) On an annual basis, DHIS releases on CDC WONDER de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. http://wonder.cdc.gov/WelcomeT.html. On an annual basis, DHIS releases on Data.CDC.Gov de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. https://data.cdc.gov/browse?q=NNDSS (A more specific site will be provided once the first data are made available in 2016) In addition to the de-identified aggregated DHIS NNDSS data described above, CDC programs may make additional NNDSS data available on WONDER according to the condition-specific data use/data access guidelines of those programs. TX-DSHS-19-1309-A-002568 7. Procedures for Maintaining Security of Information during Data Transmission and Use The security of private information during electronic transmission from jurisdictions to DHIS is maintained by technologies (computers and servers) that use national public health standards for messaging systems which provide security mechanisms for jurisdictions to use when submitting data. Most case records are encrypted and submitted to DHIS electronically from already existing databases via automated electronic transfers through a secure network. Electronic data are transmitted to and processed within the electronic information system platforms. The electronic data are treated in a secure manner consistent with the technical, administrative, and operational controls required by the Federal Information Security Management Act of 2002 (FISMA). These systems are also in compliance with more recent standards to protect information: the NIST Recommended Security Controls for Federal Information Systems and Organizations, Special Publication 800-53, Revised May 1, 2013.On occasion, when electronic transmission is not possible or when public health departments prefer, weekly case counts are provided by telephone, fax, mail, and email, primarily to meet weekly deadlines for publication in the MMWR. For these non-electronic transmissions, no identifiers are included, and safeguards are implemented to ensure that information is received only by the appropriate staff at DHIS. DHIS provides nationally notifiable infectious disease data to CDC programs through secure electronic platforms. The CDC’s Office of the Chief Information Security Officer examines and validates the security controls during regularly scheduled Security Assessment and Authorization processes. All hard copy materials submitted to CDC are stored in locked cabinets in restricted access areas in buildings that require card key access. Potentially identifiable information will not be disclosed unless otherwise compelled by law. 8. Procedures for Maintaining Privacy during Publication of Infectious NND data received from the jurisdictions. In the MMWR publications and tables made available online, infectious notifiable condition case counts as low as 1 and rates as low as 0.01/100,000 are presented. The primary statistical disclosure rule for the publication and online tables is the limited disclosure of information in the tables, maps and graphics: • case counts and rates are presented for the nation, each of 9 regions (New England, Mid. Atlantic, E.N. Central, W.N. Central, S. Atlantic, E.S. Central, W.S. Central, Mountain, Pacific), each reporting jurisdiction, and for some conditions, counties; • at the national level counts and rates are presented by residency status (U.S. resident or not) and, for some conditions, birthplace (U.S. or not); • national counts and rates are presented by month, age group, sex, race, and ethnicity; • counts and rates are not presented for any combinations of location and/or demographic characteristics; and • no additional information about the cases is presented. An additional disclosure rule is that if the number of cases of a condition reported nationally is less than 25, national level counts and rates by race are not presented and neither are counts and rates by ethnicity. TX-DSHS-19-1309-A-002569 A. MMWR Weekly DHIS presents provisional weekly case counts: 1. Table 1 for each selected infrequently reported notifiable condition: a. national counts: the total number reported for that week, the cumulative number for the year, a 5-yr. weekly average number, and the total number reported for each of the previous 5 years; and b. total counts for each jurisdiction that reported one or more cases that week; In a few years, when reporting jurisdictions have implemented the ability to report counts by residency status, national counts will be stratified by residency status (U.S. resident/non-U.S. resident). 2. Figure 1: a graphic for a subset of selected conditions comparing that week’s 4-week cumulative national count with the mean of 15 4-week counts selected from each of the previous 5 years. 3. Table 2: for each of the selected other nationally notifiable conditions not published in Table 1, for the nation, region, and each reporting jurisdiction: Total counts reported for that week, median and maximum counts reported during the previous 52 weeks, and cumulative annual counts through the current week for both the current year and previous year. When reporting jurisdictions have implemented the ability to report counts by residency status, national counts will be stratified by residency status. B. Annual MMWR preliminary release. DHIS presents final annual case counts for the reporting year: Table 2 For each notifiable infectious condition: total case counts for the nation and for each HHS region and reporting jurisdiction, and for a subset of conditions counts for children under age 1, 5 or 18, depending on the condition. When counts are available by residency status, national counts will be stratified by residency status. C. Annual MMWR summary Part 1. Tables for the reporting year DHIS presents the following annual final case counts and rates for each condition: 1. Counts and incidence rates for the nation, each HHS Region, and each reporting jurisdiction. TX-DSHS-19-1309-A-002570 2. National counts and incidence rates by each of the following demographic characteristics of the cases: a. month of report (12 months and “not stated”), b. age group (in years: <1, 1-4, 5-14, 15-24, 25-39, 40-64, and >65, missing), c. sex (M, F, and “not-stated), d. race (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, White, Other, and “not stated,” and e. ethnicity (Hispanic or Latino, Not Hispanic or Latino, and “not stated”). 3. National counts and rates will be stratified by residency status when counts are available by residency status. Part 2. Graphics DHIS presents the following annual final case counts and rates for selected conditions: 1. Graphs or maps with national regional, jurisdiction or county counts or incidence rates. 2. Graphs or maps with national level case counts or incidence rates by race-ethnicity, gender, or birthplace (US/non-US). Part 3. Historical Tables DHIS presents the following annual final case counts and rates for selected conditions: 1. Final annual national case counts and rates by year for selected infectious conditions. 2. Final annual national death counts for selected infectious conditions. 3. National counts will be stratified by residency status when counts are available by residency status. 9. Procedures for Data Release (Public Use Data Sets) DHIS releases downloadable, machine-readable public use data sets in two locations: On a weekly basis, DHIS releases on Data.CDC.Gov de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR (https://data.cdc.gov/browse?q=NNDSS). On a weekly basis, DHIS releases on CDC WONDER de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR. (http://wonder.cdc.gov/mmwr/mmwrmorb.asp) On an annual basis, DHIS releases on CDC WONDER de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. TX-DSHS-19-1309-A-002571 http://wonder.cdc.gov/WelcomeT.html (A more specific site will be given once the first data are made available in 2016). On an annual basis, DHIS releases on Data.CDC.Gov de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. https://data.cdc.gov/browse?q=NNDSS (A more specific site will be provided once the first data are made available in 2016) 10. Procedures for Maintaining Privacy of Information in Release of Public use Data Sets The procedures for protecting private information with the release of data are the same as those described for publication in section 8 above. 11. Sharing of nationally notifiable conditions data DHIS does not share nationally notifiable conditions data with individuals or organizations outside of CDC. When DHIS receives requests for data from individuals or organizations outside of CDC, DHIS notifies the requestor that the DHIS NNDSS program is unable to fill requests for specific datasets and that some NNDSS data are available on CDC WONDER (http://wonder.cdc.gov/) and DATA.CDC.GOV (https://data.cdc.gov/). In addition, DHIS provides a link to the web site of the CDC program that is responsible for surveillance of the condition for which data are requested and notes the availability of data and a program point of contact at that site. 12. Human Subjects Protection Public use data sets that are released by DHIS may be used for research. Because they are de-identified, they do not constitute “human subjects” under federal regulations (such as 45 CFR 46.102(f)). Therefore, institutional review board approval is not generally required under federal policy. TX-DSHS-19-1309-A-002572 Appendix 2. Sample template for a data sharing agreement This document contains a sample template for a data sharing agreement and use and disclosure of client information. Within the data sharing agreement there are important areas to consider for inclusion. At a minimum the agreement should specify the following: parties involved, including contact information; the purpose or need for the data sharing agreement; nature of the data to be collected; access and confidentiality of data; how the data is to be used; how and in what situations the agreement can be severed by either party; and relevant legal authorities (tribal, state, local, federal). DATA SHARING AGREEMENT between and ENTITIES RECEIVING AND PROVIDING DATA ENTITY RECEIVING DATA: OFFICE: CONTACT PERSON: TITLE: ADDRESS: PHONE NUMBER: EMAIL: FAX NUMBER: ENTITY PROVIDING DATA: CONTACT PERSON: ADDRESS: PHONE NUMBER: EMAIL: FAX NUMBER: TITLE: PURPOSE, AUTHORITY AND TERM OF AGREEMENT A. PURPOSE To facilitate the health of X agency or organization and Y Health Department are entering into an agreement which will allow the exchange of data and specification of data access and utilization. Y will provide data collected to X for the purposes of . B. LEGAL AUTHORITY 1. X is a whose mission is… 2. Y is an whose mission is for public benefit. TX-DSHS-19-1309-A-002573 C. PERIOD OF PERFORMANCE This Agreement shall be effective when signed by both parties and shall continue until terminated pursuant to the termination clause contained herein. DESCRIPTION OF DATA/DATA WORKPLAN The following data will be provided under this agreement: If applicable, all data generated by this project shall be approved for dissemination by the Institutional Review Board and . ACCESS TO DATA A. METHOD OF ACCESS AND TRANSFER Data will be obtained and/or accessed in the following manner: B. PERSONS HAVING ACCESS TO DATA All persons who will have access to data must complete a data privacy training through < specify >. Prior to the transfer of any data, staff members and researchers who will have access to the data shall sign , (signed copies shall be provided to X). C. FREQUENCY OF DATA EXCHANGE Data will be exchanged as needed to meet reporting requirements as well as on an ongoing basis between X and Y staff for the entire length of the project. SECURITY OF DATA Datasets containing protected health information (PHI) shall be encrypted or otherwise protected as specified. All reasonable precautions shall be taken to secure the data from individuals who do not specifically have authorized access. Data shall be kept on a password-protected file server located in a secure environment. Data will be kept in a separate directory on server which is also passwordprotected and will be accessible only by Y evaluators or staff members specifically authorized access as provided in this Agreement. CONFIDENTIALITY A. REGULATIONS COVERING CONFIDENTIALITY OF DATA The use and disclosure of information obtained under this contract shall be subject to . X and Y shall maintain the confidentiality of any information which may, in any manner, identify individual subjects. Confidentiality of all data must be ensured. B. NON-DISCLOSURE OF DATA Y shall not disclose, in whole or in part, the data described in this agreement to any individual or agency not specifically authorized by this agreement. Data shall be provided on a timely basis. Y will document uses and users of the data and will report this information routinely back to the X . TX-DSHS-19-1309-A-002574 C. Y will not disclose directly to, or use for the benefit of, any third party confidential information, knowledge or data acquired by virtue of its relationship with the other party named in this Agreement, without the prior written approval of the other party. It is understood and agreed by the parties that the obligations of this paragraph shall survive the expiration of termination of this Agreement. PROPERTY RIGHTS Original materials prepared by Y, including, without limitation: reports, proposals, analysis, writings, sound recordings, pictorial reproductions or materials of any type whatsoever, are and shall remain the of . Y will assert no right, claim or interest of any nature whatsoever with respect thereto, including specifically but, without limitation, any claim to statutory copyright. Data Use and Ownership X shall be cited as the source of the data in all tables, reports, presentations, and scientific papers, and Y shall be cited as the source of interpretations, calculations, and/or manipulations of the data. SEVERABILITY If any provision of this Agreement or any provision of any document incorporated by reference shall be held invalid, such invalidity shall not affect the other provisions of this Agreement which can be given effect without the invalid provision, if such remainder conforms to the requirement of applicable law and the fundamental purpose of this agreement, and to this end the provisions of this Agreement are declared to be severable. TERMINATION Either party may terminate this Agreement upon 30 days prior written notification to the other party. RIGHT OF INSPECTION Y shall provide X the right of access to its facilities at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this contract. ALL WRITINGS CONTAINED HEREIN This Agreement contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. TX-DSHS-19-1309-A-002575 Organization X Name/Title ________________________ Date Name/Title ________________________ Date Organization Y Name/Title ________________________ Date Name/Title ________________________ Date TX-DSHS-19-1309-A-002576 USE AND DISCLOSURE OF CLIENT INFORMATION Staff with access to confidential client information are responsible for understanding rules for use rules of behavior with respect to disclosure of the information. Outlined below are key elements for staff to remember: A. CONFIDENTIALITY OF CLIENT DATA 1. Individually identifiable patient data is confidential and is protected by various state and federal laws. 2. Confidential patient information includes all personal information (e.g., name, birth date, social security number, diagnosis, treatment, etc.) which may, in any manner, identify the individual. B. USE OF CLIENT DATA 1. Client data may be used only for purposes directly described in the data sharing agreement between X and Y 2. Any personal use of patient information is strictly prohibited. 3. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. C. DISCLOSURE OF INFORMATION 1. Identified patient information may not be disclosed to other individuals or agencies. 2. Questions related to disclosure are to be directed to X. 3. Any disclosure of information contrary to 1 above is unauthorized and is subject to penalties identified in law. Name (print): Signature: Date: Approved By: Authorizing Official, X Signature: Date: TX-DSHS-19-1309-A-002577 NNDSS Case ID: DOB: MM/DD/YYYY I OR State ID: Age: ________ years old I Case Status: Laboratory ID: □ Confirmed □ Probable Event date: MM/DD/YYYY Lab Test used to serogroup: □ □ □ Unknown TX-DSHS-19-1309-A-002578 VACCINATION INFORMATION Did the patient receive quadrivalent meningococcal vaccine? Did the patient receive serogroup B meningococcal vaccine? Date MM/DD/YY □ Unknown M M/DD/YY □ Unknown MM/DD/YY □ Unknown MM/DD/YY □ Unknown MM/DD/YY □ Unknown Jan 2019 Type □ Yes □ No □ Unknown □ Yes □ No □ Unknown Vaccine Name If yes to either, please complete the table below for each dose Lot Number □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown TX-DSHS-19-1309-A-002579 Page 2 of 2 A 1 2 3 4 5 B I C I D I E F G The Centers for Disease Control and Prevention (CDC), an agency of the Department of Health and Human Services, is authorized to collect this information, including the Social Security number (if applicable), under provisions of the Public Health Service Act, Section 301 (42 U.S.C. 241). Supplying the information is voluntary and there is no penalty for not providing it. The data will be used to increase understanding of disease patterns, develop prevention and control programs, and communicate new knowledge to the health community. Data will become part of CDC Privacy Act system 09-20-0106, "Specimen Handling for Testing and Related Data" and may be disclosed: to appropriate State or local public health departments and cooperating medical authorities to deal with conditions of public health significance; to private contractors assisting CDC in analyzing and refining records; to researchers under certain limited circumstances to conduct further investigations; to organizations to carry out audits and reviews on behalf of HHS; to the Department of Justice in the event of litigation, and to a congressional office assisting individuals in obtaining their records. An accounting of the disclosures that have been made by CDC will be made available to the subject individual upon request. Except for permissible disclosures expressly authorized by the Privacy Act, no other disclosure may be made without the subject individual's written consent. Please refer to the CDC Infectious Diseases Laboratories Test Directory for information on specimen requirements. CDC must maintain and document specific acceptance criteria to perform laboratory tests on samples obtained from humans pursuant to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accompanying regulations. 42 U.S.C. § 263a; 42 C.F.R. § 493.1241. Samples transferred to the CDC for testing or any other purpose will become the legal property of the agency unless otherwise agreed upon in writing. Samples will not be returned to the submitting entity. Submitter State: Shipment Date: State ID Neisseria meningitidis Isolates Accession # I Specimen Source I Culture Date I Date Sent to CDC State Serogroup Nmen Test Used to Serogroup TX-DSHS-19-1309-A-002580 H I J K Previously Submitted to CDC Date Previously Submitted he Social Security number (if applicable), under provisions to increase understanding of disease patterns, develop en Handling for Testing and Related Data" and may be ractors assisting CDC in analyzing and refining records; to of Justice in the event of litigation, and to a congressional on request. Except for permissible disclosures expressly . eptance criteria to perform laboratory tests on samples . § 263a; 42 C.F.R. § 493.1241. amples will 1 not be returned to the submitting entity. 2 3 4 5 Viable (Y/N) Case Date of Birth Nmen TX-DSHS-19-1309-A-002581 A B 1 2 3 4 5 Neisseria meningitidis Data Submitting Jurisdiction: Date Submitted: Case Date Range: 6 NNDSS Case ID State ID C D Laboratory ID Date of Birth E Age F G Sex Case Status (Confirmed/ Probable) H I J K L Event Date Lab confirmation method Source Test used to serogroup Serogroup TX-DSHS-19-1309-A-002582 Supplemental data for all cases M 1 2 3 4 5 6 N O P MSM Outcome Outbreak/Clu ster Related Sex of sex partners MSM not otherwise specified Q R S T U V W X Y Greek Life Taking complement inhibitor Headache Fever College HIV status Homeless College Student Year in school Residence Type TX-DSHS-19-1309-A-002583 Supplemental data for all cases Z AA 1 2 3 4 5 6 AB AC AD AE AF Diarrhea Sore Throat AG AH AI AJ AK Other Received quadrivalent vaccine? Received Serogroup B vaccine? Vaccine 1 Date Vaccine 1 Name Symptoms Stiff Neck Rash Photophobia Nausea Vomiting TX-DSHS-19-1309-A-002584 Supplemental data for all cases AL AM AN AO AP AQ AR AS AT Vaccine 1 Lot Number Vaccine 2 Date Vaccine 2 Name Vaccine 2 Lot Number Vaccine 3 Date Vaccine 3 Name Vaccine 3 Lot Number Vaccine 4 Date Vaccine 4 Name 1 2 3 4 5 6 TX-DSHS-19-1309-A-002585 Supplemental data for all cases AU AV AW AX Vaccine 4 Lot Number Vaccine 5 Date Vaccine 5 Name Vaccine 5 Lot Number 1 2 3 4 5 6 TX-DSHS-19-1309-A-002586 Supplemental data for all cases A B C D E 1 Meningococcal disease in complement inhibitor recipients 2 Please note: The variables in columns F-Q of this tab are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. This is included as a convenience for jurisdictions who choose to participate in this supplemental data collection. Instructions: Complete columns F-Q below for any case identified as taking eculizumab/Soliris or ravulizumab/Ultomiris (highlighted in yellow below). This replaces the previous supplemental case report form for these cases to streamline data submission. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 NNDSS Case ID State ID Date of Birth Age Taking complement inhibitor F G Indication for complement inhibitor treatment Specify other indication TX-DSHS-19-1309-A-002587 Complement inhibitor cases H I Date complement inhibitor treatment started Date complement inhibitor treatment ended J K Hospitalized? Number of days hospitalized L M N O P Q Sequelae? Specify sequelae Was the patient taking antibiotics at the time of disease onset? Antibiotic name Date antibiotic started Daily dose 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 TX-DSHS-19-1309-A-002588 Complement inhibitor cases 45 46 47 48 49 50 51 52 A B C D E F G TX-DSHS-19-1309-A-002589 Complement inhibitor cases 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 A yes no unknown survived died unknown confirmed probable B C A B C E W X Y NG Other Unknown male female unknown Menactra (MenACWY-D/MCV4P) Menveo (MenACWY-CRM/MCV4O) MenHibrix (Hib-MenCY-TT) Menomune (MPSV4) MCV4 Unknown Bexsero (MenB-4C) Trumenba (MenB-FHbp) MenB Unknown Unknown positive negative unknown culture/biochemical testing PCR MALDI-TOF other unknown Slide agglutination PCR WGS Other D E F Heterosexual/Straight Homosexual/Gay Bisexual Other Unknown Refused G H Males only Females only Both Males and Females Not sexually active Unknown Refused Freshman Sophomore Junior Senior Graduate Student Other Unknown On Campus Off Campus Unknown Yes, petechiae Yes, purpura Yes, type unknown Yes, other type No Unknown TX-DSHS-19-1309-A-002590 Drop down options 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 I Paroxysmal nocturnal hemoglobinuria (PNH) Atypical hemolytic uremic syndrome (aHUS) Generalized myasthenia gravis (gMG) Other Unknown TX-DSHS-19-1309-A-002591 Drop down options Protocol for Enhanced Meningococcal Disease Surveillance for the ELC VPD Surveillance Coordination Jurisdictions Last Updated: 06/28/19 TX-DSHS-19-1309-A-002592 Contents Background ...............................................................................................................................................3 CDC Personnel .........................................................................................................................................3 Supplemental Data Instructions ................................................................................................................4 Data Security and Sharing ......................................................................................................................11 Data Submission, Storage, and Access at CDC .................................................................................11 Sharing and Storing Data on HIV Status – Guidance for Jurisdictions................................................11 Data Release ..........................................................................................................................................12 Strain Sharing Policy...............................................................................................................................12 Isolate Submission Instructions...............................................................................................................13 Data and Isolate Shipping Schedule .......................................................................................................14 Background TX-DSHS-19-1309-A-002593 The main purpose of the meningococcal disease portion of the Epidemiology and Laboratory Capacity (ELC) Vaccine Preventable Diseases (VPD) surveillance coordination project is to enhance meningococcal disease surveillance to help CDC address key and pressing epidemiology and vaccine policy questions, and to monitor the impact of meningococcal vaccines on disease burden in the United States. Because the incidence of meningococcal disease has fallen to historic lows, surveillance and evaluations of vaccine effectiveness and impact have become increasingly more challenging through our existing surveillance systems and infrastructure. For example, National Notifiable Diseases Surveillance System (NNDSS) is missing data for key variables (e.g., serogroup, case outcome) from several states because of data transmission issues. NNDSS is also limited in terms of adding additional variables to answer timely and important policy questions. The goal of this project is to build on existing surveillance systems to enhance meningococcal disease surveillance data available to CDC and to build the infrastructure for evaluations of vaccine effectiveness. Data collected from this project will be used to inform key upcoming vaccine policy decisions and to evaluate new and existing Advisory Committee on Immunization Practices (ACIP) vaccine recommendations. In particular, data collected on HIV status will allow us to assess the impact of the recent ACIP recommendation for use of MenACWY vaccination in HIV-infected persons. Isolates collected through this project will be important for monitoring coverage of the newly licensed serogroup B meningococcal vaccines for strains circulating in the United States, and to monitor any changes in circulating strains due to the introduction of the serogroup B meningococcal vaccines. Note: This protocol addresses only new procedures specific to the Enhanced Meningococcal Disease Surveillance Project. Additional information on meningococcal disease surveillance can be found in the Meningococcal Disease chapter of the Manual for the Surveillance of Vaccine-Preventable Diseases, available at: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. CDC Personnel Lucy McNamara, Principal Investigator xdf4@cdc.gov 404-639-8743 Amy Blain, Surveillance Coordinator wgi9@cdc.gov 404-639-2563 Questions may also be directed to meningnet@cdc.gov. TX-DSHS-19-1309-A-002594 Supplemental Data Instructions Sites should submit the following variables to CDC via the provided MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet through the secure FTP site. Only enter a ‘yes’/‘no’ response if status is known. Please only leave variables blank where they do not apply (college student/MSM outside of defined age/sex group), otherwise enter ‘unknown’. At the end of each year, all jurisdictions will be asked to review all unknown responses to ensure that all available data have been sent to CDC. Jurisdictions will also be asked to review the outbreak status of all cases to ensure they were categorized correctly. Variable name Definition Special Instructions Reason for Collection NNDSS Case ID Unique case ID transmitted to CDC in NNDSS. This may be auto generated at your state and may be different from the State ID used to identify cases in your state system. This ID is 6 digits at CDC, so if this ID is longer at your state, we are likely receiving the last 6 digits. Having this Case ID will allow direct linkage to the NNDSS data so data will no longer need to be matched based on date of birth and event date. State ID Unique ID number for each case used in your state. This may be the same as the NNDSS case ID. The unique ID used by your state lab. This column should match the shipping spreadsheet state ID column. Complete only if an isolate was sent to CDC. This ID may be the same as the State ID, but in most cases, a different ID is being received on the shipping spreadsheet than on the supplemental data spreadsheet. Date of birth is preferred if known Having laboratory ID will allow direct linkage between the lab and epi data so data will no longer need to be matched based on date of birth and event date. Laboratory ID Date of Birth or Age MM/DD/YYYY or age in years In the event that the NNDSS ID is not available, or does not match what is received at CDC, this is one of the variables used to match to NNDSS data. TX-DSHS-19-1309-A-002595 Case Status Please select confirmed or probable based on the CSTE case definition. (https://wwwn.cdc.gov/nndss/conditions/meningococcaldisease/case-definition/2015/) Only confirmed and probable cases need to be reported on the spreadsheet Event Date MM/DD/YYYY This should match the event date variable in NNDSS. Lab confirmation method Laboratory method used to diagnose/confirm the case. Please select culture/biochemical testing, PCR, MALDI-TOF, other, or unknown. If more than one method was used, select the method based on the following algorithm: In the event that the NNDSS ID is not available, or does not match what is received at CDC, this is one of the variables used to match to NNDSS data. · Source Source of positive isolate/specimen (e.g. blood, CSF) Test used to serogroup Please select slide agglutination, PCR, whole genome sequencing (WGS), or other. Serogroup Meningococcal serogroup – A, B, C, E, W, X, Y, NG (nongroupable), other, or unknown. Please select survived or died Outcome If the case was confirmed by culture, select culture regardless of other methods used · If the case was not confirmed by culture but was positive by PCR, select PCR regardless of other methods used If positive isolates/specimens are obtained from multiple sources, please list all Leave blank if serogroup is unknown. Allows us to track casefatality rate overall, by serogroup, and in specific populations. We will be reviewing all TX-DSHS-19-1309-A-002596 Outbreak/cluster related Outbreaks will be defined as 2-3 cases of the same serogroup in an organization in <3 months OR incidence above expected of the same serogroup in the affected community or specific population in a community. https://www.cdc.gov/meningococcal/downloads/meningococcaloutbreak-guidance.pdf MSM (men who have sex with men) Because the first cases from an outbreak/cluster may not be correctly categorized as outbreak/cluster related, we are asking sites to review cases at the end of each year and update this variable as needed. Complete these variables for any cases 16 years of age and older who were reported as male to NNDSS. Sex of sex partners During the past 12 months, have you had sex with only males, only females, or with both males and females? MSM not otherwise specified · Males only · Females only · Both Males and Females · Not sexually active · Unknown · Refused Select ‘Yes’ for this variable if MSM is noted somewhere (e.g. in hospital chart), but it is not known whether this was determined based on sexual behavior. Complete these variables for any cases 16 years of age and older who were reported as male to NNDSS. cases with missing outcome at the end of the year to ensure we have the most complete information. While we usually hear about outbreaks in real time, we want to collect this variable on all cases to ensure that all cases are being categorized correctly. This information may inform vaccination policy decisions and facilitate collection of information on outbreak responses. MSM are increasingly being recognized as at greater risk for meningococcal disease compared to other men, and several meningococcal disease outbreaks have been reported among MSM populations in recent years.1-4 While we likely capture most outbreak cases occurring among MSM, in order to fully understand the risk factors associated with meningococcal disease TX-DSHS-19-1309-A-002597 Select ‘No’ for this variable if this person is known to not be MSM. in this population, we need to also capture MSM status on all sporadic cases. Select ‘Unknown’ for this variable if MSM status is unknown. We are now collecting these separate variables to better differentiate between sexual behavior and other reasons cases may be identified as MSM. HIV status Please select positive, negative, or unknown. Please only select ‘negative’ if you have verified that the patient was tested and found to be HIV-negative at or after the time of meningococcal disease onset. Otherwise a response of ‘unknown’ is preferred. We strongly encourage jurisdictions to coordinate with their jurisdiction HIV surveillance program colleagues in order to obtain more complete information on HIV status for all meningococcal disease cases. The HIV program should only provide HIV status information (and not other variables or behavioral information) for meningococcal disease cases. Data on HIV status will allow us to assess the impact of the recent ACIP recommendation for use of MenACWY vaccination in HIVinfected persons. Meningococcal disease surveillance staff should contact local HIV surveillance program staff directly to coordinate data sharing in TX-DSHS-19-1309-A-002598 accordance with local laws/regulations and data sharing and security policies. A data sharing agreement or data use agreement is recommended. Methods, security measures and frequency of data sharing should be agreed upon by programs. At a minimum, jurisdictions should send HIV status information for all meningococcal cases that occurred during the previous calendar year by the close of each funding cycle (July). For more information on handling HIV data, please see the data sharing and security section below. Homeless An individual who: lacks a fixed, regular, and adequate nighttime residence; has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation, including a car, park, abandoned building, bus or train station, airport, or camping ground; is living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements (including hotels and motels paid for by Federal, State or local government programs for lowincome individuals or by charitable organizations, congregate shelters, and transitional housing).5 Outbreaks have been reported in multiple cities in recent years among persons experiencing homelessness. This variable will provide information on sporadic cases in this population as well as a routine way of capturing these outbreaks. TX-DSHS-19-1309-A-002599 College student Case attending a college or university at the time of disease onset. Complete this variable for cases aged 15-24 years only. Year in school What was the student’s year in school at the time of disease onset? · Freshman · Sophomore · Junior · Senior · Graduate Student · Other · Unknown Where did the student live at the time of disease onset? · On Campus · Off Campus · Unknown Did the student participate in Greek life (fraternities or sororities)? · Yes · No · Unknown Case taking either: Complete these variables only for college students. Residence type Greek life Taking complement inhibitor · Eculizumab/Soliris at the time of disease onset or up to 3 months prior to disease onset. · Ravulizumab/Ultomiris at the time of disease onset or up to 8 months prior to disease onset. These variables are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. These variables are included as a convenience for jurisdictions who choose to participate in this supplemental data collection. If the patient has taken both eculizumab and ravulizumab, please select the one taken most recently. The second tab of the supplemental data spreadsheet should also be completed for any cases identified as taking eculizumab/Soliris or ravulizumab/Ultomiris. This replaces the previous supplemental case report form for these cases to streamline data collection. Several outbreaks of serogroup B meningococcal disease have been reported on university campuses in recent years. A recent analysis showed differences in risk associated with year in school and residence type, as well as with greek life participation during outbreaks; however additional information is needed especially for sporadic cases.6 This information will inform ACIP work group discussions around meningococcal vaccine policy. Eculizumab (Soliris®) is a complement component inhibitor used for treatment of paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), and generalized myasthenia gravis (gMG). Ravulizumab (Ultomiris®) is a modified version of eculizumab with a longer half-life; it is licensed for treatment TX-DSHS-19-1309-A-002600 Symptoms These variables are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. This is included as a convenience for jurisdictions who choose to participate in this supplemental data collection. of PNH. Eculizumab and ravulizumab have FDA boxed warnings for increased risk of serious meningococcal infection (~2000 times greater risk for meningococcal disease compared to healthy individuals). For all symptoms except rash, select ‘Yes’ if the symptom is associated with the current episode of meningococcal disease. For rash, if rash is present please select the appropriate rash type if known. The United Kingdom and Chile have recently reported increases in serogroup W meningococcal disease; many of these serogroup W cases first presented with GI symptoms instead of more typical meningococcal disease symptoms.7-10 Because of this, some cases were initially misdiagnosed when first presenting for care. We have also observed a high proportion of cases with GI symptoms in one serogroup W cluster in the US. For this reason, we are interested in learning if Headache Fever Include subjective as well as measured fever Stiff Neck Rash11 Did the patient have a rash, if yes, what kind of rash? · · · · · · Yes, petechiae Yes, purpura Yes, type unknown Yes, other type No Unknown If multiple rash types are present, please select the most severe type based on the following hierarchy: purpura > petechiae > other. Photophobia TX-DSHS-19-1309-A-002601 Nausea similar symptoms are being observed nationally or for other serogroups. In order to asses if the GI symptoms are presenting along with or instead of typical meningococcal disease symptoms, we need to collect typical symptoms as well. Vomiting Diarrhea Sore throat Other Vaccination history Include any other symptoms not listed above associated with the current episode of meningococcal disease. Please include MenACWY vaccines, MenB vaccines, and unknown meningococcal vaccine type. Please only select ‘No’ if you have verified non-receipt of meningococcal vaccines; a response of ‘unknown’ is preferred. If vaccine type is unknown, select ‘unknown’ for both the “Received quadrivalent vaccine?” and “Received Serogroup B vaccine?” questions. Complete the vaccine information columns, selecting ‘unknown’ for the vaccine name for each dose with unknown type. Collecting meningococcal vaccination history on all cases will allow us to monitor for breakthrough cases. VPD coordinators should collaborate with their immunization program to facilitate access to immunization information systems for assessing meningococcal vaccination status for cases. 1. 2. 3. 4. Folaranmi TA, Kretz CB, Kamiya H, MacNeil JR, Whaley MJ, Blain A, et al. Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015. Clin Infect Dis. 2017; 65(5):756-63. doi: 10.1093/cid/cix438.. Aubert L, Taha M, Boo N, Le Strat Y, Deghmane AE, Sanna A, et al. Serogroup C invasive meningococcal disease among men who have sex with men and in gay-oriented social venues in the Paris region: July 2013 to December 2014. Euro Surveill. 2015; 20(3). PubMed PMID: 25635319. Marcus U, Vogel U, Schubert A, Claus H, Baetzing-Feigenbaum J, Hellenbrand W, et al. A cluster of invasive meningococcal disease in young men who have sex with men in Berlin, October 2012 to May 2013. Euro Surveill. 2013; 18(28). PubMed PMID: 23870095. Centers for Disease Control and Prevention. Guidance for the Evaluation and Public Health Management of Suspected Outbreaks of Meningococcal Disease. 2017. TX-DSHS-19-1309-A-002602 5. Department of Housing and Urban Development. Homeless Emergency Assistance and Rapid Transition to Housing: Defining ‘‘Homeless’’. 2011. https://www.hudexchange.info/resource/1928/hearth-defining-homeless-final-rule/ 6. Weil LM, Blain A, Soeters HM, Mbaeyi SA, Hariri S, McNamara LA. Characterizing Potential Risk Factors for Serogroup B Meningococcal Disease Among College Students — United States, 2014– 2017. Oral presentation presented at: Council of State and Territorial Epidemiologists Annual Conference; June 2- June 6; Raleigh, North Carolina. 7. Ladhani S.N., Beebeejaun K., Lucidarme J., Campbell H., Gray S., Kaczmarski E. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2015; 60:578–585. 8. Cameron C, McDonald E, Smith-Palmer A, et al. Increased incidence of Meningococcal serogroup W in Scotland in 2015. Poster presented at: International Pathogenic Neisseria Conference; 5 Sep- 9 Sep; Manchester, UK. 9. Camphell H, Parikh S, Beebeejaun K, et al. Symptoms and diagnoses of invasive meningococcal disease in England 2014. Poster presented at: International Pathogenic Neisseria Conference; 5 Sep9 Sep; Manchester, UK. 10. Moreno G, López D, Vergara N, Gallegos D, Advis MF, Loayza S. Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile. [Clinical characterization of cases with meningococcal disease by W135 group in Chile, 2012]. Rev Chilena Infectol. 2013; 30(4):350-60. 11. For more information on rash types, please see: Centers for Disease Control and Prevention. Definitions of Symptoms for Reportable Illnesses. 2017. https://www.cdc.gov/quarantine/air/reportingdeaths-illness/definitions-symptoms-reportable-illnesses.html TX-DSHS-19-1309-A-002603 Data Security and Sharing All data submitted to CDC for this project are handled and stored according to the NNDSS data use agreement (see Appendix 1). Because we are collecting HIV status of cases, data will also be transmitted and stored in a manner consistent with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) policies.10 Data Submission, Storage, and Access at CDC The MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet will be transmitted through an encrypted secure FTP site to CDC and will be stored on a restricted access shared drive at CDC; access to the FTP site and share drive will be granted solely to meningococcal disease surveillance program personnel, who adhere to all non-disclosure agreements associated with personally identifiable information and other notifiable disease data. Jurisdiction meningococcal disease surveillance staff should encrypt their data before uploading to the FTP site using WinZip (version 28.5 or higher) or SecureZip. If your jurisdiction does not have access to this software, please contact the CDC meningococcal disease surveillance staff for additional guidance. Sites submitting through the secure FTP site will have no ability to access data from other jurisdictions. These procedures have been approved by the Information Systems Security Officer (ISSO) for NCIRD. Sharing and Storing Data on HIV Status – Guidance for Jurisdictions When working with their jurisdiction’s HIV surveillance program to obtain HIV status of meningococcal disease cases, VPD coordinators should ensure they are maintaining the confidentiality of these sensitive data. It is the responsibility of each jurisdiction to determine the appropriate procedures for ensuring data confidentiality in accordance with local policies, laws and regulations. In general, however, we suggest: · HIV status information should be shared in person, by phone, or through secure electronic methods (e.g.an encrypted data transfer mechanism) approved by the jurisdiction’s HIV surveillance program’s Overall Responsible Party (ORP). · Matching procedures will vary by site, but in general the meningococcal disease surveillance program will need to provide name, date of birth, and sex to the HIV program for all meningococcal disease cases to confirm identity. Date of meningococcal disease onset will also need to be shared with the HIV surveillance program to obtain accurate information on HIV status at the time of onset. · Data on the same individual from meningococcal disease and HIV surveillance systems should be matched in such a way that VPD surveillance staff receive information on HIV infection status only for individuals who developed meningococcal disease and do not receive information on any other variables from the HIV surveillance system. No other variables should be completed or verified for the supplemental spreadsheet using HIV Surveillance data. Given the small number of meningococcal disease cases in each jurisdiction, manual lookup of each meningococcal disease case by HIV surveillance staff may be feasible to ensure the minimum necessary information is shared. · Data on HIV status, whether hard copy or electronic, should be kept in a physically secure, accesscontrolled environment in accordance with CDC Data Security and Confidentiality Guidelines for HIV.10 All staff with access to these data should complete any data security and confidentiality training and sign any non-disclosure/confidentiality agreements typically required of jurisdiction HIV surveillance program staff. · A data sharing agreement should be established and both the VPD and HIV surveillance programs should ensure adherence to the CDC Data security and confidentiality guidelines for HIV, viral hepatitis, sexually transmitted disease, and tuberculosis programs: standards to facilitate sharing and use of surveillance data for public health action.12 See Appendix 2 for a sample template for a data sharing agreement. Jurisdictions may use their own format, but below is an outline of the key elements to be included: TX-DSHS-19-1309-A-002604 - Intent and scope of data sharing Potential benefits (including projected efficiencies) and risks of sharing, benefits and risks of not sharing, and methods to monitor these benefits and risks Methods that will be used to share data and roles and responsibilities of staff involved Minimum data elements needed to achieve the objective(s), including need for PII Steps that will be taken to ensure the confidentiality and security of shared data Provisions for physical and electronic security How shared data will be used, analyzed, published, released, and retained/destroyed Confidentiality agreements Knowledge and training requirements including annual training for staff who have access to PII and non-PII data · Data on HIV status of meningococcal disease cases can be used internally by the jurisdiction and shared with CDC’s Meningitis and Vaccine Preventable Diseases Branch. Any other release or use of HIV status data by the jurisdiction VPD surveillance program should be pre-approved by the jurisdiction HIV surveillance program. · Data will be reported to CDC’s Meningitis and Vaccine Preventable Disease Branch using the secure methods described above and will be reported without names. Only the data elements outlined in the supplemental data spreadsheet will be included. 12. Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action. https://www.cdc.gov/nchhstp/programintegration/docs/PCSIDataSecurityGuidelines.pdf Data Release Information collected through this project will only be published in aggregate. Data will be published on the CDC website in the form of an annual surveillance report.13 Data may also be used for epidemiological analyses which may be presented to the ACIP and at scientific conferences and may be published in scientific journals. To ensure patient confidentiality, data on HIV infection status of meningococcal disease cases will never be released on a geographic level lower than national – i.e. no state or county-level HIV infection status data will be released in any format. 13. https://www.cdc.gov/meningococcal/downloads/NCIRD-EMS-Report.pdf Strain Sharing Policy Samples transferred to the CDC for testing or any other purpose will become the legal property of the agency unless otherwise agreed upon in writing. Samples will not be returned to the submitting entity. TX-DSHS-19-1309-A-002605 Isolate Submission Instructions We are requesting all meningococcal isolates (all serogroups, all age groups) from confirmed meningococcal disease cases be submitted to CDC. If the isolate was previously submitted to CDC, you do not need to resend unless requested specifically. The variables requested on the shipping spreadsheet will include: State ID: ID assigned by the state; used to link lab and national/supplemental data Accession #: ID assigned by the state lab; usually the state lab accession or identification # Specimen source: Sterile site source of isolate Culture date: Date of collection of the isolate Date sent to CDC: Date the isolate will be sent to CDC State serogroup: State laboratory results for serogroup for N. meningitidis Test used to serogroup: List method used by state laboratory to serogroup (PCR, SASG, etc.) Viable: Indicate if viable at site lab. Enter ‘yes’ if isolate is viable and ‘no’ if isolate is nonviable DOB: Date of birth of the case patient; or age in years at disease onset (if DOB is not available) Previously submitted: Please indicate if the isolate has previously been submitted to CDC (e.g. for rapid testing due to a suspected outbreak) Date previously submitted: If previously submitted, please indicate the date it was previously submitted and the reference center it was submitted to Shipping instructions: 1. All vials should be labeled with the accession # and state ID as listed on the Excel shipping spreadsheet. a. Labels that can withstand dry ice and water should be used. Large labels that require “flagging” (i.e., those where the label wraps around and the excess length is stuck to itself) should not be used as they can rip and samples could be misidentified. b. Slants: Labels should contain the date inoculated in addition to the state ID and accession #. c. All non-viable isolates should be sent in the original primary tube/vial and labeled with the state ID and accession #. 2. Sample Preparation and Transport Conditions: a. All N. meningitidis isolates should be pure, fresh cultures. Frozen stock or slant shipments are preferred. b. Frozen stocks: If more than 10 isolates are being shipped, all isolates should be sent frozen. Collect the isolate’s overnight growth from the agar plate with a sterile swab and resuspend bacteria in an appropriate freezer medium (such as TSB with 15% glycerol or defibrinated sheep blood). Frozen isolates should be shipped with DRY ICE. c. Slants: Inoculate cultures on chocolate agar slants and incubate overnight at @ 37oC in a 5% CO2 atmosphere. After overnight incubation, inoculated slants can be sent at ROOM TEMPERATURE. d. Silica gel packages: If shipping on silica, collect the isolate’s overnight growth from the agar plate with a sterile swab. The swab should then be placed into the silica gel package and shipped with ICE PACKS. If ice packs are not available, ship the isolates at ROOM TEMPERATURE. DO NOT use dry ice. 3. Viable and non-viable isolates may be shipped together in the same package. 4. The completed ENHANCED MENINGOCOCCAL DISEASE SURVEILLANCE SHIPPING SPREADSHEET must be e-mailed to CDC before a shipment is sent (meningnet@cdc.gov) and a hard copy of the spreadsheet must also be included in every isolate shipment. 5. Isolates should be shipped by FedEx or Express mail, category B. All isolates should be sent in compliance with shipping regulations for infectious substances. Additionally, each package should have the following written on the outside of the package: “DO NOT expose to extreme temperatures”. If shipping via FedEx, no shippers’ declaration required Address: ATTN: STAT Lab c/o Bacterial Meningitis Laboratory Unit 10/44 Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Laboratory Contact: Melissa Whaley or Caelin Potts E-mail: dbq3@cdc.gov and lyi3@cdc.gov Tel: (404) 639-3920 and (404) 718-5532 TX-DSHS-19-1309-A-002606 Data and Isolate Shipping Schedule Please send both the MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet and the ENHANCED MENINGOCOCCAL DISEASE SURVEILLANCE SHIPPING SPREADSHEET and ship isolates to CDC during your site’s scheduled months below. Please submit data and isolates during the week of the 15th of your designated months. Submission Month October 2019 Arizona, California, Indiana, Kentucky, Maine, Missouri, New Jersey, New York, South Carolina, Utah November 2019 Alabama, Houston, Iowa, Kansas, Mississippi, Montana, New Hampshire, Oklahoma, Texas December 2019 Arkansas, Chicago, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Louisiana, Washington D.C., West Virginia January 2020 LA County, Massachusetts, Michigan, NYC, Palau, South Dakota, Tennessee, US Virgin Islands, Washington, Wyoming February 2020 Alaska, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Pennsylvania, Philadelphia, Puerto Rico, Rhode Island, Vermont, Virginia, Wisconsin [Connecticut, Maryland, Georgia, Minnesota, New Mexico]* Arizona, California, Indiana, Kentucky, Maine, Missouri, New Jersey, New York, South Carolina, Utah March 2020 April 2020 May 2020 June 2020 Alabama, Houston, Iowa, Kansas, Mississippi, Montana, New Hampshire, Oklahoma, Texas Arkansas, Chicago, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Louisiana, Washington D.C., West Virginia LA County, Massachusetts, Michigan, Palau, South Dakota, Tennessee, US Virgin Islands, Washington, Wyoming July 2020 Alaska, Nebraska, Nevada, North Carolina, North Dakota, NYC, Ohio, Pennsylvania, Philadelphia, Puerto Rico, Rhode Island, Vermont, Virginia, Wisconsin [Connecticut, Georgia, Maryland, Minnesota, New Mexico]* *Data only (Submit all isolates through ABCs) TX-DSHS-19-1309-A-002607 Quarterly Activity Summary for Vaccine-Preventable Diseases (VPDs) Surveillance Coordination Surveillance Coordination for NNDSS Vaccine Preventable Diseases and Enhanced Surveillance for Meningococcal Disease, Varicella, and Acute Flaccid Myelitis (ELC CoAg – Project O) Responses should briefly describe the status of VPD surveillance coordination activities in your jurisdiction. For each of the 7 strategies, select the progress level that best describes your jurisdiction’s current activity status (i.e., exceeds expectations, meets expectations, needs improvement) and provide a brief rationale (2-3 sentences) for the selection. You also have the option to describe specific successes and challenges related to each strategy. When completing this summary, it will be helpful to focus on the progress made toward specific activities proposed by your jurisdiction in the annual application for the ELC CoAg. Quarter being assessed: July 1 - September 30, 2019 Jurisdiction: Summary completed by: Strategy 1: Enhance investigation and outbreak response (1b) · Describe status of activities to: o Establish/maintain a VPD surveillance coordinator position that: § Supports surveillance for selected VPDs and related conditions for which surveillance is conducted through NNDSS or the ELC O Project; § Ensures the use and implementation of standard investigative questionnaires, data collection/sharing tools, and methods; § Leads/assists in the timely investigations of and data submissions for cases, clusters, and outbreaks; and § Engages in and evaluates ELC Project O activities. o Collect case data on key and enhanced variables, as described in CDC guidance. o Provide surveillance data to support evaluation of public health response to meningococcal disease (if applicable). o Ensure reporting sources inform state/local health departments of varicella outbreaks. Jurisdiction Status and Rationale Progress level selection for strategy 1: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 2: Improve surveillance and reporting (1c) · Describe status of activities to: o Develop, implement, and maintain surveillance systems. o Evaluate and enhance surveillance systems based on CDC guidelines. o Conduct regular assessment of surveillance data and implement processes to improve completeness, timeliness, and quality of case data (e.g., review surveillance indicator report to identify areas for improvement). TX-DSHS-19-1309-A-002608 1 o Facilitate coordination/exchange of surveillance data with CDC. (e.g., provide case notifications and other surveillance data reports to CDC with complete information on key and enhanced variables). Jurisdiction Status and Rationale Progress level selection for strategy 2: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 3: Enhance laboratory testing for surveillance and reporting (1d) · Describe status of activities to: o Support maintenance of the availability of appropriate surveillance testing capacity within jurisdiction public health laboratories, VPD Reference Centers, and/or CDC laboratories. o Implement a flexible plan for use and acquisition of laboratory supplies and testing that addresses changing needs/purposes for each disease/condition. o Collect isolates from confirmed and probable cases of meningococcal disease and test for serogroup and additional molecular characterization. Jurisdiction Status and Rationale Progress level selection for strategy 3: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 4: Improve laboratory coordination and outreach to improve efficiency (1f) · Describe status of activities to: o Support linkage of laboratory specimens, isolates, and results with epidemiologic and clinical case-patient data. o Coordinate activities to increase access to specimens and isolates so that laboratory data are available to inform surveillance activities (e.g., ensure routine transportation of clinical isolates to jurisdiction public health or other lab). Jurisdiction Status and Rationale Progress level selection for strategy 4: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) TX-DSHS-19-1309-A-002609 2 Successes: Challenges: Strategy 5: Enhance coordination between partners between epi‐lab‐HIT (1g) · Describe status of activities to support and integrate epidemiology, laboratory, immunization, and health information activities (e.g., foster collaboration between VPD program and other public health programs to facilitate collection of key and enhanced variables, ensure coordination between partners to facilitate access to IIS data for assessing case vaccination status). Jurisdiction Status and Rationale Progress level selection for strategy 5: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 6: Sustain and/or enhance information systems (1i) · Describe status of activities to support VPD surveillance through coordination between epidemiology, laboratory, immunization, and health information systems (e.g., NNDSS, IIS, electronic lab reports, electronic case reports, HL7 messages) to enhance use and exchange of electronic data files. Jurisdiction Status and Rationale Progress level selection for strategy 6: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 7: Enhance coordination between partners (3a) · Describe status of activities to: o o o Foster collaboration among city, county, state, federal, and other internal and external partners to improve outbreak and case‐based reporting for VPDs and related conditions (e.g., AFM). Engage and collaborate with stakeholders by providing surveillance data to inform and support policies and public health evaluations for VPDs and related conditions (e.g., AFM). Communicate and coordinate with public health partners to ensure appropriate investigation, testing, and case‐based reporting for VPDs and related conditions (e.g., ensure public health partners receive ongoing training and education so they are informed of the importance of collecting the key variablesAFM). TX-DSHS-19-1309-A-002610 3 Jurisdiction Status and Rationale Progress level selection for strategy 7: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: TX-DSHS-19-1309-A-002611 4 Instructions for Completing the Varicella Outbreak Surveillance Reporting Worksheet GENERAL. Please complete the Varicella Outbreak Surveillance Reporting Worksheet to keep track of the number of cases associated with varicella clusters/outbreaks each year. Each case that is associated with a cluster (3-4 cases) or outbreak (5 or more cases) of varicella (epidemiologically linked), regardless of household status, should be listed in the line list on the ‘Outbreak Sheet’. Please keep a running list of cases for the year. Add outbreak cases for each new quarter of report to the previous list and submit the entire list each quarter. Please complete as much information as possible for each case. Listing each case and their information will help provide the data needed to assess characteristics of cases associated with varicella clusters/outbreaks to help guide control and prevention strategies. Reports should be submitted quarterly to CDC via email: alopez@cdc.gov or fax: 404-3153398. Cover Sheet SITE REPORTING. Select Grantee site from drop down menu. NAME OF PERSON REPORTING. Name of person completing worksheet. PHONE. Phone number of person completing worksheet. EMAIL. Email of person completing worksheet. QUARTER OF REPORT. Select the current reporting quarter. Quarters are based on the calendar year (January to December). 6. YEAR OF REPORT. Enter the year of report. 7. TOTAL NUMBER OF OUTBREAKS. Enter the cumulative number of outbreaks identified through current period of report. 1. 2. 3. 4. 5. Outbreak Sheet A. CASE #. This is to keep track of the total number of cases reported during the project year (August to July) and does NOT need to be changed. B. GRANTEE. Select Grantee site from drop down menu. C. OUTBREAK NAME OR ID. Name or ID given to the cluster/outbreak that the case is associated with. The outbreak name/ID is important because it will allow us to group together cases from the same cluster/outbreak, and will be used to generate information on cluster/outbreak size and duration. D. OUTBREAK SETTING. Select a setting for the cluster/outbreak from the drop down menu. If “other” is selected, please specify the setting in the cell. E. CASE ID. Grantee assigned ID for each case associated with cluster/outbreak. F. RASH ONSET DATE. Case-patient’s rash onset date. G. AGE. Case-patient’s age at time of illness. H. NUMBER OF LESIONS. Enter range of lesions for case-patient. Valid values include: <50, 50-249, 50-500, 250-499, ≥500, Unknown. Select from drop down menu. **If case-patient has <50 lesions, 1 Page of 2 (Nov 2015) TX-DSHS-19-1309-A-002612 I. J. K. L. M. N. O. P. Q. R. please enter the number of lesions in the cell, if known. ***Please only enter ‘unknown’ if number of lesions truly unknown. VACCINATED WITH VARICELLA CONTAINING VACCINE. Was case-patient vaccinated with varicella-containing vaccine? Select from drop down menu. IF VACCINATED, # OF DOSES. If case-patient vaccinated with varicella-containing vaccine, how many doses were received? Select from drop down menu. DATE OF VACCINATION (DOSE 1). Date of vaccination for dose 1 (MM/DD/YYYY), if known. DATE OF VACCINATION (DOSE 2). Date of vaccination for dose 2 (MM/DD/YYYY), if known. If ≥3 doses given, please provide dates of vaccination for additional doses in COMMENTS (column R). HISTORY OF VARICELLA DISEASE. Did the case-patient have varicella in the past, before this current episode? Select from drop down menu. HOW HISTORY OF DISEASE ASSESSED. If case-patient had history of varicella disease in the past, how was it assessed? Select from drop down menu. WAS CASE LABORATORY CONFIRMED. Was a specimen collected for laboratory confirmation and the case was laboratory-confirmed as having varicella? A case would be considered laboratoryconfirmed if (1) VZV was detected by PCR from a skin lesion (ideally vesicles or crusts/scabs), (2) positive VZV IgM, or (3) 4-fold rise in IgG antibody from acute to convalescent sera. Select from drop down menu. WAS CASE HOSPITALIZED. Was the case-patient hospitalized because of this illness? Select from drop down menu. COMPLICATIONS. Specify any complications that the case-patient experienced because of this illness. COMMENTS. List any other comments about this case-patient that are helpful, such as source of exposure, whether case-patient is in the same household as another case-patient that is part of the cluster/outbreak, immunocompromised status if known, did varicella illness result in death, other outbreak setting from those listed in drop down menu for OUTBREAK SETTING (column D), additional dates of vaccination if vaccinated with ≥3 doses, etc. 2 Page of 2 (Nov 2015) TX-DSHS-19-1309-A-002613 Data Element Priorities for Generic V2 7/2/2019 Priority 1 2 Data Element Name Local Subject ID Birth Date Subject’s Sex Race Category Subject Address State Subject Address ZIP Code Subject Address County Ethnic Group Deceased Date Local Record ID Date First Electronically Submitted Date of Electronic Case Notification to CDC Notification Result Status Condition Code Country of Birth Country of Usual Residence Date of Illness Onset Pregnancy Status Diagnosis Date Hospitalized Subject Died State Case Identifier Legacy Case Identifier Age at Case Investigation Age Unit at Case Investigation Case Disease Imported Code Imported Country Imported State Country of Exposure State or Province of Exposure Case Class Status Code Case Outbreak Indicator Case Outbreak Name Jurisdiction Code Date Reported MMWR Week MMWR Year Reporting State Reporting County National Reporting Jurisdiction Illness End Date Illness Duration Illness Duration Units Admission Date Discharge Date Duration of Hospital Stay in Days Binational Reporting Criteria Earliest Date Reported to County Earliest Date Reported to State Date First Reported to PHD TX-DSHS-19-1309-A-002614 3 Other Race Text Other Birth Place Imported City Imported County City of Exposure County of Exposure Transmission Mode Immediate National Notifiable Condition Reporting Source Type Code Reporting Source ZIP Code Person Reporting to CDC - Name Person Reporting to CDC - Phone Number Person Reporting to CDC - Email Case Investigation Start Date Date CDC Was First Verbally Notified of This Case Comment TX-DSHS-19-1309-A-002615 Data Element Priorities for H. influenzae 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Epi-Linked to a Laboratory-Confirmed Case Laboratory Testing Performed Laboratory Confirmed Test Type Specimen Type Specimen Collection Date/Time Organism Name Test Result Serotype Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine History Information Source Vaccine Information Source Indicator Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units Previous Contact With Hib Disease Hib Contact Type Previous Contact With Non-b or Nontypeable H. influenzae Case Non-b or Nontypeable Contact Type In Day Care Recurrent Disease with Same Pathogen Residence Premature Infant Test Method Serotype Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002616 3 Insurance Weight Weight Units Height Height Units Long Term Care Resident Case Investigation Status Code Previous State ID (Recurrent Case) Case Report Form Status Patient Address City ABCs State ID Test Result Quantitative Result Units Performing Laboratory Name Vaccine History Comments Susceptibility Test Antimicrobial Susceptibility Test Type Antimicrobial Susceptibility Test Interpretation Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002617 Data Element Priorities for N. meningitidis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Laboratory Testing Performed Laboratory Confirmed Test Type Organism Name Specimen Type Specimen Collection Date/Time Test Result Serogroup Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Name Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine History Information Source Vaccine Information Source Indicator Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Attending Higher Education College Grade in School College Living Situation Name of College/University Recurrent Disease with Same Pathogen Had Sex with a Male within the Past 12 Months Had Sex with a Female within the Past 12 Months Number of Male Sexual Partners HIV Status Homeless Signs and Symptoms Signs and Symptoms Indicator Eculizumab Residence Epi-Linked to a Laboratory-Confirmed Case Test Method Serogroup Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002618 3 Insurance Weight Weight Units Height Height Units Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units In Day Care Secondary Case Long Term Care Resident Case Investigation Status Code Previous State ID (Recurrent Case) Case Report Form Status Patient Address City ABCS State ID Test Result Quantitative Result Units Performing Laboratory Name Susceptibility Test Antimicrobial Susceptibility Test Type Antimicrobial Susceptibility Test Interpretation Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Vaccine History Comments Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002619 Data Element Priorities for IPD 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Epi-Linked Laboratory Testing Performed Laboratory Confirmed Test Type Specimen Type Specimen Collection Date/Time Organism Name Test Result Serotype Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Manufacturer Vaccine Dose Number Vaccine History Information Source Vaccine Information Source Indicator In Day Care Long Term Care Resident Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Hospital ICU Residence Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units Premature Infant Recurrent Disease with Same Pathogen Test Method Serotype Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units Susceptibility Test Oxacillin Zone Size Oxacillin Interpretation Antimicrobial Susceptibility Test Type Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Antimicrobial Susceptibility Test Interpretation Minimum Inhibitory Concentration Sign Antimicrobial Susceptibility Test Result Quantitative Value VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002620 3 Case Investigation Status Code Patient Address City Insurance ABCs State ID Previous State ID (Recurrent Case) Test Result Quantitative Result Units Performing Laboratory Name Vaccine History Comments Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002621 Data Element Priorities for Psittacosis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Signs and Symptoms Signs and Symptoms Indicator Laboratory Testing Performed Laboratory Confirmed Test Type Titer Test Type Titer Test Method Organism Name Test Result Specimen Type Specimen Collection Date/Time Test Result Quantitative Result Units Performing Laboratory Type Autopsy Specimen Type Result of Autopsy Date of Autopsy Autopsy Laboratory Name Occupation at Date of Onset Industry at Date of Onset Occupational Duties Contact Type Bird Type Bird Species Number of Birds Healthy Bird Non-Healthy Bird Details Type of Establishment Where Exposure Occurred Name of Establishment Where Exposure Occurred Address of Establishment Where Exposure Occurred Transmission Setting Date of Exposure Illness Onset Age Illness Onset Age Units Antibiotics Given Hospital ICU Performing Laboratory Name Test Manufacturer Date Specimen Sent to CDC Specimen Sent to CDC Chest X-ray for Pneumonia Date of Chest X-ray Personal Protective Equipment Respiratory Protective Equipment TX-DSHS-19-1309-A-002622 3 Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Highest Measured Temperature Temperature Units Medication Administered Medication Administered Dose Antibiotic Dose Units Date Treatment or Therapy Started Date Treatment or Therapy Stopped Treatment Duration Annual Respirator Fit Testing and Training Glove Material Case Investigation Status Code Patient Address City TX-DSHS-19-1309-A-002623 Data Element Priorities for Legionellosis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Legionella Diagnosis Illness Onset Age Illness Onset Age Units Nights Away From Home Name of Accommodation Street Address of Accommodation State of Accommodation City of Accommodation Country of Accommodation Accommodation Room Number Accommodation Comments Date Checked In to Accommodation Date Checked Out of Accommodation Zip Code of Accommodation Healthcare Setting Associated Healthcare Exposure Assisted/Senior Living Facility Test Type Specimen Type Test Result Performing Laboratory Type Hospital Name City of Treatment Hospital State of Treatment Hospital Transmission Setting Healthcare Setting Exposure Type Healthcare Facility Name Transplant Center Healthcare Facility Reason Visited Address of Healthcare Facility City of Healthcare Facility State of Facility Zip Code of Healthcare Facility Date Arrived at Healthcare Facility Date Departed Healthcare Facility Healthcare Setting Exposure Comments Associated Assisted/Senior Living Facility Exposure Assisted/Senior Living Facility Type Assisted/Senior Living Facility Exposure Type Assisted/Senior Living Facility Name Street Address of Assisted/Senior Living Facility City of Assisted/Senior Living Facility State of Assisted/Senior Living Facility Zip Code of Assisted/Senior Living Facility Date Arrived Assisted/Senior Living Facility Date Departed From The Assisted/Senior Living Facility Assisted/Senior Living Facility Comments Exposure Exposure Indicator Location of Exposure Date(s) of exposure Humidifier Respiratory Therapy Equipment Water Source Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Current Occupation Specimen Sent to CDC Specimen Collection Date/Time Organism Name Serogroup Date Specimen Sent to CDC TX-DSHS-19-1309-A-002624 3 Case Investigation Status Code Patient Address City Healthcare Facility Water Management Program Assisted/Senior Living Facility Water Management Program Recent Cruise Travel Name of Cruise Line Name of Ship Cruise Departure City Cruise Departure State Cruise Departure Country Date of Cruise Departure Cruise Return City Cruise Return State Cruise Return Country Date of Cruise Return Cabin Number Port of Call City Port of Call Country Port of Call State Port of Call Date CDC NORS Outbreak ID Current Occupation Standardized Current Industry Current Industry Standardized Titer Test Type Test Result Quantitative Result Units Performing Laboratory Name Test Manufacturer Test Brand Name TX-DSHS-19-1309-A-002625 Data Element Priorities for Generic V2 7/2/2019 Priority 1 Data Element Name Local Subject ID Birth Date Subject’s Sex Race Category Subject Address State Subject Address ZIP Code Subject Address County Ethnic Group Deceased Date Local Record ID Date First Electronically Submitted Date of Electronic Case Notification to CDC Notification Result Status Condition Code Country of Birth Country of Usual Residence Date of Illness Onset Pregnancy Status Diagnosis Date Hospitalized Subject Died State Case Identifier Legacy Case Identifier Age at Case Investigation Age Unit at Case Investigation Case Disease Imported Code Imported Country Imported State Country of Exposure State or Province of Exposure Case Class Status Code Case Outbreak Indicator Case Outbreak Name Jurisdiction Code Date Reported MMWR Week MMWR Year Reporting State Reporting County National Reporting Jurisdiction TX-DSHS-19-1309-A-002626 2 3 Illness End Date Illness Duration Illness Duration Units Duration of Hospital Stay in Days Binational Reporting Criteria Earliest Date Reported to County Earliest Date Reported to State Date First Reported to PHD Other Race Text Other Birth Place Admission Date Discharge Date Imported City Imported County City of Exposure County of Exposure Transmission Mode Immediate National Notifiable Condition Reporting Source Type Code Reporting Source ZIP Code Person Reporting to CDC - Name Person Reporting to CDC - Phone Number Person Reporting to CDC - Email Case Investigation Start Date Date CDC Was First Verbally Notified of This Case Comment TX-DSHS-19-1309-A-002627 Data Element Priorities for Measles 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Signs and Symptoms Signs and Symptoms Indicator Generalized Rash Rash Onset Date Rash Duration Age at Rash Onset Age Type at Rash Onset Highest Measured Temperature Temperature Units Type of Complication Type of Complications Indicator Transmission Setting Epi-Linked US Acquired Traceable to International Import Length of Time in the US Length of Time in the US Units Case Patient a Healthcare Worker Import Status Confirmation Method International Destination(s) of Recent Travel Date of Return From Travel Laboratory Testing Performed Laboratory Confirmed Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Number of Doses Received Before 1st Birthday Number of Doses Received On or After 1st Birthday Vaccination Doses Prior to Illness Onset Vaccinated Per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002628 2 3 Detection Method Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Fever Onset Chest X-ray for Pneumonia Patient Address City Age and Setting Verified Case Investigation Status Code Confirmation Date Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Sample Analyzed Date/ Time Date of Last Dose Prior to Illness Onset Vaccine History Comments TX-DSHS-19-1309-A-002629 Data Element Priorities for Rubella 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Signs and Symptoms Signs and Symptoms Indicator Rash Onset Date Rash Duration Highest Measured Temperature Temperature Units Type of Complication Type of Complications Indicator Age at Rash Onset Age Type at Rash Onset Part of Outbreak Transmission Setting Epi-Linked Traceable to International Import Confirmation Method Length of Time in the US Length of Time in the US Units US Acquired Case Patient a Healthcare Worker Import Status International Destination(s) of Recent Travel Date of Return From Travel Number of Weeks Gestation at Onset of Illness Trimester at Onset of Illness Documentation of Previous Disease Immunity Testing Result of Previous Immunity Testing Pregnancy Outcome At the time of cessation of pregnancy, What Was the Age of the Fetus (In Weeks) Was an Autopsy Performed Result of Autopsy Laboratory Testing Performed Laboratory Confirmed Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Number of Doses Received On or After 1st Birthday Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002630 2 3 Detection Method Year of Previous Immunity Testing Diagnosed With the Condition Before Previous Case Diagnosed By Was Previous Disease Serologically Confirmed Year of Previous Disease Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Fever Onset Cause of Death Age and Setting Verified Confirmation Date Case Investigation Status Code Patient Address City Expected Delivery Date Expected Place of Delivery Age of Subject at Time of Immunity Testing (in years) Age at Previous Diagnosis Age Units at Previous Diagnosis Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Specimen Analyzed Date/Time Date of Last Dose Prior to Illness Onset Vaccine History Comments TX-DSHS-19-1309-A-002631 Data Element Priorities for Congenital Rubella Syndrome 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Type of Complication Type of Complications Indicator Confirmation Method Birth State Did the Mother Have a Rash What was the Mother's Rash Onset Date Did the Mother Have a Fever What was the Mother's Fever Onset Date Gestational Age Age at Diagnosis Age (unit) at Diagnosis Mother's Birth Country Length of Time Mother Has Been in the US Mother's Country of Residence Was Prenatal Care Obtained For this Pregnancy Was There a Rubella-like Illness During This Pregnancy Month of Pregnancy in Which Symptoms First Occurred Rubella Lab Testing Mother Was Rubella Diagnosed By a Physician At Time of Illness Was Rubella Serologically Confirmed At Time of Illness US Acquired Did the Mother Travel Outside the US During the First Trimester of Pregnancy International Destination(s) of Recent Travel Date Left For Travel Date Returned From Travel Was the Mother Directly Exposed to a Confirmed Case If Mother Directly Exposed to a Confirmed Rubella Case, Specify the Relationship Mother's Date of Exposure to a Confirmed Rubella Case Laboratory Testing Performed Laboratory Confirmed Specimen From Mother or Infant Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did Mother Ever Receive a Vaccine Against This Disease Source of Mother's Vaccine Information Number of Doses Received On Or After 1st Birthday Date of Last Dose Prior to Illness Onset Vaccinated Per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002632 2 3 At the time of cessation of pregnancy, what was the age of the fetus (in weeks) Detection Method Mother's Rash Duration (in days) Mother's Fever Duration (in days) Did the Mother Have Arthralgia/Arthritis Did the Mother Have Lymphadenopathy Birth Weight Birth Weight (unit) Did the Mother Have Serological Testing Prior to This pregnancy Mother's Pre-Pregnancy Serological Test Date Mother's Pre-Pregnancy Serological Test Interpretation If Rubella Was Not Diagnosed By a Physician, Diagnosed By Whom Has Mother Given Birth In the US Previously Number of Total Live Births If Mother Has Given Birth in US, Number of Births Delivered in US Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Last Evaluation by a Healthcare Provider Primary Cause of Death from Death Certificate Secondary Cause of Death from Death Certificate Case Investigation Status Code Patient Address City Confirmation Date Clinical Case Appraisal Other Clinical Features of Maternal Illness Mother's Age at Delivery Mother's Age at Delivery (units) Did the Mother Attend a Family Planning Clinic Prior to Conception of This Infant Number of Children Less Than 18 Years of Age Living in Household During This Pregnancy Were Any of the Children Living in the Household Immunized With Rubella-Containing Vaccine Number of Children Less Than 18 Years of Age Immunized With the Rubella Vaccine Date of First Prenatal Visit for This Pregnancy Where was Prenatal Care For This Pregnancy Obtained Pregnancy Outcome Does the Mother Know Where She Might Have Been Exposed to Rubella If Mother Has Given Birth in US, List Dates (years) Number of Previous Pregnancies Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Specimen Analyzed Date/Time TX-DSHS-19-1309-A-002633 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 I B C D E F Varicella Outbreak Reporting Worksheet (Quarterly) G H I J I Site Reporting: I Name Person Reporting: I Phone: I Email: I Quarter of Report: I Year of Report: I Total Number outbreaks: I 15 16 17 I 18 Please e-mail or fax the Cover and Outbreak sheets to Adriana Lopez at CDC: alopez@cdc.gov or 404-315-3398. 19 IIf you have any questions please contact her by e-mail or phone: alopez@cdc.gov or 404-639-8369. 20 I (Nov 2015) 21 Varicella Outbreak Line List, Appendix 20, Surveillance Manual Cover Sheet TX-DSHS-19-1309-A-002634 #P - 1 A B C D E F G Outbreak Outbreak Rash Onset Case # Grantee Name or ID Setting Case ID* date Age 2 1 3 2 4 3 5 4 6 5 7 6 8 7 9 8 10 9 11 10 12 11 13 12 14 13 15 14 16 15 17 16 18 17 19 18 20 19 21 20 22 23 24 * Please list data for individual cases associated with outbreaks of ≥3 cases † Please list number of lesions as follows: <50 (list number if known), 50-249, 50-500, 25 250-500, >500, unknown ‡ If more than 2 doses of varicella vaccine received, please enter dates of vaccination 26 for additional doses in comments section 27 Please e-mail or fax the Cover and Outbreak Sheets to Adriana Lopez at CDC: 28 alopez@cdc.gov or 404-315-3398. If you have any questions please contact her by e-mail or phone: alopez@cdc.gov or 404-639-8369. 29 H I J K L M N Case Vaccination and Disease History before start of outbreak Vaccinated If with varicella vaccinated, History of How history of Number containing # of doses Date of Date of varicella disease of vaccine (1, 2, ≥3, vaccination vaccination disease (Yes, assessed Lesions† (Yes, No, Unk) Unk) (dose 1) (dose 2)‡ No, Unk) (Provider, Self) Outbreak Sheet TX-DSHS-19-1309-A-002635 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 O Was case laboratory confirmed? (Yes, No, Unk) P Q Was case hospitalized? Complications (specify) (Yes, No, Unk) R Comments (e.g., source of exposure, relationship between cases [siblings, classmates]) 25 26 27 28 29 Outbreak Sheet TX-DSHS-19-1309-A-002636 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 A B Elementary school Middle school High school Day care Mixed grade school College/University Correctional facility Group shelter Long term care facility Healthcare Community Other (specify in cell) C D E F <50 (specify exact # in Yes cell) 50-249 No 250-500 Unknown 50-500 >500 Unknown G H 1 2 ≥3 Unknown I J Provider Parent/self Sheet2 K L AK AL AR AZ CA CHI CO CT DE FL GA HOU HI ID IA IL IN KS KY LA LAC MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NY NYC NV OH OK OR PA PHI PR RI SC SD TN TX UT VA VT WA WI WV M N Aug-Oct Nov-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec TX-DSHS-19-1309-A-002637 56 57 58 59 60 61 62 63 A B C D E F G H I J Sheet2 K L M WY USVI GUA AMERICAN SAMOA NMI CNMI FSM PALAU N TX-DSHS-19-1309-A-002638 From: VPD Surv ELC (CDC) Sent: Monday, October 07, 2019 3:12 PM EDT To: Roush, Sandra (CDC/DDID/NCIRD/OD) CC: VPD Surv ELC (CDC) Subject: Update: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET Attachment(s): "For Jurisdictions - QSCAS Template v9 (FY18-19)-locked.docx","Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19.pdf","Summary of Measles Rubella and CRS Priorities 7 2 19.pdf","Enhanced Meningococcal Surveillance Protocol ELC VPD_v06282019.docx","Appendices for EMDS_07312018.docx","Data Collection Guidance Worksheet 06282019.pdf","Enhanced Meningococcal Disease Surveillance Supplemental Data_06282019.xlsx","Enhanced Meningococcal Disease Surveillance Shipping Spreadsheet_08132018.xls","Instructions for Completing the Varicella Outbreak Surveillance Worksheet August 2016.docx","Varicella outbreak surveillance reporting worksheet_Aug 2016.xlsx","NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15_ 2019 from 3_00-4_30 ET.ics" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. AllPlease note that the agenda for Mumps tier 2 activities has been updated (see below).No data submission deadline has yet been scheduled for the mumps activity. CDC will provide preliminary information related to the mumps activity during the October 15 call, with additional specific details following the call (e.g., the date of the ELC Tier 2 mumps activities kickoff call, an updated data collection tool/spreadsheet, data submission deadlines). Please let me know if you have any questions or concerns. ThanksBreanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Friday, October 4, 2019 10:07 AM To: VPD Surv ELC (CDC) Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) Subject: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET AllPlease save the date for the next NCIRD Quarterly All-Jurisdiction Vaccine Preventable Disease (VPD) Surveillance Call, which will take place on October 15, 2019 from 3:00-4:30pm ET. Call-in information and preliminary agenda are below. Additional attachments/slide sets may be forthcoming. Toll Free Number: 800-779-5184 Participant Passcode: 6296401 Following the entry of the passcode, please provide the requested details when prompted. Agenda for October 15, 2019 Quarterly All-Jurisdiction VPD Surveillance Call Time 3:00 – 3:10 3:10-3:30 3:30-3:35 Topic Surveillance Coordination Implementation of HL7 message mapping guide Meningococcal Disease Pertussis Haemophilus influenzae Speaker • Information General Surveillance Updates FY19 ELC CoAg Surveillance Indicators Recent communications Conferences Announcements/Reminders Action Item Surveillance Coordination Activity Summary deadlines (ELC CoAg) Sandy Roush Information Presentation: New Jersey’s activities to prepare for HL7 MMG implementation. Presentation: MMG implementation in NBS jurisdictions. Elizabeth Zaremski (NJ) & Michael Wodajo • • • • • • • • • Information Project Updates Action Item Meningococcal Disease: Supplemental data and isolates due to CDC on 15th of designated month (ELC CoAg) Pertussis: Tier 2 data and isolates due in January 2020 (ELC CoAg) H flu: Tier 2 data and isolates due the week of October • • • • • • • • Notes/Attachments • • Amy Blain • • For Jurisdictions - QSCAS Template v9locked.docx Data element Priorities for Implementation of the Mumps, Pertussis, and Varicella Massage Mapping Guides: https://wwwn.cdc.gov/nndss/casenotification/message-mapping-guides.html Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19 Summary of Measles Rubella and CRS Priorities 7 2 19 Enhanced Meningococcal Surveillance Protocol ELC VPD_v06282019.docx Appendices for EMDS_07312018.docx Data Collection Guidance Worksheet 06282019.pdf Enhanced Meningococcal Disease Surveillance Supplemental Data_06282019.xls Enhanced Meningococcal Disease Surveillance Shipping TX-DSHS-19-1309-A-002639 15, 2019 (ELC CoAg) 3:35-3:50 Spreadsheet_08132018.xls Acute Flaccid Myelitis Information Updates Varicella Action Items Varicella outbreak report deadline: October 10, 2019 (ELC CoAg) Varicella completeness report: due December 31 (ELC CoAg) Adriana Lopez Measles Information Presentation: Elimination status Nakia Clemmons & Jessica Anderson Mumps Action Items [: Mumps Tier 2 data: information to be provided by CDC mumps program (ELC CoAg) Presentation: CDC Guidance for mump outbreaks at universities • Adriana Lopez • • 3:50-3:55 • 3:55-4:05 • • Instructions for Completing the Varicella Outbreak Surveillance Worksheet August 2016.docx Varicella outbreak surveillance reporting worksheet_Aug 2016.xlsx . 4:05-4:20 Mariel Marlow • 4:20-4:30 Q&A Jurisdictions Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 TX-DSHS-19-1309-A-002640 Appendices for Enhanced Meningococcal Disease Surveillance for the ELC VPD Surveillance Coordination Jurisdictions Contents Appendix 1. NNDSS Data Use Agreement .....................................................................................................2 Appendix 2. Sample template for a data sharing agreement ........................................................................11 TX-DSHS-19-1309-A-002641 Appendix 1. NNDSS Data Use Agreement Division of Health Informatics and Surveillance (DHIS) Data Use and Access Plan for DHIS Nationally Notifiable Diseases Data Center for Surveillance, Epidemiology and Laboratory Services (CSELS) Centers for Disease Control and Prevention (CDC) Atlanta, GA 30333 Policy Last Revised: August 4, 2016 Program Contact: Umed Ajani, DHIS, CSELS Phone: (404) 498-0258 E-mail: uaa0@cdc.gov Table of Contents 1. Introduction 2. Program description 3. Nationally notifiable infectious diseases data collection 4. Privacy Act and private information in data reported to DHIS 5. Procedures for assuring data quality 6. DHIS data use 7. Procedures for maintaining security of information during data transmission and use 8. Procedures for maintaining privacy of information during publication 9. Procedures for data release (public use data sets) 10. Procedures for maintaining privacy of information in release of public use data sets 11. Sharing of DHIS nationally notifiable infectious disease data 12. Human subjects protection 1. Introduction This document summarizes the Division of Health Informatics and Surveillance (DHIS), Center for Surveillance, Epidemiology and Laboratory Services (CSELS), plan for receiving, securing, provisioning, publishing, and releasing nationally notifiable conditions data received from state, territorial and local jurisdictions for the National Notifiable Diseases Surveillance System (NNDSS) by electronic health information systems administered by DHIS. It also covers DHIS’s publishing data the Division receives from CDC programs for publication in the Morbidity and Mortality Weekly Report (MMWR (http://www.cdc.gov/mmwr/index.html) and the release of those data. DHIS receives notifiable NNDSS data from CDC programs that want DHIS to make their data available to the public through the CDC WONDER portal (http://wonder.cdc.gov/WelcomeT.html#NNDSS). The release of each of the CDC programs’ data on TX-DSHS-19-1309-A-002642 WONDER is based on guidance provided to DHIS by those programs and this document does not cover receiving, securing, and releasing those data. This plan has been developed in accordance with the CDC/ATSDR Policy on Public Health Research and Nonresearch data management and access (http://masoapplications.cdc.gov/Policy/Doc/policy385.pdf). CDC is the nation’s principal disease prevention and health promotion organization. In support of its mission, CDC collects, generates, stores, uses, and routinely provides access to public health data. Public health and scientific advancement are best served when public health data are released to, or shared with, other public health agencies, academic researchers, private researchers (if appropriate) and other partners in an open, timely, and appropriate way. CDC also recognizes the critical importance of maintaining standards of data quality; upholding individual and institutional privacy and confidentiality; protecting information based on national security concerns and law enforcement investigations and activities; supporting commitments made in data use agreements (DUAs) with organizations that provide data to CDC; protecting proprietary interests and business confidential information; protecting intellectual property rights; considering ethical matters; and ensuring impartiality in the sharing of public health data. This plan has also been developed with the recognition that CDC programs in the Center for Global Health (CGH), National Center for Chronic Disease Prevention and Control (NCCDPHP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), National Center for Environmental Health (NCEH), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), National Center for Immunization and Respiratory Disease (NCIRD), and National Institute for Occupational Safety and Health (NIOSH) have primary responsibility at CDC for surveillance of specific nationally notifiable conditions. These centers and programs also receive, secure, use, publish, and release and/or share their nationally notifiable conditions data in accord with their Centers’ guidance. In this document, the term “data release” means the dissemination of data for public-use so that CDC no longer controls the data. The term “data sharing” means granting certain individuals or organizations access to data that cannot be released publicly, for example, data that contain personally identifiable or potentially identifiable information. Office of Management and Budget (OMB) Memorandum M-07-16 defines personally identifiable information as “information that can be used to distinguish or trace an individual’s identity either alone or when combined with other personal or identifying information that is linked or associated with the individual.” The term “data provisioning” refers to DHIS’s providing conditionspecific data to the CDC programs responsible for national level surveillance, prevention and control for each condition. 2. Program Description DHIS’s receiving, securing, provisioning, publishing and releasing notifiable conditions data are components of NNDSS. NNDSS is a nationwide collaboration that enables all levels of public health—local, state, territorial, federal, and international—to share notifiable conditions-related health information. Public health uses this information to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable infectious and noninfectious diseases and conditions. Some additional information about NNDSS, including a brief description of data collection, is provided below in this document. More detailed information on NNDSS is available at: (http://wwwn.cdc.gov/nndss/). TX-DSHS-19-1309-A-002643 DHIS currently supports NNDSS by receiving, securing, processing, and provisioning nationally notifiable conditions data to specific CDC programs in CGH, NCEH, NCEZID, NCHHSTP, and NCIRD. DHIS also supports local, state, and territorial public health departments in their collection, management and submission of notifiable conditions case notification data to CDC for NNDSS. DHIS provides this support through funding, health information exchange standards and frameworks, electronic health information systems, and technical support through the NNDSS web site, tools, and training. Together, DHIS and the CDC programs prepare annual summaries of infectious and noninfectious diseases and conditions, which are published in the CDC MMWR. 3. Nationally Notifiable Diseases Data Collection A number of different legislative and regulatory decisions have authorized federal collection of notifiable disease data and given responsibility for that data collection to CDC (https://wwwn.cdc.gov/nndss/history.html). In 1961, responsibility for the collection of data on nationally notifiable diseases and deaths was transferred from the National Office of Vital Statistics to CDC. CDC is responsible for the dissemination of nationally notifiable diseases’ information, as authorized by the Public Health Service Act (42 USC 241) of January 4, 2012 Data collection for notifiable disease surveillance begins at the level of local, state, and territorial public health departments (also known as jurisdictions). Jurisdictional laws and regulations mandate reporting of cases of specified infectious and noninfectious conditions to health departments. The jurisdictions work with healthcare providers, laboratories, hospitals, and other partners to obtain the information needed to monitor, control, and prevent the occurrence and spread of these health conditions. CDC programs in CGH, NCCDPHP, NCEH, NCEZID, NCHHSTP, NCIRD, and NIOSH collaborate with the Council of State and Territorial Epidemiologists (CSTE) to determine which conditions reported to local, state, and territorial public health departments are nationally notifiable. CDC programs, in collaboration with subject matter experts in CSTE and in health departments, determine what data elements are included in national notifications. Core data elements, with common definitions, are collected for all of the conditions submitted to DHIS. The core data elements include the name of the condition; demographic data; administrative data such as the jurisdiction submitting the case; epidemiologic data; characteristics of the condition; and contact information for the person submitting the notification to CDC. For many of the conditions, the public health department may also submit data elements which are specific to the condition. The condition-specific data elements vary by condition and may include signs and symptoms, additional diagnostic data, treatment data, vaccination history, laboratory tests and results, and risk factors. Once CSTE makes a recommendation that a condition is nationally notifiable and CDC has obtained approval from the Office of Management and Budget for receipt of the data under the Paperwork Reduction Act, electronic data exchange systems are developed, and health departments participating in NNDSS may voluntarily submit notifications data to DHIS through DHIS-administered information systems or to other CDC programs responsible for those specific conditions. DHIS collaborates with CGH, NCEH, NCEZID, NCHHSTP, and NCIRD to develop and submit a request for OMB approval (OMB Control Number 09200728) for the NNDSS data submitted to CDC through DHIS systems. Jurisdiction transmission of data to DHIS is supported by several interconnected health information exchange frameworks and electronic information systems. Most case records are submitted electronically from jurisdiction information systems via automated electronic transfers through a secure network. TX-DSHS-19-1309-A-002644 Supplemental information may be received at DHIS by telephone, fax, mail, and email. Procedures for maintaining security of the data during transmission to DHIS are described in section 7 below. 4. Privacy Act and Personally Identifiable Information in Data Reported to DHIS The nationally notifiable conditions data received by DHIS contain sensitive personally identifiable health information (PII), which are subject to the Privacy Act. The Privacy Act is a Federal law that protects PII held by a federal agency in a system of records from which information is retrieved by an individual’s name, an identification number, or some other unique identifier assigned to the individual. The CDC Privacy Act System of Records Notice that covers NNDSS is 09-20-0136. This notice provides information to the public about the existence of the CDC research and surveillance systems covered by the notice, how data are used, how data are safeguarded, and how information may be disclosed (http://www.cdc.gov/SORNnotice/09-20-0136.htm/). The nationally notifiable conditions electronic records received by DHIS are stored at DHIS indefinitely. DHIS implements a number of safeguards to prevent the disclosure of PII and to prevent the identification of individuals when data are published, released or shared (Sections 7, 8, 10, and 12, below). 5. Procedures for Assuring Quality of Data A major purpose of the DHIS-administered information system is to provide mechanisms by which CDC may receive nationally notifiable conditions data submitted by local, territorial and state health departments through one organization (DHIS) and assess and assure the quality of the data. Electronic data sent to DHIS are defined by the applicable messaging, vocabulary, and programmatic standards. These data can go through validations ensuring the proper messaging structure of the data, content consistent with values identified in the Public Health Information Network (PHIN) Vocabulary Access and Distribution System (VADS) code sets, and conformance to programmatically defined business rules. On a weekly basis, DHIS staff evaluate the information submitted by the jurisdictions and review case reports for missing data elements, for inconsistencies among data elements and for data values that are not consistent with the values identified in the PHIN VADS code sets. When potential errors are identified, DHIS staff works with the individuals at the state or local health department who report the data to DHIS to resolve errors. Only data that meet data quality criteria are published or released. On an annual basis, DHIS staff work with the staff in state and territorial health departments and with staff in NCEZID, NCHHSTP, NCIRD, CGH, and NCEH to finalize reports of cases for that year. Final approval is obtained from the appropriate chief epidemiologist from each state or territory. Only data that meet data quality criteria are published or released. 6. DHIS Data Use DHIS conducts a number of different activities with the NNDSS data it receives from the jurisdictions. Data receipt, processing and quality assurance As noted in section 5 above, DHIS provides information systems and procedures by which the CDC may receive NNDSS data from the jurisdictions and DHIS administers data processing systems and conducts procedures to assure data quality. TX-DSHS-19-1309-A-002645 Data Provisioning A primary DHIS activity is to provision data for specific notifiable conditions to the CDC programs responsible for the conditions so those programs’ can use the data for their national surveillance activities. Publication of Data On a weekly basis, DHIS publishes in the MMWR weekly report the numbers of provisional cases of nationally notifiable infectious diseases submitted by the jurisdictions to DHIS during the current week. DHIS also includes in the MMWR weekly report numbers of provisional cases of a few notifiable infectious conditions provided to DHIS by CDC programs that receive notifiable conditions data from jurisdictions through other information systems. Once each year in the MMWR weekly, DHIS publishes a preliminary release (which DHIS calls an “early release”) of annual finalized notifiable infectious disease case counts for that year. At a later date, DHIS collaborates with the CDC infectious disease programs to publish a more detailed annual Summary of Notifiable Infectious Diseases and Conditions, United States. Annually, DHIS also collaborates with CDC noninfectious conditions and disease outbreaks programs to publish an annual summary of information previously published by the noninfectious conditions and disease outbreaks programs. That report is entitled the Annual Summary of Notifiable Noninfectious Conditions and Disease Outbreaks, United States. (Centers for Disease Control and Prevention. [Summary of Noninfectious Conditions and Disease Outbreaks]. Published October 23, 2015 for MMWR Morb Mortal Wkly Rep 2013;26(No.54): 1-89.) Data Release On a weekly basis, DHIS releases on Data.CDC.Gov de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR (https://data.cdc.gov/browse?q=NNDSS). On a weekly basis, DHIS releases on CDC WONDER de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR. (http://wonder.cdc.gov/mmwr/mmwrmorb.asp) On an annual basis, DHIS releases on CDC WONDER de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. http://wonder.cdc.gov/WelcomeT.html. On an annual basis, DHIS releases on Data.CDC.Gov de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. https://data.cdc.gov/browse?q=NNDSS (A more specific site will be provided once the first data are made available in 2016) In addition to the de-identified aggregated DHIS NNDSS data described above, CDC programs may make additional NNDSS data available on WONDER according to the condition-specific data use/data access guidelines of those programs. TX-DSHS-19-1309-A-002646 7. Procedures for Maintaining Security of Information during Data Transmission and Use The security of private information during electronic transmission from jurisdictions to DHIS is maintained by technologies (computers and servers) that use national public health standards for messaging systems which provide security mechanisms for jurisdictions to use when submitting data. Most case records are encrypted and submitted to DHIS electronically from already existing databases via automated electronic transfers through a secure network. Electronic data are transmitted to and processed within the electronic information system platforms. The electronic data are treated in a secure manner consistent with the technical, administrative, and operational controls required by the Federal Information Security Management Act of 2002 (FISMA). These systems are also in compliance with more recent standards to protect information: the NIST Recommended Security Controls for Federal Information Systems and Organizations, Special Publication 800-53, Revised May 1, 2013.On occasion, when electronic transmission is not possible or when public health departments prefer, weekly case counts are provided by telephone, fax, mail, and email, primarily to meet weekly deadlines for publication in the MMWR. For these non-electronic transmissions, no identifiers are included, and safeguards are implemented to ensure that information is received only by the appropriate staff at DHIS. DHIS provides nationally notifiable infectious disease data to CDC programs through secure electronic platforms. The CDC’s Office of the Chief Information Security Officer examines and validates the security controls during regularly scheduled Security Assessment and Authorization processes. All hard copy materials submitted to CDC are stored in locked cabinets in restricted access areas in buildings that require card key access. Potentially identifiable information will not be disclosed unless otherwise compelled by law. 8. Procedures for Maintaining Privacy during Publication of Infectious NND data received from the jurisdictions. In the MMWR publications and tables made available online, infectious notifiable condition case counts as low as 1 and rates as low as 0.01/100,000 are presented. The primary statistical disclosure rule for the publication and online tables is the limited disclosure of information in the tables, maps and graphics: • case counts and rates are presented for the nation, each of 9 regions (New England, Mid. Atlantic, E.N. Central, W.N. Central, S. Atlantic, E.S. Central, W.S. Central, Mountain, Pacific), each reporting jurisdiction, and for some conditions, counties; • at the national level counts and rates are presented by residency status (U.S. resident or not) and, for some conditions, birthplace (U.S. or not); • national counts and rates are presented by month, age group, sex, race, and ethnicity; • counts and rates are not presented for any combinations of location and/or demographic characteristics; and • no additional information about the cases is presented. An additional disclosure rule is that if the number of cases of a condition reported nationally is less than 25, national level counts and rates by race are not presented and neither are counts and rates by ethnicity. TX-DSHS-19-1309-A-002647 A. MMWR Weekly DHIS presents provisional weekly case counts: 1. Table 1 for each selected infrequently reported notifiable condition: a. national counts: the total number reported for that week, the cumulative number for the year, a 5-yr. weekly average number, and the total number reported for each of the previous 5 years; and b. total counts for each jurisdiction that reported one or more cases that week; In a few years, when reporting jurisdictions have implemented the ability to report counts by residency status, national counts will be stratified by residency status (U.S. resident/non-U.S. resident). 2. Figure 1: a graphic for a subset of selected conditions comparing that week’s 4-week cumulative national count with the mean of 15 4-week counts selected from each of the previous 5 years. 3. Table 2: for each of the selected other nationally notifiable conditions not published in Table 1, for the nation, region, and each reporting jurisdiction: Total counts reported for that week, median and maximum counts reported during the previous 52 weeks, and cumulative annual counts through the current week for both the current year and previous year. When reporting jurisdictions have implemented the ability to report counts by residency status, national counts will be stratified by residency status. B. Annual MMWR preliminary release. DHIS presents final annual case counts for the reporting year: Table 2 For each notifiable infectious condition: total case counts for the nation and for each HHS region and reporting jurisdiction, and for a subset of conditions counts for children under age 1, 5 or 18, depending on the condition. When counts are available by residency status, national counts will be stratified by residency status. C. Annual MMWR summary Part 1. Tables for the reporting year DHIS presents the following annual final case counts and rates for each condition: 1. Counts and incidence rates for the nation, each HHS Region, and each reporting jurisdiction. TX-DSHS-19-1309-A-002648 2. National counts and incidence rates by each of the following demographic characteristics of the cases: a. month of report (12 months and “not stated”), b. age group (in years: <1, 1-4, 5-14, 15-24, 25-39, 40-64, and >65, missing), c. sex (M, F, and “not-stated), d. race (American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, White, Other, and “not stated,” and e. ethnicity (Hispanic or Latino, Not Hispanic or Latino, and “not stated”). 3. National counts and rates will be stratified by residency status when counts are available by residency status. Part 2. Graphics DHIS presents the following annual final case counts and rates for selected conditions: 1. Graphs or maps with national regional, jurisdiction or county counts or incidence rates. 2. Graphs or maps with national level case counts or incidence rates by race-ethnicity, gender, or birthplace (US/non-US). Part 3. Historical Tables DHIS presents the following annual final case counts and rates for selected conditions: 1. Final annual national case counts and rates by year for selected infectious conditions. 2. Final annual national death counts for selected infectious conditions. 3. National counts will be stratified by residency status when counts are available by residency status. 9. Procedures for Data Release (Public Use Data Sets) DHIS releases downloadable, machine-readable public use data sets in two locations: On a weekly basis, DHIS releases on Data.CDC.Gov de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR (https://data.cdc.gov/browse?q=NNDSS). On a weekly basis, DHIS releases on CDC WONDER de-identified aggregated provisional case counts of notifiable infectious diseases in the same format as the tables published in MMWR. (http://wonder.cdc.gov/mmwr/mmwrmorb.asp) On an annual basis, DHIS releases on CDC WONDER de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. TX-DSHS-19-1309-A-002649 http://wonder.cdc.gov/WelcomeT.html (A more specific site will be given once the first data are made available in 2016). On an annual basis, DHIS releases on Data.CDC.Gov de-identified aggregated finalized notifiable infectious diseases data tables in the same formats as published in MMWR. https://data.cdc.gov/browse?q=NNDSS (A more specific site will be provided once the first data are made available in 2016) 10. Procedures for Maintaining Privacy of Information in Release of Public use Data Sets The procedures for protecting private information with the release of data are the same as those described for publication in section 8 above. 11. Sharing of nationally notifiable conditions data DHIS does not share nationally notifiable conditions data with individuals or organizations outside of CDC. When DHIS receives requests for data from individuals or organizations outside of CDC, DHIS notifies the requestor that the DHIS NNDSS program is unable to fill requests for specific datasets and that some NNDSS data are available on CDC WONDER (http://wonder.cdc.gov/) and DATA.CDC.GOV (https://data.cdc.gov/). In addition, DHIS provides a link to the web site of the CDC program that is responsible for surveillance of the condition for which data are requested and notes the availability of data and a program point of contact at that site. 12. Human Subjects Protection Public use data sets that are released by DHIS may be used for research. Because they are de-identified, they do not constitute “human subjects” under federal regulations (such as 45 CFR 46.102(f)). Therefore, institutional review board approval is not generally required under federal policy. TX-DSHS-19-1309-A-002650 Appendix 2. Sample template for a data sharing agreement This document contains a sample template for a data sharing agreement and use and disclosure of client information. Within the data sharing agreement there are important areas to consider for inclusion. At a minimum the agreement should specify the following: parties involved, including contact information; the purpose or need for the data sharing agreement; nature of the data to be collected; access and confidentiality of data; how the data is to be used; how and in what situations the agreement can be severed by either party; and relevant legal authorities (tribal, state, local, federal). DATA SHARING AGREEMENT between and ENTITIES RECEIVING AND PROVIDING DATA ENTITY RECEIVING DATA: OFFICE: CONTACT PERSON: TITLE: ADDRESS: PHONE NUMBER: EMAIL: FAX NUMBER: ENTITY PROVIDING DATA: CONTACT PERSON: ADDRESS: PHONE NUMBER: EMAIL: FAX NUMBER: TITLE: PURPOSE, AUTHORITY AND TERM OF AGREEMENT A. PURPOSE To facilitate the health of X agency or organization and Y Health Department are entering into an agreement which will allow the exchange of data and specification of data access and utilization. Y will provide data collected to X for the purposes of . B. LEGAL AUTHORITY 1. X is a whose mission is… 2. Y is an whose mission is for public benefit. TX-DSHS-19-1309-A-002651 C. PERIOD OF PERFORMANCE This Agreement shall be effective when signed by both parties and shall continue until terminated pursuant to the termination clause contained herein. DESCRIPTION OF DATA/DATA WORKPLAN The following data will be provided under this agreement: If applicable, all data generated by this project shall be approved for dissemination by the Institutional Review Board and . ACCESS TO DATA A. METHOD OF ACCESS AND TRANSFER Data will be obtained and/or accessed in the following manner: B. PERSONS HAVING ACCESS TO DATA All persons who will have access to data must complete a data privacy training through < specify >. Prior to the transfer of any data, staff members and researchers who will have access to the data shall sign , (signed copies shall be provided to X). C. FREQUENCY OF DATA EXCHANGE Data will be exchanged as needed to meet reporting requirements as well as on an ongoing basis between X and Y staff for the entire length of the project. SECURITY OF DATA Datasets containing protected health information (PHI) shall be encrypted or otherwise protected as specified. All reasonable precautions shall be taken to secure the data from individuals who do not specifically have authorized access. Data shall be kept on a password-protected file server located in a secure environment. Data will be kept in a separate directory on server which is also passwordprotected and will be accessible only by Y evaluators or staff members specifically authorized access as provided in this Agreement. CONFIDENTIALITY A. REGULATIONS COVERING CONFIDENTIALITY OF DATA The use and disclosure of information obtained under this contract shall be subject to . X and Y shall maintain the confidentiality of any information which may, in any manner, identify individual subjects. Confidentiality of all data must be ensured. B. NON-DISCLOSURE OF DATA Y shall not disclose, in whole or in part, the data described in this agreement to any individual or agency not specifically authorized by this agreement. Data shall be provided on a timely basis. Y will document uses and users of the data and will report this information routinely back to the X . TX-DSHS-19-1309-A-002652 C. Y will not disclose directly to, or use for the benefit of, any third party confidential information, knowledge or data acquired by virtue of its relationship with the other party named in this Agreement, without the prior written approval of the other party. It is understood and agreed by the parties that the obligations of this paragraph shall survive the expiration of termination of this Agreement. PROPERTY RIGHTS Original materials prepared by Y, including, without limitation: reports, proposals, analysis, writings, sound recordings, pictorial reproductions or materials of any type whatsoever, are and shall remain the of . Y will assert no right, claim or interest of any nature whatsoever with respect thereto, including specifically but, without limitation, any claim to statutory copyright. Data Use and Ownership X shall be cited as the source of the data in all tables, reports, presentations, and scientific papers, and Y shall be cited as the source of interpretations, calculations, and/or manipulations of the data. SEVERABILITY If any provision of this Agreement or any provision of any document incorporated by reference shall be held invalid, such invalidity shall not affect the other provisions of this Agreement which can be given effect without the invalid provision, if such remainder conforms to the requirement of applicable law and the fundamental purpose of this agreement, and to this end the provisions of this Agreement are declared to be severable. TERMINATION Either party may terminate this Agreement upon 30 days prior written notification to the other party. RIGHT OF INSPECTION Y shall provide X the right of access to its facilities at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this contract. ALL WRITINGS CONTAINED HEREIN This Agreement contains all the terms and conditions agreed upon by the parties. No other understandings, oral or otherwise, regarding the subject matter of this Agreement shall be deemed to exist or to bind any of the parties hereto. TX-DSHS-19-1309-A-002653 Organization X Name/Title ________________________ Date Name/Title ________________________ Date Organization Y Name/Title ________________________ Date Name/Title ________________________ Date TX-DSHS-19-1309-A-002654 USE AND DISCLOSURE OF CLIENT INFORMATION Staff with access to confidential client information are responsible for understanding rules for use rules of behavior with respect to disclosure of the information. Outlined below are key elements for staff to remember: A. CONFIDENTIALITY OF CLIENT DATA 1. Individually identifiable patient data is confidential and is protected by various state and federal laws. 2. Confidential patient information includes all personal information (e.g., name, birth date, social security number, diagnosis, treatment, etc.) which may, in any manner, identify the individual. B. USE OF CLIENT DATA 1. Client data may be used only for purposes directly described in the data sharing agreement between X and Y 2. Any personal use of patient information is strictly prohibited. 3. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. C. DISCLOSURE OF INFORMATION 1. Identified patient information may not be disclosed to other individuals or agencies. 2. Questions related to disclosure are to be directed to X. 3. Any disclosure of information contrary to 1 above is unauthorized and is subject to penalties identified in law. Name (print): Signature: Date: Approved By: Authorizing Official, X Signature: Date: TX-DSHS-19-1309-A-002655 NNDSS Case ID: DOB: MM/DD/YYYY I OR State ID: Age: ________ years old I Case Status: Laboratory ID: □ Confirmed □ Probable Event date: MM/DD/YYYY Lab Test used to serogroup: □ □ □ Unknown TX-DSHS-19-1309-A-002656 VACCINATION INFORMATION Did the patient receive quadrivalent meningococcal vaccine? Did the patient receive serogroup B meningococcal vaccine? Date MM/DD/YY □ Unknown M M/DD/YY □ Unknown MM/DD/YY □ Unknown MM/DD/YY □ Unknown MM/DD/YY □ Unknown Jan 2019 Type □ Yes □ No □ Unknown □ Yes □ No □ Unknown Vaccine Name If yes to either, please complete the table below for each dose Lot Number □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown □ MenACWY □ MenB □ Other: _______________________ □ Unknown TX-DSHS-19-1309-A-002657 Page 2 of 2 A 1 2 3 4 5 B I C I D I E F G The Centers for Disease Control and Prevention (CDC), an agency of the Department of Health and Human Services, is authorized to collect this information, including the Social Security number (if applicable), under provisions of the Public Health Service Act, Section 301 (42 U.S.C. 241). Supplying the information is voluntary and there is no penalty for not providing it. The data will be used to increase understanding of disease patterns, develop prevention and control programs, and communicate new knowledge to the health community. Data will become part of CDC Privacy Act system 09-20-0106, "Specimen Handling for Testing and Related Data" and may be disclosed: to appropriate State or local public health departments and cooperating medical authorities to deal with conditions of public health significance; to private contractors assisting CDC in analyzing and refining records; to researchers under certain limited circumstances to conduct further investigations; to organizations to carry out audits and reviews on behalf of HHS; to the Department of Justice in the event of litigation, and to a congressional office assisting individuals in obtaining their records. An accounting of the disclosures that have been made by CDC will be made available to the subject individual upon request. Except for permissible disclosures expressly authorized by the Privacy Act, no other disclosure may be made without the subject individual's written consent. Please refer to the CDC Infectious Diseases Laboratories Test Directory for information on specimen requirements. CDC must maintain and document specific acceptance criteria to perform laboratory tests on samples obtained from humans pursuant to the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and accompanying regulations. 42 U.S.C. § 263a; 42 C.F.R. § 493.1241. Samples transferred to the CDC for testing or any other purpose will become the legal property of the agency unless otherwise agreed upon in writing. Samples will not be returned to the submitting entity. Submitter State: Shipment Date: State ID Neisseria meningitidis Isolates Accession # I Specimen Source I Culture Date I Date Sent to CDC State Serogroup Nmen Test Used to Serogroup TX-DSHS-19-1309-A-002658 H I J K Previously Submitted to CDC Date Previously Submitted he Social Security number (if applicable), under provisions to increase understanding of disease patterns, develop en Handling for Testing and Related Data" and may be ractors assisting CDC in analyzing and refining records; to of Justice in the event of litigation, and to a congressional on request. Except for permissible disclosures expressly . eptance criteria to perform laboratory tests on samples . § 263a; 42 C.F.R. § 493.1241. amples will 1 not be returned to the submitting entity. 2 3 4 5 Viable (Y/N) Case Date of Birth Nmen TX-DSHS-19-1309-A-002659 A B 1 2 3 4 5 Neisseria meningitidis Data Submitting Jurisdiction: Date Submitted: Case Date Range: 6 NNDSS Case ID State ID C D Laboratory ID Date of Birth E Age F G Sex Case Status (Confirmed/ Probable) H I J K L Event Date Lab confirmation method Source Test used to serogroup Serogroup TX-DSHS-19-1309-A-002660 Supplemental data for all cases M 1 2 3 4 5 6 N O P MSM Outcome Outbreak/Clu ster Related Sex of sex partners MSM not otherwise specified Q R S T U V W X Y Greek Life Taking complement inhibitor Headache Fever College HIV status Homeless College Student Year in school Residence Type TX-DSHS-19-1309-A-002661 Supplemental data for all cases Z AA 1 2 3 4 5 6 AB AC AD AE AF Diarrhea Sore Throat AG AH AI AJ AK Other Received quadrivalent vaccine? Received Serogroup B vaccine? Vaccine 1 Date Vaccine 1 Name Symptoms Stiff Neck Rash Photophobia Nausea Vomiting TX-DSHS-19-1309-A-002662 Supplemental data for all cases AL AM AN AO AP AQ AR AS AT Vaccine 1 Lot Number Vaccine 2 Date Vaccine 2 Name Vaccine 2 Lot Number Vaccine 3 Date Vaccine 3 Name Vaccine 3 Lot Number Vaccine 4 Date Vaccine 4 Name 1 2 3 4 5 6 TX-DSHS-19-1309-A-002663 Supplemental data for all cases AU AV AW AX Vaccine 4 Lot Number Vaccine 5 Date Vaccine 5 Name Vaccine 5 Lot Number 1 2 3 4 5 6 TX-DSHS-19-1309-A-002664 Supplemental data for all cases A B C D E 1 Meningococcal disease in complement inhibitor recipients 2 Please note: The variables in columns F-Q of this tab are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. This is included as a convenience for jurisdictions who choose to participate in this supplemental data collection. Instructions: Complete columns F-Q below for any case identified as taking eculizumab/Soliris or ravulizumab/Ultomiris (highlighted in yellow below). This replaces the previous supplemental case report form for these cases to streamline data submission. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 NNDSS Case ID State ID Date of Birth Age Taking complement inhibitor F G Indication for complement inhibitor treatment Specify other indication TX-DSHS-19-1309-A-002665 Complement inhibitor cases H I Date complement inhibitor treatment started Date complement inhibitor treatment ended J K Hospitalized? Number of days hospitalized L M N O P Q Sequelae? Specify sequelae Was the patient taking antibiotics at the time of disease onset? Antibiotic name Date antibiotic started Daily dose 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 TX-DSHS-19-1309-A-002666 Complement inhibitor cases 45 46 47 48 49 50 51 52 A B C D E F G TX-DSHS-19-1309-A-002667 Complement inhibitor cases 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 A yes no unknown survived died unknown confirmed probable B C A B C E W X Y NG Other Unknown male female unknown Menactra (MenACWY-D/MCV4P) Menveo (MenACWY-CRM/MCV4O) MenHibrix (Hib-MenCY-TT) Menomune (MPSV4) MCV4 Unknown Bexsero (MenB-4C) Trumenba (MenB-FHbp) MenB Unknown Unknown positive negative unknown culture/biochemical testing PCR MALDI-TOF other unknown Slide agglutination PCR WGS Other D E F Heterosexual/Straight Homosexual/Gay Bisexual Other Unknown Refused G H Males only Females only Both Males and Females Not sexually active Unknown Refused Freshman Sophomore Junior Senior Graduate Student Other Unknown On Campus Off Campus Unknown Yes, petechiae Yes, purpura Yes, type unknown Yes, other type No Unknown TX-DSHS-19-1309-A-002668 Drop down options 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 I Paroxysmal nocturnal hemoglobinuria (PNH) Atypical hemolytic uremic syndrome (aHUS) Generalized myasthenia gravis (gMG) Other Unknown TX-DSHS-19-1309-A-002669 Drop down options Protocol for Enhanced Meningococcal Disease Surveillance for the ELC VPD Surveillance Coordination Jurisdictions Last Updated: 06/28/19 TX-DSHS-19-1309-A-002670 Contents Background ...............................................................................................................................................3 CDC Personnel .........................................................................................................................................3 Supplemental Data Instructions ................................................................................................................4 Data Security and Sharing ......................................................................................................................11 Data Submission, Storage, and Access at CDC .................................................................................11 Sharing and Storing Data on HIV Status – Guidance for Jurisdictions................................................11 Data Release ..........................................................................................................................................12 Strain Sharing Policy...............................................................................................................................12 Isolate Submission Instructions...............................................................................................................13 Data and Isolate Shipping Schedule .......................................................................................................14 Background TX-DSHS-19-1309-A-002671 The main purpose of the meningococcal disease portion of the Epidemiology and Laboratory Capacity (ELC) Vaccine Preventable Diseases (VPD) surveillance coordination project is to enhance meningococcal disease surveillance to help CDC address key and pressing epidemiology and vaccine policy questions, and to monitor the impact of meningococcal vaccines on disease burden in the United States. Because the incidence of meningococcal disease has fallen to historic lows, surveillance and evaluations of vaccine effectiveness and impact have become increasingly more challenging through our existing surveillance systems and infrastructure. For example, National Notifiable Diseases Surveillance System (NNDSS) is missing data for key variables (e.g., serogroup, case outcome) from several states because of data transmission issues. NNDSS is also limited in terms of adding additional variables to answer timely and important policy questions. The goal of this project is to build on existing surveillance systems to enhance meningococcal disease surveillance data available to CDC and to build the infrastructure for evaluations of vaccine effectiveness. Data collected from this project will be used to inform key upcoming vaccine policy decisions and to evaluate new and existing Advisory Committee on Immunization Practices (ACIP) vaccine recommendations. In particular, data collected on HIV status will allow us to assess the impact of the recent ACIP recommendation for use of MenACWY vaccination in HIV-infected persons. Isolates collected through this project will be important for monitoring coverage of the newly licensed serogroup B meningococcal vaccines for strains circulating in the United States, and to monitor any changes in circulating strains due to the introduction of the serogroup B meningococcal vaccines. Note: This protocol addresses only new procedures specific to the Enhanced Meningococcal Disease Surveillance Project. Additional information on meningococcal disease surveillance can be found in the Meningococcal Disease chapter of the Manual for the Surveillance of Vaccine-Preventable Diseases, available at: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html. CDC Personnel Lucy McNamara, Principal Investigator xdf4@cdc.gov 404-639-8743 Amy Blain, Surveillance Coordinator wgi9@cdc.gov 404-639-2563 Questions may also be directed to meningnet@cdc.gov. TX-DSHS-19-1309-A-002672 Supplemental Data Instructions Sites should submit the following variables to CDC via the provided MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet through the secure FTP site. Only enter a ‘yes’/‘no’ response if status is known. Please only leave variables blank where they do not apply (college student/MSM outside of defined age/sex group), otherwise enter ‘unknown’. At the end of each year, all jurisdictions will be asked to review all unknown responses to ensure that all available data have been sent to CDC. Jurisdictions will also be asked to review the outbreak status of all cases to ensure they were categorized correctly. Variable name Definition Special Instructions Reason for Collection NNDSS Case ID Unique case ID transmitted to CDC in NNDSS. This may be auto generated at your state and may be different from the State ID used to identify cases in your state system. This ID is 6 digits at CDC, so if this ID is longer at your state, we are likely receiving the last 6 digits. Having this Case ID will allow direct linkage to the NNDSS data so data will no longer need to be matched based on date of birth and event date. State ID Unique ID number for each case used in your state. This may be the same as the NNDSS case ID. The unique ID used by your state lab. This column should match the shipping spreadsheet state ID column. Complete only if an isolate was sent to CDC. This ID may be the same as the State ID, but in most cases, a different ID is being received on the shipping spreadsheet than on the supplemental data spreadsheet. Date of birth is preferred if known Having laboratory ID will allow direct linkage between the lab and epi data so data will no longer need to be matched based on date of birth and event date. Laboratory ID Date of Birth or Age MM/DD/YYYY or age in years In the event that the NNDSS ID is not available, or does not match what is received at CDC, this is one of the variables used to match to NNDSS data. TX-DSHS-19-1309-A-002673 Case Status Please select confirmed or probable based on the CSTE case definition. (https://wwwn.cdc.gov/nndss/conditions/meningococcaldisease/case-definition/2015/) Only confirmed and probable cases need to be reported on the spreadsheet Event Date MM/DD/YYYY This should match the event date variable in NNDSS. Lab confirmation method Laboratory method used to diagnose/confirm the case. Please select culture/biochemical testing, PCR, MALDI-TOF, other, or unknown. If more than one method was used, select the method based on the following algorithm: In the event that the NNDSS ID is not available, or does not match what is received at CDC, this is one of the variables used to match to NNDSS data. · Source Source of positive isolate/specimen (e.g. blood, CSF) Test used to serogroup Please select slide agglutination, PCR, whole genome sequencing (WGS), or other. Serogroup Meningococcal serogroup – A, B, C, E, W, X, Y, NG (nongroupable), other, or unknown. Please select survived or died Outcome If the case was confirmed by culture, select culture regardless of other methods used · If the case was not confirmed by culture but was positive by PCR, select PCR regardless of other methods used If positive isolates/specimens are obtained from multiple sources, please list all Leave blank if serogroup is unknown. Allows us to track casefatality rate overall, by serogroup, and in specific populations. We will be reviewing all TX-DSHS-19-1309-A-002674 Outbreak/cluster related Outbreaks will be defined as 2-3 cases of the same serogroup in an organization in <3 months OR incidence above expected of the same serogroup in the affected community or specific population in a community. https://www.cdc.gov/meningococcal/downloads/meningococcaloutbreak-guidance.pdf MSM (men who have sex with men) Because the first cases from an outbreak/cluster may not be correctly categorized as outbreak/cluster related, we are asking sites to review cases at the end of each year and update this variable as needed. Complete these variables for any cases 16 years of age and older who were reported as male to NNDSS. Sex of sex partners During the past 12 months, have you had sex with only males, only females, or with both males and females? MSM not otherwise specified · Males only · Females only · Both Males and Females · Not sexually active · Unknown · Refused Select ‘Yes’ for this variable if MSM is noted somewhere (e.g. in hospital chart), but it is not known whether this was determined based on sexual behavior. Complete these variables for any cases 16 years of age and older who were reported as male to NNDSS. cases with missing outcome at the end of the year to ensure we have the most complete information. While we usually hear about outbreaks in real time, we want to collect this variable on all cases to ensure that all cases are being categorized correctly. This information may inform vaccination policy decisions and facilitate collection of information on outbreak responses. MSM are increasingly being recognized as at greater risk for meningococcal disease compared to other men, and several meningococcal disease outbreaks have been reported among MSM populations in recent years.1-4 While we likely capture most outbreak cases occurring among MSM, in order to fully understand the risk factors associated with meningococcal disease TX-DSHS-19-1309-A-002675 Select ‘No’ for this variable if this person is known to not be MSM. in this population, we need to also capture MSM status on all sporadic cases. Select ‘Unknown’ for this variable if MSM status is unknown. We are now collecting these separate variables to better differentiate between sexual behavior and other reasons cases may be identified as MSM. HIV status Please select positive, negative, or unknown. Please only select ‘negative’ if you have verified that the patient was tested and found to be HIV-negative at or after the time of meningococcal disease onset. Otherwise a response of ‘unknown’ is preferred. We strongly encourage jurisdictions to coordinate with their jurisdiction HIV surveillance program colleagues in order to obtain more complete information on HIV status for all meningococcal disease cases. The HIV program should only provide HIV status information (and not other variables or behavioral information) for meningococcal disease cases. Data on HIV status will allow us to assess the impact of the recent ACIP recommendation for use of MenACWY vaccination in HIVinfected persons. Meningococcal disease surveillance staff should contact local HIV surveillance program staff directly to coordinate data sharing in TX-DSHS-19-1309-A-002676 accordance with local laws/regulations and data sharing and security policies. A data sharing agreement or data use agreement is recommended. Methods, security measures and frequency of data sharing should be agreed upon by programs. At a minimum, jurisdictions should send HIV status information for all meningococcal cases that occurred during the previous calendar year by the close of each funding cycle (July). For more information on handling HIV data, please see the data sharing and security section below. Homeless An individual who: lacks a fixed, regular, and adequate nighttime residence; has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation, including a car, park, abandoned building, bus or train station, airport, or camping ground; is living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements (including hotels and motels paid for by Federal, State or local government programs for lowincome individuals or by charitable organizations, congregate shelters, and transitional housing).5 Outbreaks have been reported in multiple cities in recent years among persons experiencing homelessness. This variable will provide information on sporadic cases in this population as well as a routine way of capturing these outbreaks. TX-DSHS-19-1309-A-002677 College student Case attending a college or university at the time of disease onset. Complete this variable for cases aged 15-24 years only. Year in school What was the student’s year in school at the time of disease onset? · Freshman · Sophomore · Junior · Senior · Graduate Student · Other · Unknown Where did the student live at the time of disease onset? · On Campus · Off Campus · Unknown Did the student participate in Greek life (fraternities or sororities)? · Yes · No · Unknown Case taking either: Complete these variables only for college students. Residence type Greek life Taking complement inhibitor · Eculizumab/Soliris at the time of disease onset or up to 3 months prior to disease onset. · Ravulizumab/Ultomiris at the time of disease onset or up to 8 months prior to disease onset. These variables are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. These variables are included as a convenience for jurisdictions who choose to participate in this supplemental data collection. If the patient has taken both eculizumab and ravulizumab, please select the one taken most recently. The second tab of the supplemental data spreadsheet should also be completed for any cases identified as taking eculizumab/Soliris or ravulizumab/Ultomiris. This replaces the previous supplemental case report form for these cases to streamline data collection. Several outbreaks of serogroup B meningococcal disease have been reported on university campuses in recent years. A recent analysis showed differences in risk associated with year in school and residence type, as well as with greek life participation during outbreaks; however additional information is needed especially for sporadic cases.6 This information will inform ACIP work group discussions around meningococcal vaccine policy. Eculizumab (Soliris®) is a complement component inhibitor used for treatment of paroxysmal nocturnal hemoglobinuria (PNH), atypical hemolytic uremic syndrome (aHUS), and generalized myasthenia gravis (gMG). Ravulizumab (Ultomiris®) is a modified version of eculizumab with a longer half-life; it is licensed for treatment TX-DSHS-19-1309-A-002678 Symptoms These variables are part of a supplemental data collection activity that is NOT part of NNDSS meningococcal disease surveillance. This is included as a convenience for jurisdictions who choose to participate in this supplemental data collection. of PNH. Eculizumab and ravulizumab have FDA boxed warnings for increased risk of serious meningococcal infection (~2000 times greater risk for meningococcal disease compared to healthy individuals). For all symptoms except rash, select ‘Yes’ if the symptom is associated with the current episode of meningococcal disease. For rash, if rash is present please select the appropriate rash type if known. The United Kingdom and Chile have recently reported increases in serogroup W meningococcal disease; many of these serogroup W cases first presented with GI symptoms instead of more typical meningococcal disease symptoms.7-10 Because of this, some cases were initially misdiagnosed when first presenting for care. We have also observed a high proportion of cases with GI symptoms in one serogroup W cluster in the US. For this reason, we are interested in learning if Headache Fever Include subjective as well as measured fever Stiff Neck Rash11 Did the patient have a rash, if yes, what kind of rash? · · · · · · Yes, petechiae Yes, purpura Yes, type unknown Yes, other type No Unknown If multiple rash types are present, please select the most severe type based on the following hierarchy: purpura > petechiae > other. Photophobia TX-DSHS-19-1309-A-002679 Nausea similar symptoms are being observed nationally or for other serogroups. In order to asses if the GI symptoms are presenting along with or instead of typical meningococcal disease symptoms, we need to collect typical symptoms as well. Vomiting Diarrhea Sore throat Other Vaccination history Include any other symptoms not listed above associated with the current episode of meningococcal disease. Please include MenACWY vaccines, MenB vaccines, and unknown meningococcal vaccine type. Please only select ‘No’ if you have verified non-receipt of meningococcal vaccines; a response of ‘unknown’ is preferred. If vaccine type is unknown, select ‘unknown’ for both the “Received quadrivalent vaccine?” and “Received Serogroup B vaccine?” questions. Complete the vaccine information columns, selecting ‘unknown’ for the vaccine name for each dose with unknown type. Collecting meningococcal vaccination history on all cases will allow us to monitor for breakthrough cases. VPD coordinators should collaborate with their immunization program to facilitate access to immunization information systems for assessing meningococcal vaccination status for cases. 1. 2. 3. 4. Folaranmi TA, Kretz CB, Kamiya H, MacNeil JR, Whaley MJ, Blain A, et al. Increased Risk for Meningococcal Disease Among Men Who Have Sex With Men in the United States, 2012-2015. Clin Infect Dis. 2017; 65(5):756-63. doi: 10.1093/cid/cix438.. Aubert L, Taha M, Boo N, Le Strat Y, Deghmane AE, Sanna A, et al. Serogroup C invasive meningococcal disease among men who have sex with men and in gay-oriented social venues in the Paris region: July 2013 to December 2014. Euro Surveill. 2015; 20(3). PubMed PMID: 25635319. Marcus U, Vogel U, Schubert A, Claus H, Baetzing-Feigenbaum J, Hellenbrand W, et al. A cluster of invasive meningococcal disease in young men who have sex with men in Berlin, October 2012 to May 2013. Euro Surveill. 2013; 18(28). PubMed PMID: 23870095. Centers for Disease Control and Prevention. Guidance for the Evaluation and Public Health Management of Suspected Outbreaks of Meningococcal Disease. 2017. TX-DSHS-19-1309-A-002680 5. Department of Housing and Urban Development. Homeless Emergency Assistance and Rapid Transition to Housing: Defining ‘‘Homeless’’. 2011. https://www.hudexchange.info/resource/1928/hearth-defining-homeless-final-rule/ 6. Weil LM, Blain A, Soeters HM, Mbaeyi SA, Hariri S, McNamara LA. Characterizing Potential Risk Factors for Serogroup B Meningococcal Disease Among College Students — United States, 2014– 2017. Oral presentation presented at: Council of State and Territorial Epidemiologists Annual Conference; June 2- June 6; Raleigh, North Carolina. 7. Ladhani S.N., Beebeejaun K., Lucidarme J., Campbell H., Gray S., Kaczmarski E. Increase in endemic Neisseria meningitidis capsular group W sequence type 11 complex associated with severe invasive disease in England and Wales. Clin Infect Dis. 2015; 60:578–585. 8. Cameron C, McDonald E, Smith-Palmer A, et al. Increased incidence of Meningococcal serogroup W in Scotland in 2015. Poster presented at: International Pathogenic Neisseria Conference; 5 Sep- 9 Sep; Manchester, UK. 9. Camphell H, Parikh S, Beebeejaun K, et al. Symptoms and diagnoses of invasive meningococcal disease in England 2014. Poster presented at: International Pathogenic Neisseria Conference; 5 Sep9 Sep; Manchester, UK. 10. Moreno G, López D, Vergara N, Gallegos D, Advis MF, Loayza S. Caracterización clínica de los casos de enfermedad meningocóccica por serogrupo W135 confirmados durante el año 2012 en Chile. [Clinical characterization of cases with meningococcal disease by W135 group in Chile, 2012]. Rev Chilena Infectol. 2013; 30(4):350-60. 11. For more information on rash types, please see: Centers for Disease Control and Prevention. Definitions of Symptoms for Reportable Illnesses. 2017. https://www.cdc.gov/quarantine/air/reportingdeaths-illness/definitions-symptoms-reportable-illnesses.html TX-DSHS-19-1309-A-002681 Data Security and Sharing All data submitted to CDC for this project are handled and stored according to the NNDSS data use agreement (see Appendix 1). Because we are collecting HIV status of cases, data will also be transmitted and stored in a manner consistent with the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) policies.10 Data Submission, Storage, and Access at CDC The MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet will be transmitted through an encrypted secure FTP site to CDC and will be stored on a restricted access shared drive at CDC; access to the FTP site and share drive will be granted solely to meningococcal disease surveillance program personnel, who adhere to all non-disclosure agreements associated with personally identifiable information and other notifiable disease data. Jurisdiction meningococcal disease surveillance staff should encrypt their data before uploading to the FTP site using WinZip (version 28.5 or higher) or SecureZip. If your jurisdiction does not have access to this software, please contact the CDC meningococcal disease surveillance staff for additional guidance. Sites submitting through the secure FTP site will have no ability to access data from other jurisdictions. These procedures have been approved by the Information Systems Security Officer (ISSO) for NCIRD. Sharing and Storing Data on HIV Status – Guidance for Jurisdictions When working with their jurisdiction’s HIV surveillance program to obtain HIV status of meningococcal disease cases, VPD coordinators should ensure they are maintaining the confidentiality of these sensitive data. It is the responsibility of each jurisdiction to determine the appropriate procedures for ensuring data confidentiality in accordance with local policies, laws and regulations. In general, however, we suggest: · HIV status information should be shared in person, by phone, or through secure electronic methods (e.g.an encrypted data transfer mechanism) approved by the jurisdiction’s HIV surveillance program’s Overall Responsible Party (ORP). · Matching procedures will vary by site, but in general the meningococcal disease surveillance program will need to provide name, date of birth, and sex to the HIV program for all meningococcal disease cases to confirm identity. Date of meningococcal disease onset will also need to be shared with the HIV surveillance program to obtain accurate information on HIV status at the time of onset. · Data on the same individual from meningococcal disease and HIV surveillance systems should be matched in such a way that VPD surveillance staff receive information on HIV infection status only for individuals who developed meningococcal disease and do not receive information on any other variables from the HIV surveillance system. No other variables should be completed or verified for the supplemental spreadsheet using HIV Surveillance data. Given the small number of meningococcal disease cases in each jurisdiction, manual lookup of each meningococcal disease case by HIV surveillance staff may be feasible to ensure the minimum necessary information is shared. · Data on HIV status, whether hard copy or electronic, should be kept in a physically secure, accesscontrolled environment in accordance with CDC Data Security and Confidentiality Guidelines for HIV.10 All staff with access to these data should complete any data security and confidentiality training and sign any non-disclosure/confidentiality agreements typically required of jurisdiction HIV surveillance program staff. · A data sharing agreement should be established and both the VPD and HIV surveillance programs should ensure adherence to the CDC Data security and confidentiality guidelines for HIV, viral hepatitis, sexually transmitted disease, and tuberculosis programs: standards to facilitate sharing and use of surveillance data for public health action.12 See Appendix 2 for a sample template for a data sharing agreement. Jurisdictions may use their own format, but below is an outline of the key elements to be included: TX-DSHS-19-1309-A-002682 - Intent and scope of data sharing Potential benefits (including projected efficiencies) and risks of sharing, benefits and risks of not sharing, and methods to monitor these benefits and risks Methods that will be used to share data and roles and responsibilities of staff involved Minimum data elements needed to achieve the objective(s), including need for PII Steps that will be taken to ensure the confidentiality and security of shared data Provisions for physical and electronic security How shared data will be used, analyzed, published, released, and retained/destroyed Confidentiality agreements Knowledge and training requirements including annual training for staff who have access to PII and non-PII data · Data on HIV status of meningococcal disease cases can be used internally by the jurisdiction and shared with CDC’s Meningitis and Vaccine Preventable Diseases Branch. Any other release or use of HIV status data by the jurisdiction VPD surveillance program should be pre-approved by the jurisdiction HIV surveillance program. · Data will be reported to CDC’s Meningitis and Vaccine Preventable Disease Branch using the secure methods described above and will be reported without names. Only the data elements outlined in the supplemental data spreadsheet will be included. 12. Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Programs: Standards to Facilitate Sharing and Use of Surveillance Data for Public Health Action. https://www.cdc.gov/nchhstp/programintegration/docs/PCSIDataSecurityGuidelines.pdf Data Release Information collected through this project will only be published in aggregate. Data will be published on the CDC website in the form of an annual surveillance report.13 Data may also be used for epidemiological analyses which may be presented to the ACIP and at scientific conferences and may be published in scientific journals. To ensure patient confidentiality, data on HIV infection status of meningococcal disease cases will never be released on a geographic level lower than national – i.e. no state or county-level HIV infection status data will be released in any format. 13. https://www.cdc.gov/meningococcal/downloads/NCIRD-EMS-Report.pdf Strain Sharing Policy Samples transferred to the CDC for testing or any other purpose will become the legal property of the agency unless otherwise agreed upon in writing. Samples will not be returned to the submitting entity. TX-DSHS-19-1309-A-002683 Isolate Submission Instructions We are requesting all meningococcal isolates (all serogroups, all age groups) from confirmed meningococcal disease cases be submitted to CDC. If the isolate was previously submitted to CDC, you do not need to resend unless requested specifically. The variables requested on the shipping spreadsheet will include: State ID: ID assigned by the state; used to link lab and national/supplemental data Accession #: ID assigned by the state lab; usually the state lab accession or identification # Specimen source: Sterile site source of isolate Culture date: Date of collection of the isolate Date sent to CDC: Date the isolate will be sent to CDC State serogroup: State laboratory results for serogroup for N. meningitidis Test used to serogroup: List method used by state laboratory to serogroup (PCR, SASG, etc.) Viable: Indicate if viable at site lab. Enter ‘yes’ if isolate is viable and ‘no’ if isolate is nonviable DOB: Date of birth of the case patient; or age in years at disease onset (if DOB is not available) Previously submitted: Please indicate if the isolate has previously been submitted to CDC (e.g. for rapid testing due to a suspected outbreak) Date previously submitted: If previously submitted, please indicate the date it was previously submitted and the reference center it was submitted to Shipping instructions: 1. All vials should be labeled with the accession # and state ID as listed on the Excel shipping spreadsheet. a. Labels that can withstand dry ice and water should be used. Large labels that require “flagging” (i.e., those where the label wraps around and the excess length is stuck to itself) should not be used as they can rip and samples could be misidentified. b. Slants: Labels should contain the date inoculated in addition to the state ID and accession #. c. All non-viable isolates should be sent in the original primary tube/vial and labeled with the state ID and accession #. 2. Sample Preparation and Transport Conditions: a. All N. meningitidis isolates should be pure, fresh cultures. Frozen stock or slant shipments are preferred. b. Frozen stocks: If more than 10 isolates are being shipped, all isolates should be sent frozen. Collect the isolate’s overnight growth from the agar plate with a sterile swab and resuspend bacteria in an appropriate freezer medium (such as TSB with 15% glycerol or defibrinated sheep blood). Frozen isolates should be shipped with DRY ICE. c. Slants: Inoculate cultures on chocolate agar slants and incubate overnight at @ 37oC in a 5% CO2 atmosphere. After overnight incubation, inoculated slants can be sent at ROOM TEMPERATURE. d. Silica gel packages: If shipping on silica, collect the isolate’s overnight growth from the agar plate with a sterile swab. The swab should then be placed into the silica gel package and shipped with ICE PACKS. If ice packs are not available, ship the isolates at ROOM TEMPERATURE. DO NOT use dry ice. 3. Viable and non-viable isolates may be shipped together in the same package. 4. The completed ENHANCED MENINGOCOCCAL DISEASE SURVEILLANCE SHIPPING SPREADSHEET must be e-mailed to CDC before a shipment is sent (meningnet@cdc.gov) and a hard copy of the spreadsheet must also be included in every isolate shipment. 5. Isolates should be shipped by FedEx or Express mail, category B. All isolates should be sent in compliance with shipping regulations for infectious substances. Additionally, each package should have the following written on the outside of the package: “DO NOT expose to extreme temperatures”. If shipping via FedEx, no shippers’ declaration required Address: ATTN: STAT Lab c/o Bacterial Meningitis Laboratory Unit 10/44 Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA 30333 Laboratory Contact: Melissa Whaley or Caelin Potts E-mail: dbq3@cdc.gov and lyi3@cdc.gov Tel: (404) 639-3920 and (404) 718-5532 TX-DSHS-19-1309-A-002684 Data and Isolate Shipping Schedule Please send both the MENINGOCOCCAL DISEASE SUPPLEMENTAL DATA spreadsheet and the ENHANCED MENINGOCOCCAL DISEASE SURVEILLANCE SHIPPING SPREADSHEET and ship isolates to CDC during your site’s scheduled months below. Please submit data and isolates during the week of the 15th of your designated months. Submission Month October 2019 Arizona, California, Indiana, Kentucky, Maine, Missouri, New Jersey, New York, South Carolina, Utah November 2019 Alabama, Houston, Iowa, Kansas, Mississippi, Montana, New Hampshire, Oklahoma, Texas December 2019 Arkansas, Chicago, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Louisiana, Washington D.C., West Virginia January 2020 LA County, Massachusetts, Michigan, NYC, Palau, South Dakota, Tennessee, US Virgin Islands, Washington, Wyoming February 2020 Alaska, Nebraska, Nevada, North Carolina, North Dakota, Ohio, Pennsylvania, Philadelphia, Puerto Rico, Rhode Island, Vermont, Virginia, Wisconsin [Connecticut, Maryland, Georgia, Minnesota, New Mexico]* Arizona, California, Indiana, Kentucky, Maine, Missouri, New Jersey, New York, South Carolina, Utah March 2020 April 2020 May 2020 June 2020 Alabama, Houston, Iowa, Kansas, Mississippi, Montana, New Hampshire, Oklahoma, Texas Arkansas, Chicago, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Louisiana, Washington D.C., West Virginia LA County, Massachusetts, Michigan, Palau, South Dakota, Tennessee, US Virgin Islands, Washington, Wyoming July 2020 Alaska, Nebraska, Nevada, North Carolina, North Dakota, NYC, Ohio, Pennsylvania, Philadelphia, Puerto Rico, Rhode Island, Vermont, Virginia, Wisconsin [Connecticut, Georgia, Maryland, Minnesota, New Mexico]* *Data only (Submit all isolates through ABCs) TX-DSHS-19-1309-A-002685 Quarterly Activity Summary for Vaccine-Preventable Diseases (VPDs) Surveillance Coordination Surveillance Coordination for NNDSS Vaccine Preventable Diseases and Enhanced Surveillance for Meningococcal Disease, Varicella, and Acute Flaccid Myelitis (ELC CoAg – Project O) Responses should briefly describe the status of VPD surveillance coordination activities in your jurisdiction. For each of the 7 strategies, select the progress level that best describes your jurisdiction’s current activity status (i.e., exceeds expectations, meets expectations, needs improvement) and provide a brief rationale (2-3 sentences) for the selection. You also have the option to describe specific successes and challenges related to each strategy. When completing this summary, it will be helpful to focus on the progress made toward specific activities proposed by your jurisdiction in the annual application for the ELC CoAg. Quarter being assessed: July 1 - September 30, 2019 Jurisdiction: Summary completed by: Strategy 1: Enhance investigation and outbreak response (1b) · Describe status of activities to: o Establish/maintain a VPD surveillance coordinator position that: § Supports surveillance for selected VPDs and related conditions for which surveillance is conducted through NNDSS or the ELC O Project; § Ensures the use and implementation of standard investigative questionnaires, data collection/sharing tools, and methods; § Leads/assists in the timely investigations of and data submissions for cases, clusters, and outbreaks; and § Engages in and evaluates ELC Project O activities. o Collect case data on key and enhanced variables, as described in CDC guidance. o Provide surveillance data to support evaluation of public health response to meningococcal disease (if applicable). o Ensure reporting sources inform state/local health departments of varicella outbreaks. Jurisdiction Status and Rationale Progress level selection for strategy 1: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 2: Improve surveillance and reporting (1c) · Describe status of activities to: o Develop, implement, and maintain surveillance systems. o Evaluate and enhance surveillance systems based on CDC guidelines. o Conduct regular assessment of surveillance data and implement processes to improve completeness, timeliness, and quality of case data (e.g., review surveillance indicator report to identify areas for improvement). TX-DSHS-19-1309-A-002686 1 o Facilitate coordination/exchange of surveillance data with CDC. (e.g., provide case notifications and other surveillance data reports to CDC with complete information on key and enhanced variables). Jurisdiction Status and Rationale Progress level selection for strategy 2: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 3: Enhance laboratory testing for surveillance and reporting (1d) · Describe status of activities to: o Support maintenance of the availability of appropriate surveillance testing capacity within jurisdiction public health laboratories, VPD Reference Centers, and/or CDC laboratories. o Implement a flexible plan for use and acquisition of laboratory supplies and testing that addresses changing needs/purposes for each disease/condition. o Collect isolates from confirmed and probable cases of meningococcal disease and test for serogroup and additional molecular characterization. Jurisdiction Status and Rationale Progress level selection for strategy 3: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 4: Improve laboratory coordination and outreach to improve efficiency (1f) · Describe status of activities to: o Support linkage of laboratory specimens, isolates, and results with epidemiologic and clinical case-patient data. o Coordinate activities to increase access to specimens and isolates so that laboratory data are available to inform surveillance activities (e.g., ensure routine transportation of clinical isolates to jurisdiction public health or other lab). Jurisdiction Status and Rationale Progress level selection for strategy 4: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) TX-DSHS-19-1309-A-002687 2 Successes: Challenges: Strategy 5: Enhance coordination between partners between epi‐lab‐HIT (1g) · Describe status of activities to support and integrate epidemiology, laboratory, immunization, and health information activities (e.g., foster collaboration between VPD program and other public health programs to facilitate collection of key and enhanced variables, ensure coordination between partners to facilitate access to IIS data for assessing case vaccination status). Jurisdiction Status and Rationale Progress level selection for strategy 5: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 6: Sustain and/or enhance information systems (1i) · Describe status of activities to support VPD surveillance through coordination between epidemiology, laboratory, immunization, and health information systems (e.g., NNDSS, IIS, electronic lab reports, electronic case reports, HL7 messages) to enhance use and exchange of electronic data files. Jurisdiction Status and Rationale Progress level selection for strategy 6: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: Strategy 7: Enhance coordination between partners (3a) · Describe status of activities to: o o o Foster collaboration among city, county, state, federal, and other internal and external partners to improve outbreak and case‐based reporting for VPDs and related conditions (e.g., AFM). Engage and collaborate with stakeholders by providing surveillance data to inform and support policies and public health evaluations for VPDs and related conditions (e.g., AFM). Communicate and coordinate with public health partners to ensure appropriate investigation, testing, and case‐based reporting for VPDs and related conditions (e.g., ensure public health partners receive ongoing training and education so they are informed of the importance of collecting the key variablesAFM). TX-DSHS-19-1309-A-002688 3 Jurisdiction Status and Rationale Progress level selection for strategy 7: Select progress level Rationale for selection (2-3 sentences): Additional Narrative (Optional) Successes: Challenges: TX-DSHS-19-1309-A-002689 4 Instructions for Completing the Varicella Outbreak Surveillance Reporting Worksheet GENERAL. Please complete the Varicella Outbreak Surveillance Reporting Worksheet to keep track of the number of cases associated with varicella clusters/outbreaks each year. Each case that is associated with a cluster (3-4 cases) or outbreak (5 or more cases) of varicella (epidemiologically linked), regardless of household status, should be listed in the line list on the ‘Outbreak Sheet’. Please keep a running list of cases for the year. Add outbreak cases for each new quarter of report to the previous list and submit the entire list each quarter. Please complete as much information as possible for each case. Listing each case and their information will help provide the data needed to assess characteristics of cases associated with varicella clusters/outbreaks to help guide control and prevention strategies. Reports should be submitted quarterly to CDC via email: alopez@cdc.gov or fax: 404-3153398. Cover Sheet SITE REPORTING. Select Grantee site from drop down menu. NAME OF PERSON REPORTING. Name of person completing worksheet. PHONE. Phone number of person completing worksheet. EMAIL. Email of person completing worksheet. QUARTER OF REPORT. Select the current reporting quarter. Quarters are based on the calendar year (January to December). 6. YEAR OF REPORT. Enter the year of report. 7. TOTAL NUMBER OF OUTBREAKS. Enter the cumulative number of outbreaks identified through current period of report. 1. 2. 3. 4. 5. Outbreak Sheet A. CASE #. This is to keep track of the total number of cases reported during the project year (August to July) and does NOT need to be changed. B. GRANTEE. Select Grantee site from drop down menu. C. OUTBREAK NAME OR ID. Name or ID given to the cluster/outbreak that the case is associated with. The outbreak name/ID is important because it will allow us to group together cases from the same cluster/outbreak, and will be used to generate information on cluster/outbreak size and duration. D. OUTBREAK SETTING. Select a setting for the cluster/outbreak from the drop down menu. If “other” is selected, please specify the setting in the cell. E. CASE ID. Grantee assigned ID for each case associated with cluster/outbreak. F. RASH ONSET DATE. Case-patient’s rash onset date. G. AGE. Case-patient’s age at time of illness. H. NUMBER OF LESIONS. Enter range of lesions for case-patient. Valid values include: <50, 50-249, 50-500, 250-499, ≥500, Unknown. Select from drop down menu. **If case-patient has <50 lesions, 1 Page of 2 (Nov 2015) TX-DSHS-19-1309-A-002690 I. J. K. L. M. N. O. P. Q. R. please enter the number of lesions in the cell, if known. ***Please only enter ‘unknown’ if number of lesions truly unknown. VACCINATED WITH VARICELLA CONTAINING VACCINE. Was case-patient vaccinated with varicella-containing vaccine? Select from drop down menu. IF VACCINATED, # OF DOSES. If case-patient vaccinated with varicella-containing vaccine, how many doses were received? Select from drop down menu. DATE OF VACCINATION (DOSE 1). Date of vaccination for dose 1 (MM/DD/YYYY), if known. DATE OF VACCINATION (DOSE 2). Date of vaccination for dose 2 (MM/DD/YYYY), if known. If ≥3 doses given, please provide dates of vaccination for additional doses in COMMENTS (column R). HISTORY OF VARICELLA DISEASE. Did the case-patient have varicella in the past, before this current episode? Select from drop down menu. HOW HISTORY OF DISEASE ASSESSED. If case-patient had history of varicella disease in the past, how was it assessed? Select from drop down menu. WAS CASE LABORATORY CONFIRMED. Was a specimen collected for laboratory confirmation and the case was laboratory-confirmed as having varicella? A case would be considered laboratoryconfirmed if (1) VZV was detected by PCR from a skin lesion (ideally vesicles or crusts/scabs), (2) positive VZV IgM, or (3) 4-fold rise in IgG antibody from acute to convalescent sera. Select from drop down menu. WAS CASE HOSPITALIZED. Was the case-patient hospitalized because of this illness? Select from drop down menu. COMPLICATIONS. Specify any complications that the case-patient experienced because of this illness. COMMENTS. List any other comments about this case-patient that are helpful, such as source of exposure, whether case-patient is in the same household as another case-patient that is part of the cluster/outbreak, immunocompromised status if known, did varicella illness result in death, other outbreak setting from those listed in drop down menu for OUTBREAK SETTING (column D), additional dates of vaccination if vaccinated with ≥3 doses, etc. 2 Page of 2 (Nov 2015) TX-DSHS-19-1309-A-002691 BEGIN:VCALENDAR PRODID:-//Microsoft Corporation//Outlook 16.0 MIMEDIR//EN VERSION:2.0 METHOD:PUBLISH X-MS-OLKFORCEINSPECTOROPEN:TRUE BEGIN:VTIMEZONE TZID:Eastern Standard Time BEGIN:STANDARD DTSTART:16011104T020000 RRULE:FREQ=YEARLY;BYDAY=1SU;BYMONTH=11 TZOFFSETFROM:-0400 TZOFFSETTO:-0500 END:STANDARD BEGIN:DAYLIGHT DTSTART:16010311T020000 RRULE:FREQ=YEARLY;BYDAY=2SU;BYMONTH=3 TZOFFSETFROM:-0500 TZOFFSETTO:-0400 END:DAYLIGHT END:VTIMEZONE BEGIN:VEVENT CLASS:PUBLIC CREATED:20191007T135602Z DESCRIPTION:All-\n \nPlease save the date for the next NCIRD Quarterly All- Jurisdiction Vaccine Preventable Disease (VPD) Surveillance Call\, which w ill take place on October 15\, 2019 from 3:00-4:30pm ET. Please see email sent October 4\, 2019 for attachments. Presentation attachments/slide sets may be forthcoming.\n \nToll Free Number: 800-779-5184\nParticipant Passc ode: 6296401\nFollowing the entry of the passcode\, please provide the req uested details when prompted.\n\n\n\n \nAgenda for October 15\, 2019 Quart erly All-Jurisdiction VPD Surveillance Call\n\n\n\nTime\nTopic\nSpeaker\nN otes/Attachments\n3:00 – 3:10\nSurveillance Coordination\nInformation\n* General Surveillance Updates\n* FY19 ELC CoAg\n* Surveillance Indicators\ n* Recent communications\n* Conferences\n* Announcements/Reminders\nAction Item\n* Surveillance Coordination Activity Summary deadlines (ELC CoAg)\n Sandy Roush\n* For Jurisdictions - QSCAS Template v9-locked.docx\n* Data e lement Priorities for Implementation of the Mumps\, Pertussis\, and Varice lla Massage Mapping Guides: https://wwwn.cdc.gov/nndss/case-notification/m essage-mapping-guides.html\n* Summary of H influenzae N meningitidis IPD P sittacosis and Legionellosis 7 2 19\n* Summary of Measles Rubella and CRS Priorities 7 2 19\n3:103:30\nImplementation of HL7 message mapping guide\ nInformation\n* Presentation: New Jersey’s activities to prepare for HL7 MMG implementation.\n* Presentation: MMG implementation in NBS jurisdicti ons.\nElizabeth Zaremski (NJ) & Michael Wodajo\n \n3:303:35\nMeningococca l Disease\nPertussis\nHaemophilus influenzae\nInformation\n* Project Updat es\nAction Item\n* Meningococcal Disease: Supplemental data and isolates d ue to CDC on 15th of designated month (ELC CoAg)\n* Pertussis: Tier 2 data and isolates due January 2020 (ELC CoAg)\n* H flu: Tier 2 data and isolat es due October 2019 (ELC CoAg)\nAmy Blain\n* Enhanced Meningococcal Survei llance Protocol ELC VPD_v06282019.docx\n* Appendices for EMDS_07312018.doc x\n* Data Collection Guidance Worksheet 06282019.pdf\n* Enhanced Meningoco ccal Disease Surveillance Supplemental Data_06282019.xls\n* Enhanced Menin gococcal Disease Surveillance Shipping Spreadsheet_08132018.xls\n3:35-3:50 \nAcute Flaccid Myelitis\nInformation\n* Updates\nAdriana Lopez\n \n3:50-3 :55\nVaricella\nAction Items\n* Varicella outbreak report deadline: Octobe r 10\, 2019 (ELC CoAg)\n* Varicella completeness report: due at the end of December (ELC CoAg)\nAdriana Lopez\n* Instructions for Completing the Var icella Outbreak Surveillance Worksheet August 2016.docx\n* Varicella outbr eak surveillance reporting worksheet_Aug 2016.xlsx\n3:55-4:05\nMeasles\nIn formation\n* Presentation: Elimination status\nNakia Clemmons & Jessica An derson\n \n4:05-4:20\nMumps\nAction Items\n* Mumps Tier 2 data information to come (ELC CoAg)\n* Presentation: CDC Guidance for mump outbreaks at un iversities\nMariel Marlow\n \n4:20-4:30\nQ & A\n Jurisdictions\n \n \n \n DTEND;TZID="Eastern Standard Time":20191015T163000 DTSTAMP:20191007T135602Z DTSTART;TZID="Eastern Standard Time":20191015T150000 LAST-MODIFIED:20191007T135602Z LOCATION:CDC Royal Campus Bldg. 24\, Rm 6106 / Conference Line PRIORITY:5 SEQUENCE:0 SUMMARY;LANGUAGE=en-us:NCIRD Quarterly All-Jurisdiction VPD Surveillance ca ll - October 15\, 2019 from 3:00-4:30 ET TRANSP:OPAQUE UID:040000008200E00074C5B7101A82E00800000000F06F7A6DF57CD501000000000000000 01000000061082B064D968F4887BA5A7B5535190E X-ALT-DESC;FMTTYPE=text/html: All\; Please save the date for the next \;NCI RD Quarterly All-Jurisdiction Vaccine Preventable Disease (VPD) Surveillan ce Call\, which will take place on \; October 15\, 2019 from 3:00-4:30pm ET. Please see email sent October 4\, 2019 for attachments. Presentation attachments/slide sets may be forthcoming. \; Toll Fr ee Number: \;800-779-5184 Participant Passcode: \;6 296401 Following the entry of the passcode\, please provide the requested details when prompted. \; < /tr>< td width=330 style='width:247.5pt\;border-top:none\;border-left:none\;bord er-bottom:solid windowtext 1.0pt\;border-right:solid windowtext 1.0pt\;pad ding:0in 5.4pt 0in 5.4pt\;height:36.85pt'> Agenda for Octobe r 15\, 2019 Quarterly All-Jurisdiction VPD Surveillance Call Topic Speaker Notes/Attachments Time Information< /span> • • • • • • 3:00 – Surveillance \; 3:10 Coordination General Surveillance Updates FY19 ELC CoAg Surveillance Indicators Recent communications Conferences Announcements/Reminders • • Sandy Roush Action Item • Surveillance Coordinatio n Activity Summary deadlines \;(ELC CoAg) • • For Jurisdictions - QSCAS Template v9locked.docx Data element Priorities for Implementation of the Mumps\ , Pertussis\, and Varicella Massage Mapping Guides: \;https://wwwn.cdc.gov/nndss/casenotification/message-mapping-guid es.html Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19 Summary of Measl es Rubella and CRS Priorities 7 2 19 Information Implementation 3:10of HL7 3:30< message /span> mapping guide • • Presentation: \;New Jersey’\;s activities to Elizabeth Zaremski (NJ) &\; prepare for HL7 MMG implementati on. Michael Woda jo Presentation:&nbs p\;MMG implementation in NBS jurisdictions. Information< /span> TX-DSHS-19-1309-A-002692 • Enhanced Meningococcal Surveillance Information< /span> • Project Updates Meningococcal Action Item Disease 3:30-3 Pertussis :35 Haemophilus in fluenzae • • • • Meningococca l Disease: Supplemental Amy Blain data and isolates due to CDC on 15th \;of designated month \;(ELC CoAg) P ertussis: \;Tier 2 data and isolates due January 2020 \;(ELC CoAg) H flu: \;Tier 2 data and isolates due October 2019 \;(ELC CoAg)< o:p> • • Enhanced Meningococcal Surveillance Protocol ELC VPD_v 06282019.docx Appendices for EMDS_07312018.docx < li class=MsoNormal style='mso-margintop-alt:auto\;mso-margin-bottom-alt:a uto\;mso-list:l9 level1 lfo7\;tab-stops:list .5in'>Data Collection Guidance Wor ksheet 06282019.pdf Enhanced Meningococcal Disease Surveillance Supplementa l Data_06282019.xls Enhanced Meningococcal Disease Surveillance Shipping Sp readsheet_08132018.xls Information 3:35- Acute Flaccid 3:50 Myelitis • Updates Adriana Lopez Action Items 3:50V aricella 3:55 3:55Meas les 4:05 • • • Varicella outbreak report deadline: Oc tober 10\, 2019 \;(ELC CoAg) Adriana Lopez Varicella completeness report: due at the end of December \;(ELC CoAg)< /o:p> • Instructions for Completing the Varicella Outbreak Sur veillance Worksheet August 2016.docx Varicella outbre ak surveillance reporting worksheet_Aug 2016.xls x < p style='margin:0in\;marginbottom:.0001pt\;background:white'>InformationNakia Clemmons &\; Jessica • Presentation: \;< /span>Elimination statu s Anderson Action Items 4:05Mumps 4:20 4:20Q &\; A 4:30 • • Mum ps Tier 2 data information to come \;(ELC CoAg) Presentation: CDC Guidance for mump outbreaks at universities Mariel Marlow

Jurisdictions \; \; X-MICROSOFT-CDO-BUSYSTATUS:BUSY X-MICROSOFT-CDO-IMPORTANCE:1 X-MICROSOFT-DISALLOW-COUNTER:FALSE X-MS-OLKAUTOFILLLOCATION:FALSE X-MS-OLK-CONFTYPE:0 BEGIN:VALARM TRIGGER:-PT15M ACTION:DISPLAY DESCRIPTION:Reminder END:VALARM END:VEVENT END:VCALENDAR TX-DSHS-19-1309-A-002693 Data Element Priorities for Generic V2 7/2/2019 Priority 1 2 Data Element Name Local Subject ID Birth Date Subject’s Sex Race Category Subject Address State Subject Address ZIP Code Subject Address County Ethnic Group Deceased Date Local Record ID Date First Electronically Submitted Date of Electronic Case Notification to CDC Notification Result Status Condition Code Country of Birth Country of Usual Residence Date of Illness Onset Pregnancy Status Diagnosis Date Hospitalized Subject Died State Case Identifier Legacy Case Identifier Age at Case Investigation Age Unit at Case Investigation Case Disease Imported Code Imported Country Imported State Country of Exposure State or Province of Exposure Case Class Status Code Case Outbreak Indicator Case Outbreak Name Jurisdiction Code Date Reported MMWR Week MMWR Year Reporting State Reporting County National Reporting Jurisdiction Illness End Date Illness Duration Illness Duration Units Admission Date Discharge Date Duration of Hospital Stay in Days Binational Reporting Criteria Earliest Date Reported to County Earliest Date Reported to State Date First Reported to PHD TX-DSHS-19-1309-A-002694 3 Other Race Text Other Birth Place Imported City Imported County City of Exposure County of Exposure Transmission Mode Immediate National Notifiable Condition Reporting Source Type Code Reporting Source ZIP Code Person Reporting to CDC - Name Person Reporting to CDC - Phone Number Person Reporting to CDC - Email Case Investigation Start Date Date CDC Was First Verbally Notified of This Case Comment TX-DSHS-19-1309-A-002695 Data Element Priorities for H. influenzae 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Epi-Linked to a Laboratory-Confirmed Case Laboratory Testing Performed Laboratory Confirmed Test Type Specimen Type Specimen Collection Date/Time Organism Name Test Result Serotype Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine History Information Source Vaccine Information Source Indicator Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units Previous Contact With Hib Disease Hib Contact Type Previous Contact With Non-b or Nontypeable H. influenzae Case Non-b or Nontypeable Contact Type In Day Care Recurrent Disease with Same Pathogen Residence Premature Infant Test Method Serotype Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002696 3 Insurance Weight Weight Units Height Height Units Long Term Care Resident Case Investigation Status Code Previous State ID (Recurrent Case) Case Report Form Status Patient Address City ABCs State ID Test Result Quantitative Result Units Performing Laboratory Name Vaccine History Comments Susceptibility Test Antimicrobial Susceptibility Test Type Antimicrobial Susceptibility Test Interpretation Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002697 Data Element Priorities for N. meningitidis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Laboratory Testing Performed Laboratory Confirmed Test Type Organism Name Specimen Type Specimen Collection Date/Time Test Result Serogroup Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Name Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine History Information Source Vaccine Information Source Indicator Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Attending Higher Education College Grade in School College Living Situation Name of College/University Recurrent Disease with Same Pathogen Had Sex with a Male within the Past 12 Months Had Sex with a Female within the Past 12 Months Number of Male Sexual Partners HIV Status Homeless Signs and Symptoms Signs and Symptoms Indicator Eculizumab Residence Epi-Linked to a Laboratory-Confirmed Case Test Method Serogroup Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002698 3 Insurance Weight Weight Units Height Height Units Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units In Day Care Secondary Case Long Term Care Resident Case Investigation Status Code Previous State ID (Recurrent Case) Case Report Form Status Patient Address City ABCS State ID Test Result Quantitative Result Units Performing Laboratory Name Susceptibility Test Antimicrobial Susceptibility Test Type Antimicrobial Susceptibility Test Interpretation Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Vaccine History Comments Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002699 Data Element Priorities for IPD 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Bacterial Infection Syndrome Illness Onset Age Illness Onset Age Units Epi-Linked Laboratory Testing Performed Laboratory Confirmed Test Type Specimen Type Specimen Collection Date/Time Organism Name Test Result Serotype Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Date of Last Dose Prior to Illness Onset Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Manufacturer Vaccine Dose Number Vaccine History Information Source Vaccine Information Source Indicator In Day Care Long Term Care Resident Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Hospital ICU Residence Pregnancy Status at the Time of First Positive Culture Pregnancy Outcome Gestational Age Birth Weight Birth Weight Units Premature Infant Recurrent Disease with Same Pathogen Test Method Serotype Method Test Manufacturer Lab Accession Number Date Specimen Sent to CDC Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Age at Vaccination Age at Vaccination Units Susceptibility Test Oxacillin Zone Size Oxacillin Interpretation Antimicrobial Susceptibility Test Type Susceptibility Testing Performing Lab Type Antimicrobial Susceptibility Test Method Antimicrobial Susceptibility Test Interpretation Minimum Inhibitory Concentration Sign Antimicrobial Susceptibility Test Result Quantitative Value VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier TX-DSHS-19-1309-A-002700 3 Case Investigation Status Code Patient Address City Insurance ABCs State ID Previous State ID (Recurrent Case) Test Result Quantitative Result Units Performing Laboratory Name Vaccine History Comments Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized TX-DSHS-19-1309-A-002701 Data Element Priorities for Psittacosis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Signs and Symptoms Signs and Symptoms Indicator Laboratory Testing Performed Laboratory Confirmed Test Type Titer Test Type Titer Test Method Organism Name Test Result Specimen Type Specimen Collection Date/Time Test Result Quantitative Result Units Performing Laboratory Type Autopsy Specimen Type Result of Autopsy Date of Autopsy Autopsy Laboratory Name Occupation at Date of Onset Industry at Date of Onset Occupational Duties Contact Type Bird Type Bird Species Number of Birds Healthy Bird Non-Healthy Bird Details Type of Establishment Where Exposure Occurred Name of Establishment Where Exposure Occurred Address of Establishment Where Exposure Occurred Transmission Setting Date of Exposure Illness Onset Age Illness Onset Age Units Antibiotics Given Hospital ICU Performing Laboratory Name Test Manufacturer Date Specimen Sent to CDC Specimen Sent to CDC Chest X-ray for Pneumonia Date of Chest X-ray Personal Protective Equipment Respiratory Protective Equipment TX-DSHS-19-1309-A-002702 3 Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Highest Measured Temperature Temperature Units Medication Administered Medication Administered Dose Antibiotic Dose Units Date Treatment or Therapy Started Date Treatment or Therapy Stopped Treatment Duration Annual Respirator Fit Testing and Training Glove Material Case Investigation Status Code Patient Address City TX-DSHS-19-1309-A-002703 Data Element Priorities for Legionellosis 7/2/2019 Priority 1 2 Data Element Name Message Profile Identifier RIBD Case Type Legionella Diagnosis Illness Onset Age Illness Onset Age Units Nights Away From Home Name of Accommodation Street Address of Accommodation State of Accommodation City of Accommodation Country of Accommodation Accommodation Room Number Accommodation Comments Date Checked In to Accommodation Date Checked Out of Accommodation Zip Code of Accommodation Healthcare Setting Associated Healthcare Exposure Assisted/Senior Living Facility Test Type Specimen Type Test Result Performing Laboratory Type Hospital Name City of Treatment Hospital State of Treatment Hospital Transmission Setting Healthcare Setting Exposure Type Healthcare Facility Name Transplant Center Healthcare Facility Reason Visited Address of Healthcare Facility City of Healthcare Facility State of Facility Zip Code of Healthcare Facility Date Arrived at Healthcare Facility Date Departed Healthcare Facility Healthcare Setting Exposure Comments Associated Assisted/Senior Living Facility Exposure Assisted/Senior Living Facility Type Assisted/Senior Living Facility Exposure Type Assisted/Senior Living Facility Name Street Address of Assisted/Senior Living Facility City of Assisted/Senior Living Facility State of Assisted/Senior Living Facility Zip Code of Assisted/Senior Living Facility Date Arrived Assisted/Senior Living Facility Date Departed From The Assisted/Senior Living Facility Assisted/Senior Living Facility Comments Exposure Exposure Indicator Location of Exposure Date(s) of exposure Humidifier Respiratory Therapy Equipment Water Source Did Underlying Condition(s) Exist Underlying Condition(s) Underlying Conditions Indicator Current Occupation Specimen Sent to CDC Specimen Collection Date/Time Organism Name Serogroup Date Specimen Sent to CDC TX-DSHS-19-1309-A-002704 3 Case Investigation Status Code Patient Address City Healthcare Facility Water Management Program Assisted/Senior Living Facility Water Management Program Recent Cruise Travel Name of Cruise Line Name of Ship Cruise Departure City Cruise Departure State Cruise Departure Country Date of Cruise Departure Cruise Return City Cruise Return State Cruise Return Country Date of Cruise Return Cabin Number Port of Call City Port of Call Country Port of Call State Port of Call Date CDC NORS Outbreak ID Current Occupation Standardized Current Industry Current Industry Standardized Titer Test Type Test Result Quantitative Result Units Performing Laboratory Name Test Manufacturer Test Brand Name TX-DSHS-19-1309-A-002705 Data Element Priorities for Generic V2 7/2/2019 Priority 1 Data Element Name Local Subject ID Birth Date Subject’s Sex Race Category Subject Address State Subject Address ZIP Code Subject Address County Ethnic Group Deceased Date Local Record ID Date First Electronically Submitted Date of Electronic Case Notification to CDC Notification Result Status Condition Code Country of Birth Country of Usual Residence Date of Illness Onset Pregnancy Status Diagnosis Date Hospitalized Subject Died State Case Identifier Legacy Case Identifier Age at Case Investigation Age Unit at Case Investigation Case Disease Imported Code Imported Country Imported State Country of Exposure State or Province of Exposure Case Class Status Code Case Outbreak Indicator Case Outbreak Name Jurisdiction Code Date Reported MMWR Week MMWR Year Reporting State Reporting County National Reporting Jurisdiction TX-DSHS-19-1309-A-002706 2 3 Illness End Date Illness Duration Illness Duration Units Duration of Hospital Stay in Days Binational Reporting Criteria Earliest Date Reported to County Earliest Date Reported to State Date First Reported to PHD Other Race Text Other Birth Place Admission Date Discharge Date Imported City Imported County City of Exposure County of Exposure Transmission Mode Immediate National Notifiable Condition Reporting Source Type Code Reporting Source ZIP Code Person Reporting to CDC - Name Person Reporting to CDC - Phone Number Person Reporting to CDC - Email Case Investigation Start Date Date CDC Was First Verbally Notified of This Case Comment TX-DSHS-19-1309-A-002707 Data Element Priorities for Measles 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Signs and Symptoms Signs and Symptoms Indicator Generalized Rash Rash Onset Date Rash Duration Age at Rash Onset Age Type at Rash Onset Highest Measured Temperature Temperature Units Type of Complication Type of Complications Indicator Transmission Setting Epi-Linked US Acquired Traceable to International Import Length of Time in the US Length of Time in the US Units Case Patient a Healthcare Worker Import Status Confirmation Method International Destination(s) of Recent Travel Date of Return From Travel Laboratory Testing Performed Laboratory Confirmed Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Number of Doses Received Before 1st Birthday Number of Doses Received On or After 1st Birthday Vaccination Doses Prior to Illness Onset Vaccinated Per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002708 2 3 Detection Method Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Fever Onset Chest X-ray for Pneumonia Patient Address City Age and Setting Verified Case Investigation Status Code Confirmation Date Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Sample Analyzed Date/ Time Date of Last Dose Prior to Illness Onset Vaccine History Comments TX-DSHS-19-1309-A-002709 Data Element Priorities for Rubella 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Signs and Symptoms Signs and Symptoms Indicator Rash Onset Date Rash Duration Highest Measured Temperature Temperature Units Type of Complication Type of Complications Indicator Age at Rash Onset Age Type at Rash Onset Part of Outbreak Transmission Setting Epi-Linked Traceable to International Import Confirmation Method Length of Time in the US Length of Time in the US Units US Acquired Case Patient a Healthcare Worker Import Status International Destination(s) of Recent Travel Date of Return From Travel Number of Weeks Gestation at Onset of Illness Trimester at Onset of Illness Documentation of Previous Disease Immunity Testing Result of Previous Immunity Testing Pregnancy Outcome At the time of cessation of pregnancy, What Was the Age of the Fetus (In Weeks) Was an Autopsy Performed Result of Autopsy Laboratory Testing Performed Laboratory Confirmed Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did the Subject Ever Receive a Vaccine Against This Disease Number of Doses Received On or After 1st Birthday Vaccination Doses Prior to Onset Vaccinated per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002710 2 3 Detection Method Year of Previous Immunity Testing Diagnosed With the Condition Before Previous Case Diagnosed By Was Previous Disease Serologically Confirmed Year of Previous Disease Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Fever Onset Cause of Death Age and Setting Verified Confirmation Date Case Investigation Status Code Patient Address City Expected Delivery Date Expected Place of Delivery Age of Subject at Time of Immunity Testing (in years) Age at Previous Diagnosis Age Units at Previous Diagnosis Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Specimen Analyzed Date/Time Date of Last Dose Prior to Illness Onset Vaccine History Comments TX-DSHS-19-1309-A-002711 Data Element Priorities for Congenital Rubella Syndrome 7/2/2019 Priority 1 Data Element Name Message Profile Identifier Type of Complication Type of Complications Indicator Confirmation Method Birth State Did the Mother Have a Rash What was the Mother's Rash Onset Date Did the Mother Have a Fever What was the Mother's Fever Onset Date Gestational Age Age at Diagnosis Age (unit) at Diagnosis Mother's Birth Country Length of Time Mother Has Been in the US Mother's Country of Residence Was Prenatal Care Obtained For this Pregnancy Was There a Rubella-like Illness During This Pregnancy Month of Pregnancy in Which Symptoms First Occurred Rubella Lab Testing Mother Was Rubella Diagnosed By a Physician At Time of Illness Was Rubella Serologically Confirmed At Time of Illness US Acquired Did the Mother Travel Outside the US During the First Trimester of Pregnancy International Destination(s) of Recent Travel Date Left For Travel Date Returned From Travel Was the Mother Directly Exposed to a Confirmed Case If Mother Directly Exposed to a Confirmed Rubella Case, Specify the Relationship Mother's Date of Exposure to a Confirmed Rubella Case Laboratory Testing Performed Laboratory Confirmed Specimen From Mother or Infant Test Type Test Result Genotype Sequence Specimen Source Specimen Collection Date/Time Performing Laboratory Type Did Mother Ever Receive a Vaccine Against This Disease Source of Mother's Vaccine Information Number of Doses Received On Or After 1st Birthday Date of Last Dose Prior to Illness Onset Vaccinated Per ACIP Recommendations Reason Not Vaccinated Per ACIP Recommendations Vaccine Type Vaccine Administered Date Vaccine Dose Number Vaccine Manufacturer Vaccine Event Information Source TX-DSHS-19-1309-A-002712 2 3 At the time of cessation of pregnancy, what was the age of the fetus (in weeks) Detection Method Mother's Rash Duration (in days) Mother's Fever Duration (in days) Did the Mother Have Arthralgia/Arthritis Did the Mother Have Lymphadenopathy Birth Weight Birth Weight (unit) Did the Mother Have Serological Testing Prior to This pregnancy Mother's Pre-Pregnancy Serological Test Date Mother's Pre-Pregnancy Serological Test Interpretation If Rubella Was Not Diagnosed By a Physician, Diagnosed By Whom Has Mother Given Birth In the US Previously Number of Total Live Births If Mother Has Given Birth in US, Number of Births Delivered in US Specimen Sent to CDC VPD Lab Message Reference Laboratory VPD Lab Message Patient Identifier VPD Lab Message Specimen Identifier Date Specimen Sent to CDC Vaccine Lot Number Vaccine Expiration Date National Drug Code (NDC) Vaccination Record Identifier Date of Last Evaluation by a Healthcare Provider Primary Cause of Death from Death Certificate Secondary Cause of Death from Death Certificate Case Investigation Status Code Patient Address City Confirmation Date Clinical Case Appraisal Other Clinical Features of Maternal Illness Mother's Age at Delivery Mother's Age at Delivery (units) Did the Mother Attend a Family Planning Clinic Prior to Conception of This Infant Number of Children Less Than 18 Years of Age Living in Household During This Pregnancy Were Any of the Children Living in the Household Immunized With Rubella-Containing Vaccine Number of Children Less Than 18 Years of Age Immunized With the Rubella Vaccine Date of First Prenatal Visit for This Pregnancy Where was Prenatal Care For This Pregnancy Obtained Pregnancy Outcome Does the Mother Know Where She Might Have Been Exposed to Rubella If Mother Has Given Birth in US, List Dates (years) Number of Previous Pregnancies Current Occupation Current Occupation Standardized Current Industry Current Industry Standardized Test Result Quantitative Result Units Specimen Type Specimen Analyzed Date/Time TX-DSHS-19-1309-A-002713 A 1 2 3 4 5 6 7 8 9 10 11 12 13 14 I B C D E F Varicella Outbreak Reporting Worksheet (Quarterly) G H I J I Site Reporting: I Name Person Reporting: I Phone: I Email: I Quarter of Report: I Year of Report: I Total Number outbreaks: I 15 16 17 I 18 Please e-mail or fax the Cover and Outbreak sheets to Adriana Lopez at CDC: alopez@cdc.gov or 404-315-3398. 19 IIf you have any questions please contact her by e-mail or phone: alopez@cdc.gov or 404-639-8369. 20 I (Nov 2015) 21 Varicella Outbreak Line List, Appendix 20, Surveillance Manual Cover Sheet TX-DSHS-19-1309-A-002714 #P - 1 A B C D E F G Outbreak Outbreak Rash Onset Case # Grantee Name or ID Setting Case ID* date Age 2 1 3 2 4 3 5 4 6 5 7 6 8 7 9 8 10 9 11 10 12 11 13 12 14 13 15 14 16 15 17 16 18 17 19 18 20 19 21 20 22 23 24 * Please list data for individual cases associated with outbreaks of ≥3 cases † Please list number of lesions as follows: <50 (list number if known), 50-249, 50-500, 25 250-500, >500, unknown ‡ If more than 2 doses of varicella vaccine received, please enter dates of vaccination 26 for additional doses in comments section 27 Please e-mail or fax the Cover and Outbreak Sheets to Adriana Lopez at CDC: 28 alopez@cdc.gov or 404-315-3398. If you have any questions please contact her by e-mail or phone: alopez@cdc.gov or 404-639-8369. 29 H I J K L M N Case Vaccination and Disease History before start of outbreak Vaccinated If with varicella vaccinated, History of How history of Number containing # of doses Date of Date of varicella disease of vaccine (1, 2, ≥3, vaccination vaccination disease (Yes, assessed Lesions† (Yes, No, Unk) Unk) (dose 1) (dose 2)‡ No, Unk) (Provider, Self) Outbreak Sheet TX-DSHS-19-1309-A-002715 - 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 O Was case laboratory confirmed? (Yes, No, Unk) P Q Was case hospitalized? Complications (specify) (Yes, No, Unk) R Comments (e.g., source of exposure, relationship between cases [siblings, classmates]) 25 26 27 28 29 Outbreak Sheet TX-DSHS-19-1309-A-002716 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 A B Elementary school Middle school High school Day care Mixed grade school College/University Correctional facility Group shelter Long term care facility Healthcare Community Other (specify in cell) C D E F <50 (specify exact # in Yes cell) 50-249 No 250-500 Unknown 50-500 >500 Unknown G H 1 2 ≥3 Unknown I J Provider Parent/self Sheet2 K L AK AL AR AZ CA CHI CO CT DE FL GA HOU HI ID IA IL IN KS KY LA LAC MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NY NYC NV OH OK OR PA PHI PR RI SC SD TN TX UT VA VT WA WI WV M N Aug-Oct Nov-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec TX-DSHS-19-1309-A-002717 56 57 58 59 60 61 62 63 A B C D E F G H I J Sheet2 K L M WY USVI GUA AMERICAN SAMOA NMI CNMI FSM PALAU N TX-DSHS-19-1309-A-002718 From: Centers for Disease Control and Prevention Sent: Thursday, October 10, 2019 9:25 AM EDT To: Garcia,Imelda M (DSHS) Subject: Latest Podcast - Emerging Infectious Diseases Journal - October 10, 2019 WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal LATEST PODCAST — OCTOBER 10, 2019 Ahead of Print About the Journal Current Cover Candida auris outbreaks, Colombia Download the PDF of the podcast transcript (87KB) Peer Reviewers Search EID Contact EID Dr. Brendan Jackson, a medical epidemiologist at CDC, discusses Candida auris infections in hospitals in Colombia. Running time = 29:34 Read the associated article in the July 2019 issue of the EID Journal Hospital-Associated Multicenter Outbreak of Emerging Fungus Candida auris, Colombia, 2016 — P. A. Armstrong et al. Browse all of EID's Podcast Content CDC EID Podcasts Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30329 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002719 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 2019 10:44 AM EDT CC: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/D DID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman , "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDI D/NCEZID/DPEI ) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NC EZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L.(CDC/DDID/NCEZID/DPEI); Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ; Light, Megan (CDC/DDI D/NCEZID/DPEI) Subject: Closeout Report Update WA RNING : T his email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sende r and know the content is safe. Greetings. On 5/7/19, the Office of Grant Services (O(iS) issued a (iranl Nole in GrantSolulions (attached letter was dated 5/2/19) infrnming all ELC Recipients that all final reports for the closeout ofCK14 - 1401 must be submitted by 10/29/19. Please see the attached OGS leller for details regarding the specifk requirements. ln the letter. there is i11e11Lio11 of three (3) required allachme11ts that need to be part of the refei·enced Grant Closeout amendmeill that n eeds to go into GrantSolutions. The second attachme11l (i.e .. Final Pei.fomwnce l'rngress and b·aluation Report) is what you either have completed or are in the process of completing in the t.LC CK 14-1401Closeout Repm1 portal in REDCap . And lo be clear, the only thing that needs lo be extrac ted as a l'DF and uploaded into (hanlSolulions is the ELC CK] 4-1401 Closeflut Repflrt - there is no need lo include the 131'5completed te111p lales. Once you complete your Closeout Report in REDCap, please fol low these steps lo extract a l'DF which can the11be uploaded as an allachme11l in GrantSolutions under the OGS-required Grant Closeout ame11dme11t. 1. Aflei· completing and saving the 5- Year Closeout Report on the ''ELC CK 14-1401 Closeout Report" page , go to the top of the page and select ''Download l'DF Instrument". CK14-140 1 ELC Closeout Repor t '™'"" I '.:;-POFoltnsuumen[(i;) ~ It~ e 1110 £0: e-a~< d.11'1e,mv ELC CD4-1401 Cfos.eoutJIE>port lod~nt ., Edlbl\t -Ilg 11K AK MtWQn~.as ~ of)"flut f~OUlfW-Ofl.. • .., )'OIJI')Urtodlroonfor chisp,._,, rop,..,...,. the ....,,.., , boW:. A drnp down menu wil I appear and select ''This data entry 2. 101111with saved data" CIK1I4-1401 ELC Closeout Report At'110Nc I~ Dd ~Of al~>) • ELC ~thl5 ,,;, f .._ Shorci ~ '""' j f3Y!000i8Ml5dffl entrY data @ntrylormW1th:1-a'ted~ {comp.act.} iooclplt, ~iJld.lta entty form, (hl•ni<) °1Alld01• tnlr)' ro,m,W1th-..id.llil • ~dai41entrwformsw1lh5a't"eddcitd{comoactj 3. IJln,y """Y'°"" \tll,nlQ lNS da111 -cutting Closeout Report You will have the option t1)save this document l1) your computer, save the document and upload to Gran tSolutions . lf you have questions about REDCap &/or l'DF extractirn1, please contact Char Njornge (w kv2 ,akdc.f!ov ). l f you have questions about the Grant please contact your Grant Specialist (Karen Zion: wv(S,a).cdc gov or Tonya Jenkins: uio6@.cdc gov). Closeout ame11d111e11t, Sincerely, The ELC Team TX-DSHS-19-1309-A-002720 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 201910:51 AM EDT CC: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/D DID/NCEZID /DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman , "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDI D/NCEZID/DPEI ) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NC EZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L.(CDC/DDID/NCEZID/DPEI); Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ; Light, Megan (CDC/DDI D/NCEZID/DPEI) Subject: RE: Closeout Report Update Attachment(s): "ELC 90 Day Closeout Notification.pdf" WAR NING : Th is ema il is from outside the HHS system . Do not click on links or attachmen ts unless you expec t them from the sende r and know the conten t is safe . Greetings, Sorry, the letter was not attached in previous email, but it is attached here. Thank you, The ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 2019 10:44 AM Cc: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NCEZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L. (CDC/DDID/NCEZID/DPEI) ; Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ;Light , Megan (CDC/DDID/NCEZID/DPEI) Subject: Closeout Report Update Greetings. On 5/7/19, the Office or Grant Services (OGS) issued a Chant Note in GrantSolutions (attached letter was dated 5/2/19) i11fo1mi11g all ELC Recipients that all rinal reports for the closeout orCK14-1401 must be submitted by 10/29/19. Please see the attached O(iS letter for details regarding the specific requirements. In the letter, there is irnintion or three (3) required attachments that need to be part or the rererenced Grant Closeout amendment that needs to go into (irantSolutions. The second attachment (i.e .. Final !'e1.fmma11ce l'mgress a11dt:valuatirm Report) is what you either have completed or are in the process or completing in the cLC CK 14-1401 Closeout Repm1 portal in REDCap . And to be clear, the only thing that needs to be extrac ted as a l'DF and uploaded into GrantSolutions is the ELC CK! 4-1401 Cluseout Report - there is 110need to include the l:l 1'5 completed temp lates. Once you complete your Clt)seoul Report in REDCap, please rollow these steps to extract a l'DF which can then be uploaded as an attachmen t in GrantSolutions under the OGS-required Grant Closeout amendment. 1. After completing and saving the 5- Year Closeout Report 011the ' "ELC CK 14-1401 Closeout Report" pag e, go to the top or the page and select '·Download l'DF Instrument" . CK14·1401 ELCClos<: out Report "<00"5' I~ - "°""' •n-l{l.) l1 R \110( 0.: 8-asrcd..ruJl!fit ry •· Etc CK14- 140 1 c foseou, A!!pon -¥- Ed1un1,1,h10uSlmd1Rg <)'d• lnform,a..... systr-,ylH••~ lrlfo:rmationto ltel'p uslffld•-W11>1 the :ai,sanddla!leng-eswe,o from llllls P<""10111 lu!ldlng ~- and illform fuwir@(firettfon5 Jn,nc. su,:,..,...._ 2. A drop down menu will appear and select ''This data entry fonn with saved data" TX-DSHS-19-1309-A-002721 CIK114- 1401 ELC Closeo u t Re port I -'l I ._hr••- ,n lhe L,lx,ey • ELC t; ,..,d•"'""''Yltlfm(l>lo nk:J ~ ThlS datA•n<,ylonnwi1i...,-i , ea.o 1:;1hl§ o,u ,..,..d&,a CcnmpaclJ data on,,ylorm with AJUUt.J ,mtf) forms(bl-.)nk,l ll!e d pkl AJ< A.IId.1:1~,mt')' torm.s w,th Ql.l(kj d.at., 1'.:J:JJ hbt, @mrwform:iwlth wveidd.,H.ill cc-~ 3. ,cutt ing Closeou t Report You will have the option to save this document to your computer, save the document and upload to Gran tSolutions . If you have questions about REDCap &/or l'DF extraction, please contact Char Njornge ( wkv2 td.cdc.f!cw). If you have questions about the Grant Closeout amendment, please contact your Grant Specialist (Karen Zion: wvf'8ia!cdc.gov or Tonya Jenkins: pjo6@cdc .gov ). Sincerely, The ELC Team TX-DSHS-19-1309-A-002722 /,,·4 4I U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES \.... --;j Public Health Service Centers for Disease Control and Prevention (CDC) Atlanta GA 30333 Date: 05/02/2019 Reference: 90 Day Notification of Closeout Funding Opportunity Announcement Number (NOFO): CK14-1401 - The Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement Project Period: 8/ 1/2014 - 7/31/2019 Dear Recipient: This is to notify you that your ELC cooperative agreement with the Centers for Disease Control and Prevention (CDC) ends on 7/31/2019. In accordance with the terms and conditions of your award, you are required to submit all required final reports no later than ninety (90) days from the expiration date of the award. All final reports, must be submitted by 10/29/2019. Submission of Closeout Documents Closeout reports must be submitted into GrantSolutions as a Grant Closeout amendment. You will need to create a post-award amendment and select Grant Closeout as the amendment type. You will upload all required closeout reports to the amendment. You must also complete and upload as attachements the following: 181Final Equipment Inventory List Authorization/Purchase (enclosed) 181Final Performance Progress and Evaluation Report 181Final Federal Financial Reports (FFRs) - Please ensure that the applicable document number listed below is inserted into box 5 or the remarks section. Federal Financial Report Document Numbers: Non-PPHF: You will need to submit one (1) cumulative FFR for all non-PHHF funds awarded under document number: 000XXXCK14 PPHF: You will need to submit four (4) separate FFRs for PHHF funds, i.e; one FFR for each document number outlined below: PPHF budget period 0 1: 000:XXXEL14 PPHF budget period 02: 000:XXXIDlS PPHF budget period 03: 000XXXID16 PPHF budget period 04: 000:XXXCKl 7PPHF17 Zika: You will need to submit one (1) cumulative FFR for Zika that was awarded in budget periods 03 and 04: ZIKA budget period 03/04: 000:XXXCKl 7 Payment Management System You must report federal cash information to PMS on the schedule established for submission of those quarterly reports. Please note that all PMS accounts must be fully reconciled. In accordance with the terms and conditions of your award, you are required to return to CDC any unobligated funds that you have drawn as an advance payment from PMS. TX-DSHS-19-1309-A-002723 Please make special note of the following : Indirect Cost Adjustments If the grant/cooperative agreeme nt is closed based on approved provisional indirect cost rates and negotia ted final indirect cost rates are lower than the approved provisional rates, all excess indirect costs claimed must be returned to CDC within 45 days of the date of the letter transmitting the final rates. Your final rates may have come from the Department of Health and Human Services or another cognizant federal agency . The return of excess indirect costs must be accompanied by a revised final FFR. Cost Disallowances The closeout of a gran Vcoopera tive agreement does not affect your obligation to return any amounts due to the federal government as a result of later audit disallowances, refunds , corrections , or other actions. All funds due that are not returned constitute a debt to the federal government. It is not necessary to submit revised closeout documents with each repayment; however, it is necessary that each payment be accompanied by the following information: the grant/cooperative agreement number, the source or nature of the payment, and any other pertinent information rela ting to the amount that assists us in proper ly accounting for the funds . Record Retention Req uirements Financia l records, supporting documents, statistical records, and all other records pertinent to an award must be retained for a period of three years from the date of submission of the final FFR, except if any litigation, claim, financial management review, or audit is started before the expiration of the three year period {even if it extends beyond the three year period), the records must be retained until all litigation, claims or audit findings involving the records have been reso lved and final action taken. Records for real property and equipment acquired with federal funds (or any required matching or cost sharing) must be retained for three years after final disposition. Inquiries should be directed to Karen Zion at 770-488-2729 or wvf8@cdc .gov. J/ ~~ ~ely, 0 IAJA)O{~\ Karen Zion Grants Management Specialist Infectious Disease Services Branch Office of Gran t Services Centers for Dise ase Control and Prev ention cc: Project Officer/Program Official Rev. 4/9/ 14 TX-DSHS-19-1309-A-002724 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 201910:51 AM EDT CC: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/D DID/NCEZID /DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman , "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDI D/NCEZID/DPEI ) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NC EZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L.(CDC/DDID/NCEZID/DPEI); Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ; Light, Megan (CDC/DDI D/NCEZID/DPEI) Subject: RE: Closeout Report Update Attachment(s): "ELC 90 Day Closeout Notification.pdf" WAR NING : Th is ema il is from outside the HHS system . Do not click on links or attachmen ts unless you expec t them from the sende r and know the conten t is safe . Greetings, Sorry, the letter was not attached in previous email, but it is attached here. Thank you, The ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 2019 10:44 AM Cc: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NCEZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L. (CDC/DDID/NCEZID/DPEI) ; Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ;Light , Megan (CDC/DDID/NCEZID/DPEI) Subject: Closeout Report Update Greetings. On 5/7/19, the Office or Grant Services (OGS) issued a Chant Note in GrantSolutions (attached letter was dated 5/2/19) i11fo1mi11g all ELC Recipients that all rinal reports for the closeout orCK14-1401 must be submitted by 10/29/19. Please see the attached O(iS letter for details regarding the specific requirements. In the letter, there is irnintion or three (3) required attachments that need to be part or the rererenced Grant Closeout amendment that needs to go into (irantSolutions. The second attachment (i.e .. Final !'e1.fmma11ce l'mgress a11dt:valuatirm Report) is what you either have completed or are in the process or completing in the cLC CK 14-1401 Closeout Repm1 portal in REDCap . And to be clear, the only thing that needs to be extrac ted as a l'DF and uploaded into GrantSolutions is the ELC CK! 4-1401 Cluseout Report - there is 110need to include the l:l 1'5 completed temp lates. Once you complete your Clt)seoul Report in REDCap, please rollow these steps to extract a l'DF which can then be uploaded as an attachmen t in GrantSolutions under the OGS-required Grant Closeout amendment. 1. After completing and saving the 5- Year Closeout Report 011the ' "ELC CK 14-1401 Closeout Report" pag e, go to the top or the page and select '·Download l'DF Instrument" . CK14·1401 ELCClos<: out Report "<00"5' I~ - "°""' •n-l{l.) l1 R \110( 0.: 8-asrcd..ruJl!fit ry •· Etc CK14- 140 1 c foseou, A!!pon -¥- Ed1un1,1,h10uSlmd1Rg <)'d• lnform,a..... systr-,ylH••~ lrlfo:rmationto ltel'p uslffld•-W11>1 the :ai,sanddla!leng-eswe,o from llllls P<""10111 lu!ldlng ~- and illform fuwir@(firettfon5 Jn,nc. su,:,..,...._ 2. A drop down menu will appear and select ''This data entry fonn with saved data" TX-DSHS-19-1309-A-002725 CIK114- 1401 ELC Closeo u t Re port I -'l I ._hr••- ,n lhe L,lx,ey • ELC t; ,..,d•"'""''Yltlfm(l>lo nk:J ~ ThlS datA•n<,ylonnwi1i...,-i , ea.o 1:;1hl§ o,u ,..,..d&,a CcnmpaclJ data on,,ylorm with AJUUt.J ,mtf) forms(bl-.)nk,l ll!e d pkl AJ< A.IId.1:1~,mt')' torm.s w,th Ql.l(kj d.at., 1'.:J:JJ hbt, @mrwform:iwlth wveidd.,H.ill cc-~ 3. ,cutt ing Closeou t Report You will have the option to save this document to your computer, save the document and upload to Gran tSolutions . If you have questions about REDCap &/or l'DF extraction, please contact Char Njornge ( wkv2 td.cdc.f!cw). If you have questions about the Grant Closeout amendment, please contact your Grant Specialist (Karen Zion: wvf'8ia!cdc.gov or Tonya Jenkins: pjo6@cdc .gov ). Sincerely, The ELC Team TX-DSHS-19-1309-A-002726 /,,·4 4I U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES \.... --;j Public Health Service Centers for Disease Control and Prevention (CDC) Atlanta GA 30333 Date: 05/02/2019 Reference: 90 Day Notification of Closeout Funding Opportunity Announcement Number (NOFO): CK14-1401 - The Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement Project Period: 8/ 1/2014 - 7/31/2019 Dear Recipient: This is to notify you that your ELC cooperative agreement with the Centers for Disease Control and Prevention (CDC) ends on 7/31/2019. In accordance with the terms and conditions of your award, you are required to submit all required final reports no later than ninety (90) days from the expiration date of the award. All final reports, must be submitted by 10/29/2019. Submission of Closeout Documents Closeout reports must be submitted into GrantSolutions as a Grant Closeout amendment. You will need to create a post-award amendment and select Grant Closeout as the amendment type. You will upload all required closeout reports to the amendment. You must also complete and upload as attachements the following: 181Final Equipment Inventory List Authorization/Purchase (enclosed) 181Final Performance Progress and Evaluation Report 181Final Federal Financial Reports (FFRs) - Please ensure that the applicable document number listed below is inserted into box 5 or the remarks section. Federal Financial Report Document Numbers: Non-PPHF: You will need to submit one (1) cumulative FFR for all non-PHHF funds awarded under document number: 000XXXCK14 PPHF: You will need to submit four (4) separate FFRs for PHHF funds, i.e; one FFR for each document number outlined below: PPHF budget period 0 1: 000:XXXEL14 PPHF budget period 02: 000:XXXIDlS PPHF budget period 03: 000XXXID16 PPHF budget period 04: 000:XXXCKl 7PPHF17 Zika: You will need to submit one (1) cumulative FFR for Zika that was awarded in budget periods 03 and 04: ZIKA budget period 03/04: 000:XXXCKl 7 Payment Management System You must report federal cash information to PMS on the schedule established for submission of those quarterly reports. Please note that all PMS accounts must be fully reconciled. In accordance with the terms and conditions of your award, you are required to return to CDC any unobligated funds that you have drawn as an advance payment from PMS. TX-DSHS-19-1309-A-002727 Please make special note of the following : Indirect Cost Adjustments If the grant/cooperative agreeme nt is closed based on approved provisional indirect cost rates and negotia ted final indirect cost rates are lower than the approved provisional rates, all excess indirect costs claimed must be returned to CDC within 45 days of the date of the letter transmitting the final rates. Your final rates may have come from the Department of Health and Human Services or another cognizant federal agency . The return of excess indirect costs must be accompanied by a revised final FFR. Cost Disallowances The closeout of a gran Vcoopera tive agreement does not affect your obligation to return any amounts due to the federal government as a result of later audit disallowances, refunds , corrections , or other actions. All funds due that are not returned constitute a debt to the federal government. It is not necessary to submit revised closeout documents with each repayment; however, it is necessary that each payment be accompanied by the following information: the grant/cooperative agreement number, the source or nature of the payment, and any other pertinent information rela ting to the amount that assists us in proper ly accounting for the funds . Record Retention Req uirements Financia l records, supporting documents, statistical records, and all other records pertinent to an award must be retained for a period of three years from the date of submission of the final FFR, except if any litigation, claim, financial management review, or audit is started before the expiration of the three year period {even if it extends beyond the three year period), the records must be retained until all litigation, claims or audit findings involving the records have been reso lved and final action taken. Records for real property and equipment acquired with federal funds (or any required matching or cost sharing) must be retained for three years after final disposition. Inquiries should be directed to Karen Zion at 770-488-2729 or wvf8@cdc .gov. J/ ~~ ~ely, 0 IAJA)O{~\ Karen Zion Grants Management Specialist Infectious Disease Services Branch Office of Gran t Services Centers for Dise ase Control and Prev ention cc: Project Officer/Program Official Rev. 4/9/ 14 TX-DSHS-19-1309-A-002728 From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 201910:51 AM EDT CC: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/D DID/NCEZID /DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman , "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDI D/NCEZID/DPEI ) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NC EZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L.(CDC/DDID/NCEZID/DPEI); Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ; Light, Megan (CDC/DDI D/NCEZID/DPEI) Subject: RE: Closeout Report Update Attachment(s): "ELC 90 Day Closeout Notification.pdf" WAR NING : Th is ema il is from outside the HHS system . Do not click on links or attachmen ts unless you expec t them from the sende r and know the conten t is safe . Greetings, Sorry, the letter was not attached in previous email, but it is attached here. Thank you, The ELC Team From: Epidemiology and Laboratory Capacity for Infectious Diseases (CD (CDC) Sent: Friday, October 11, 2019 10:44 AM Cc: Nonnenmacher, Patrick (CDC/DDID/NCEZID/DPEI) ; Downing, Janice S. (CDC/DDID/NCEZID/DPEI) ; Brathwaite, Wayne (CDC/DDID/NCEZID/DPEI) ; Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) ; Njoroge, Charlene F. (CDC/DDID/NCEZID/DPEI) ; Pullman, "Amy" (Amanda) (CDC/DDID/NCEZID/DPEI) ; O'Connor, Angelica (CDC/DDID/NCEZID/DPEI) ; Snow, Jason N. (CDC/DDID/NCEZID/DPEI) ; Ganim, Alexandra M. (CDC/DDID/NCEZID/DPEI) ; Borrelli, Aaron (CDC/DDID/NCEZID/DPEI) ; Shultz, Alvin (CDC/DDID/NCEZID/DPEI) ; Chung, Christina L. (CDC/DDID/NCEZID/DPEI) ; Bellis, Kimberly (CDC/DDID/NCEZID/DPEI) ;Light , Megan (CDC/DDID/NCEZID/DPEI) Subject: Closeout Report Update Greetings. On 5/7/19, the Office or Grant Services (OGS) issued a Chant Note in GrantSolutions (attached letter was dated 5/2/19) i11fo1mi11g all ELC Recipients that all rinal reports for the closeout orCK14-1401 must be submitted by 10/29/19. Please see the attached O(iS letter for details regarding the specific requirements. In the letter, there is irnintion or three (3) required attachments that need to be part or the rererenced Grant Closeout amendment that needs to go into (irantSolutions. The second attachment (i.e .. Final !'e1.fmma11ce l'mgress a11dt:valuatirm Report) is what you either have completed or are in the process or completing in the cLC CK 14-1401 Closeout Repm1 portal in REDCap . And to be clear, the only thing that needs to be extrac ted as a l'DF and uploaded into GrantSolutions is the ELC CK! 4-1401 Cluseout Report - there is 110need to include the l:l 1'5 completed temp lates. Once you complete your Clt)seoul Report in REDCap, please rollow these steps to extract a l'DF which can then be uploaded as an attachmen t in GrantSolutions under the OGS-required Grant Closeout amendment. 1. After completing and saving the 5- Year Closeout Report 011the ' "ELC CK 14-1401 Closeout Report" pag e, go to the top or the page and select '·Download l'DF Instrument" . CK14·1401 ELCClos<: out Report "<00"5' I~ - "°""' •n-l{l.) l1 R \110( 0.: 8-asrcd..ruJl!fit ry •· Etc CK14- 140 1 c foseou, A!!pon -¥- Ed1un1,1,h10uSlmd1Rg <)'d• lnform,a..... systr-,ylH••~ lrlfo:rmationto ltel'p uslffld•-W11>1 the :ai,sanddla!leng-eswe,o from llllls P<""10111 lu!ldlng ~- and illform fuwir@(firettfon5 Jn,nc. su,:,..,...._ 2. A drop down menu will appear and select ''This data entry fonn with saved data" TX-DSHS-19-1309-A-002729 CIK114- 1401 ELC Closeo u t Re port I -'l I ._hr••- ,n lhe L,lx,ey • ELC t; ,..,d•"'""''Yltlfm(l>lo nk:J ~ ThlS datA•n<,ylonnwi1i...,-i , ea.o 1:;1hl§ o,u ,..,..d&,a CcnmpaclJ data on,,ylorm with AJUUt.J ,mtf) forms(bl-.)nk,l ll!e d pkl AJ< A.IId.1:1~,mt')' torm.s w,th Ql.l(kj d.at., 1'.:J:JJ hbt, @mrwform:iwlth wveidd.,H.ill cc-~ 3. ,cutt ing Closeou t Report You will have the option to save this document to your computer, save the document and upload to Gran tSolutions . If you have questions about REDCap &/or l'DF extraction, please contact Char Njornge ( wkv2 td.cdc.f!cw). If you have questions about the Grant Closeout amendment, please contact your Grant Specialist (Karen Zion: wvf'8ia!cdc.gov or Tonya Jenkins: pjo6@cdc .gov ). Sincerely, The ELC Team TX-DSHS-19-1309-A-002730 /,,·4 4I U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES \.... --;j Public Health Service Centers for Disease Control and Prevention (CDC) Atlanta GA 30333 Date: 05/02/2019 Reference: 90 Day Notification of Closeout Funding Opportunity Announcement Number (NOFO): CK14-1401 - The Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) Cooperative Agreement Project Period: 8/ 1/2014 - 7/31/2019 Dear Recipient: This is to notify you that your ELC cooperative agreement with the Centers for Disease Control and Prevention (CDC) ends on 7/31/2019. In accordance with the terms and conditions of your award, you are required to submit all required final reports no later than ninety (90) days from the expiration date of the award. All final reports, must be submitted by 10/29/2019. Submission of Closeout Documents Closeout reports must be submitted into GrantSolutions as a Grant Closeout amendment. You will need to create a post-award amendment and select Grant Closeout as the amendment type. You will upload all required closeout reports to the amendment. You must also complete and upload as attachements the following: 181Final Equipment Inventory List Authorization/Purchase (enclosed) 181Final Performance Progress and Evaluation Report 181Final Federal Financial Reports (FFRs) - Please ensure that the applicable document number listed below is inserted into box 5 or the remarks section. Federal Financial Report Document Numbers: Non-PPHF: You will need to submit one (1) cumulative FFR for all non-PHHF funds awarded under document number: 000XXXCK14 PPHF: You will need to submit four (4) separate FFRs for PHHF funds, i.e; one FFR for each document number outlined below: PPHF budget period 0 1: 000:XXXEL14 PPHF budget period 02: 000:XXXIDlS PPHF budget period 03: 000XXXID16 PPHF budget period 04: 000:XXXCKl 7PPHF17 Zika: You will need to submit one (1) cumulative FFR for Zika that was awarded in budget periods 03 and 04: ZIKA budget period 03/04: 000:XXXCKl 7 Payment Management System You must report federal cash information to PMS on the schedule established for submission of those quarterly reports. Please note that all PMS accounts must be fully reconciled. In accordance with the terms and conditions of your award, you are required to return to CDC any unobligated funds that you have drawn as an advance payment from PMS. TX-DSHS-19-1309-A-002731 Please make special note of the following : Indirect Cost Adjustments If the grant/cooperative agreeme nt is closed based on approved provisional indirect cost rates and negotia ted final indirect cost rates are lower than the approved provisional rates, all excess indirect costs claimed must be returned to CDC within 45 days of the date of the letter transmitting the final rates. Your final rates may have come from the Department of Health and Human Services or another cognizant federal agency . The return of excess indirect costs must be accompanied by a revised final FFR. Cost Disallowances The closeout of a gran Vcoopera tive agreement does not affect your obligation to return any amounts due to the federal government as a result of later audit disallowances, refunds , corrections , or other actions. All funds due that are not returned constitute a debt to the federal government. It is not necessary to submit revised closeout documents with each repayment; however, it is necessary that each payment be accompanied by the following information: the grant/cooperative agreement number, the source or nature of the payment, and any other pertinent information rela ting to the amount that assists us in proper ly accounting for the funds . Record Retention Req uirements Financia l records, supporting documents, statistical records, and all other records pertinent to an award must be retained for a period of three years from the date of submission of the final FFR, except if any litigation, claim, financial management review, or audit is started before the expiration of the three year period {even if it extends beyond the three year period), the records must be retained until all litigation, claims or audit findings involving the records have been reso lved and final action taken. Records for real property and equipment acquired with federal funds (or any required matching or cost sharing) must be retained for three years after final disposition. Inquiries should be directed to Karen Zion at 770-488-2729 or wvf8@cdc .gov. J/ ~~ ~ely, 0 IAJA)O{~\ Karen Zion Grants Management Specialist Infectious Disease Services Branch Office of Gran t Services Centers for Dise ase Control and Prev ention cc: Project Officer/Program Official Rev. 4/9/ 14 TX-DSHS-19-1309-A-002732 From: Electronic Data Exchange (CDC) Sent: Friday, October 11, 2019 11:28 AM EDT To: Electronic Data Exchange (CDC) Subject: Quest QLS Project Update Attachment(s): "Letter - Quest QLS Project.pdf" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Dear ELC Principal Investigators and ELR contacts: Please see the attached letter from Dr. Robert Pinner of CDC, Dr. Janet Piscitelli of Quest Diagnostics Incorporated, and Patina Zarcone-Gagne of APHL about the completion of the Quest QLS project and an update on exciting new projects to come. Thanks, ELR Implementation Support and Monitoring CDC Team Member: Kelsey Patel edx@cdc.gov TX-DSHS-19-1309-A-002733 �� (: 11Cff ........J),..__ ------ x_�--�-_ .. Robert W. Pinner, MD on behalf of CDC ELR Team Associate Director for Programs, Surveillance and Informatics National Center for Emerging and Zoonotic Infectious Diseases CDC �iML<.,,., X ---- --------- ------ Janet Piscitelli, MD Vice President and Chief Laboratory Officer Quest Diagnostics Incorporated TX-DSHS-19-1309-A-002735 x__ ~u02•-~e_ ------- -- ------ ---- - Patina Zarcone-Gagne Director, Informatics Association of Public Health Laboratories TX-DSHS-19-1309-A-002736 From: Aldridge,Tiffany (DSHS) Sent: Monday, October 14, 2019 12:12 PM EDT To: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) CC: Garcia,lmelda M (DSHS) Subject: RE: ELC First Quarter Calls Good Morning De'Lisa, It looks like most of our staff in Texas are available the following dates: 1) October 22, 2019 1-2 p.m. CST (first choice) 2) October 21, 2019 and October 23, 2019 2-3 p.m. CST 3) October 28, 2019 and October 29, 2019 10 - 11 a.m. Please let me know if any of these dates and times work for you. Thank You, Tiffany Aldridge, CTCM Program Sj1ecia/ist Texas Department of State Ilea/th Services Infectious Disease Prevention Section ,WC30R2 Ph: (512) 776-6658 Ce//: (5 I 2) 645-5030 Fax: (512) 776-7443 tiffa nv.a/dnd ge(/idshs.texas. gov From: Simpson, De'Lisa D. (CDC/DDID/NCEZID/DPEI) [mailto:ion9@cdc.gov] Sent: Monday, October 7, 2019 1 :20 PM Subject: ELC First Quarter Calls Importance: High WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. Greetings, I 'Will be scheduling our 1st Quarter Cal I to discuss your recent !..'.LC-supported al'tivitics in !..'.pi,Lab, and !..'.LCLeaders h ip. Please send me two preferred dates and times (one hour cal I) for the month of October with cal Is ending by Friday, November I , 2019. I wi II keep my calendar open to accommodate your availability. HO\vcvcr, I am nut available on the fi.illo'wing days due to prior enga ge ments : • • • • Tuesdays from J0:00 a.m.-1 J :OUa.m. HST Thursdays from 10:00 a.m.-1 J:OUa.m. HST Friday, October 18, 20]9 (un leave) Wednesday, October 23, 2019 (available AM only) Prior to the cal I please enter the fol lowing information into your RL'.DCap project. The entries should be completed two days pri or to your scheduled call to give me time to rcvicv.· your input. Below you'll find the link to the RL'.DCap project: https·!!nkp c,k gov Please navigate to My Pru_jects,followed by !..'.LCMonitoring Portal 2019-2020: Cross-Cutting Section (A, B, D, I..'.).The call will cover activities A I, A2, & B. We have populated your new work plans and ask that you take time t o review them and ent er t he requ ested feedback in RL'.DCar beforethe rail: • Select the "Funding Status" for each stratq,,y (fully funded, partially funded, or not funded). • Describe the impact and!or changes to each specific activity based on the approved funding levels by clicking on the comment bubble (i;;,)_ Once you click on the bubble a text box will appear. • Input the "Progress Status" (click on percentage). You also have the ability to enter comments in this section if needed by clicking on the comment bubble. • Enter the "Achieve by Date" if applicable. The dates arc prcpopulatcd from yo ur application. You only need to address this scl't ion if the dates arc missing or need to be changed from your original submission. When finished, please sclcl't the drop down response 1'compk1c 1' followed by ''Save & Exit Form'' in th e RL'.DCap po rtal. Also, please email me to let me know that you have completed your review. We will review your feedback and will follow up as needed. After yo ur jurisdiction's work plan has been updated and finalized, the data in the RL'.DCap system will be placed on "Read Only" status and no additional notes or responses wi II be made. TX-DSHS-19-1309-A-002737 We are very much looking forward to having this discussion. Feel free to contact me with any questions/concerns. Thank you. De’Lisa D. Simpson, MBA Program Advisor/Project Officer Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Division of Preparedness and Emerging Infections National Center for Emerging & Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control and Prevention 1600 Clifton Rd, Mailstop C-12 Atlanta, GA 30333 Office: 404-639-3629 Blackberry: 404-372-5928 Fax: 404-718-1874 ion9@cdc.gov TX-DSHS-19-1309-A-002738 From: VPD Surv ELC (CDC) Sent: Tuesday, October 15, 2019 10:26 AM EDT To: VPD Surv ELC (CDC) CC: Roush, Sandra (CDC/DDID/NCIRD/OD) Subject: Slide Sets: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET Attachment(s): "NJ NCIRD MMG.pptx","NBS_VPD_Page_MMG.pptx","2018 Enhanced Meningococcal Disease Surveillance Report_DRAFT_10072019.pdf","Measles Update VPD Call 10.15.19.pptx","Mumps and 3rd dose refresher_VPD all-call_Oct15_2019.pptx" WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EveryoneResending as a reminder of the October 15, 2019 All-Jurisdiction VPD Surveillance call taking place TODAY from 3:00-4:30 ET. Note that the attachments listed in the agenda can be found on the emails sent on October 4 and/or October 7. The attached documents are the presentation's slides for today's call, which have not been previously sent out. ThanksBreanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Monday, October 7, 2019 3:12 PM To: Roush, Sandra (CDC/DDID/NCIRD/OD) Cc: VPD Surv ELC (CDC) Subject: Update: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET AllPlease note that the agenda for Mumps tier 2 activities has been updated.No data submission deadline has yet been scheduled for the mumps activity. CDC will provide preliminary information related to the mumps activity during the October 15 call, with additional specific details following the call (e.g., the date of the ELC Tier 2 mumps activities kickoff call, an updated data collection tool/spreadsheet, data submission deadlines). Please let me know if you have any questions or concerns. ThanksBreanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 From: VPD Surv ELC (CDC) Sent: Friday, October 4, 2019 10:07 AM To: VPD Surv ELC (CDC) Cc: Roush, Sandra (CDC/DDID/NCIRD/OD) Subject: NCIRD Quarterly All-Jurisdiction VPD Surveillance call - October 15, 2019 from 3:00-4:30 ET AllPlease save the date for the next NCIRD Quarterly All-Jurisdiction Vaccine Preventable Disease (VPD) Surveillance Call, which will take place on October 15, 2019 from 3:00-4:30pm ET. Call-in information and preliminary agenda are below. Additional attachments/slide sets may be forthcoming. Toll Free Number: 800-779-5184 Participant Passcode: 6296401 Following the entry of the passcode, please provide the requested details when prompted. Agenda for October 15, 2019 Quarterly All-Jurisdiction VPD Surveillance Call Time Topic Speaker Information General Surveillance Updates FY19 ELC CoAg Surveillance Indicators Recent communications Conferences • • • 3:00 – 3:10 Surveillance Coordination • • • Notes/Attachments • Sandy Roush For Jurisdictions - QSCAS Template v9locked.docx Data element Priorities for Implementation of the Mumps, Pertussis, and Varicella Massage Mapping Guides: https://wwwn.cdc.gov/nndss/casenotification/message-mapping-guides.html TX-DSHS-19-1309-A-002739 • • 3:10-3:30 Implementation of HL7 message mapping guide Announcements/Reminders Action Item Surveillance Coordination Activity Summary deadlines (ELC CoAg) Information Presentation: New Jersey’s activities to prepare for HL7 MMG implementation. Presentation: MMG implementation in NBS jurisdictions. • • • • Susan Hannagan (NJ) & Michael Wodajo • Information Project Updates Action Item Meningococcal Disease: Supplemental data and isolates due to CDC on 15th of designated month (ELC CoAg) Pertussis: Tier 2 data and isolates due in January 2020 (ELC CoAg) H flu: Tier 2 data and isolates due the week of October 15, 2019 (ELC CoAg) Amy Blain Acute Flaccid Myelitis Information Updates Adriana Lopez Varicella Action Items Varicella outbreak report deadline: October 10, 2019 (ELC CoAg) Varicella completeness report: due December 31 (ELC CoAg) Adriana Lopez Measles Information Presentation: Elimination status Nakia Clemmons & Jessica Anderson Mumps Action Items Mumps Tier 2 data: information to be provided by CDC mumps program (ELC CoAg) Presentation: CDC Guidance for mump outbreaks at universities Jessica Leung • 3:30-3:35 Meningococcal Disease Pertussis Haemophilus influenzae • • • • • • • 3:50-3:55 • 3:55-4:05 • • • • 3:35-3:50 Summary of H influenzae N meningitidis IPD Psittacosis and Legionellosis 7 2 19 Summary of Measles Rubella and CRS Priorities 7 2 19 • Enhanced Meningococcal Surveillance Protocol ELC VPD_v06282019.docx Appendices for EMDS_07312018.docx Data Collection Guidance Worksheet 06282019.pdf Enhanced Meningococcal Disease Surveillance Supplemental Data_06282019.xls Enhanced Meningococcal Disease Surveillance Shipping Spreadsheet_08132018.xls Instructions for Completing the Varicella Outbreak Surveillance Worksheet August 2016.docx Varicella outbreak surveillance reporting worksheet_Aug 2016.xlsx • 4:05-4:20 • 4:20-4:30 Q&A Jurisdictions Thanks, Breanna Breanna Pennings, MPH Health Scientist Contractor, Eagle Global Scientific National Center for Immunization and Respiratory Disease Centers for Disease Control and Prevention BPennings@cdc.gov 404-718-3531 TX-DSHS-19-1309-A-002740 Confirmedand ProbableCasesReportedto the National NotifiableDiseasesSurveillanceSystem,2018 cas,as i>Qr100,000 poputatk:>n □ 0 ,00 -<0.04 □ 0. 04 - < 0 .00 D o.oo-~o.n ■ ~0.13 MeningococcalDiseaseCasesand Incidenceby Serogroupand Age - B No. (Incidence') <1 21 (0.55) 1-4 12 (0.08) 5-10 - V No ngroupable No. (Incidenc e') No. (Incidence') Other*/Unknown No. {Incidence') Total No. {Incidence') 6 (0.16) 2 (0.05) 1 (0.03) 2 (0.05) 0 (0.00) 32 (0.8 3) 10 (0.06) 1 (0.01) 4 (0.03) 1 (0.01) 1(0.01) 29 (0.18) 2 (0.01) 4 (0.02) 0 (0.00) 1 (0.00) 2 (0.01) 0 (0.00) 9 (0.04) 11-15 6 (0.03) 1 (0.00) 0 (0.00) 0 (0.00) 0(0.00) 0 (0.00 ) 7 (0.03) 16-23 21 (0.06) 3 (0.01) 0 (0.00) 0 (0.00) 8(0.02) 2 (0.01) 34 (0.10) 24-44 16 (0.02) 21 (0.02) 3 (0.00) 9 (0.01) 6 (0.01) 10 (0.07) 65 (0.07) 45-64 25 (0.03) 22 (0.03) 7 (0.01) 14 (0.02) 3 (0.00) 8 (0.01) 79 (0.09) ;;,:65 16 (0.03) 23 (0.04) 4 (0.01) 19 (0.04) 5 (0.01) 7 (0.01) 74 (0.14) Total 119 (0.04) 90 (0.03) 17 (0.01) 48 (0.01) 27(0.01) 28(0.01) 329 (0.10) Includes all confirmed and probable cases reported from all jurisdictions; 1Cases per 100,000 population; a11d;includes 1 serogroup E case. NationalCenterfor Immunizationand Res Office of Infectious Diseases TX-DSHS-19-1309-A-002741 Serogroup No. deaths B 9 .. C 13 14.8 w 4 23.5 y 7 14.6 CaseFatality Laboratory Confirmation Method 89.7% (287/320) of confirmed cases were confirmed by culture; of those 250 (87.1%) had isolates submitted to CDC. 6.3% (20/320) of confirmed cases were confirmed by PCR. 3.1%(10/320) of confirmed cases had unknown laboratory confirmation method. 7.6 NG 2 7.4 Unknown 4 16.7 Overall 39 Age (years) No.deaths 90% for 2 doses of MMR Strong public health infrastructure to detect and contain measles • Adequate surveillance • Rapid case and outbreak response TX-DSHS-19-1309-A-002751 Measles Elimination in the U.S., 2018-2019 Number of Reported Measles Cases by Week of Rash Onset - U.S., Sep 30, 2018 - Oct 8, 2019 120 t?'JCases associated with NYC and NYS outbreaks (n=lll4) 100 ■ Cases associated with other U.S. Outbreaks (n=283) ■ Cases not associated with an outbreak (n=90) Last rash onset, NYC outbre ak, Jul1 5 9.5 months, n=702 cases 80 UI 4.1 UI -.. ca u 0 Beginning of NYC and NYS outbrea ks 60 4.1 .c E Last rash onse t, NYS outbreak, Aug 19 10.5 mont hs, n=412 cases :::i z 40 20 ' 0 UI . Ja.....LL-LL_1£1....Ld.-lU....u:L....U._.1£J... J~A. . .JfU....J1£L..J~,u_L,Q,_u_.1U,_UJ....L.,1_.l£L...IA....LL-.J£L....I.A-LL.Ul....LJ_.J£L....U.....LL...J£L...L.L-~..l.4....L.L...1£J.....uL...L.L-1£L..!.L...lU.....J. lj "''1. . .!LL-1<~!4. . .l!:L..l 'l •'"----'---,,■.•_. .Jl"'-!l ~:.L r 40414243444546474849505152 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334353637383940 Week of Rash Onset (epi week) TX-DSHS-19-1309-A-002752 Measles Elimination: 2018-2019 • What if NYSor NYCfind cases later on this year? Will we lose elimination? If a case is found within or linked to these areas, then a thorough investigation will occur to determine the source of the case. That investigation will determine if elimination is in jeopardy. ■ What does the possible loss of elimination mean for the country? There won't be any economic, political, or practical penalties for losing elimination. Losing measles elimination would have no adverse implications for national vaccine programs TX-DSHS-19-1309-A-002753 Measles Elimination: 2018-2019 • CDC has been working with the Pan American Health Organization {PAHO) throughout the year to keep stakeholders updated on measles surveillance. • CDCwill meet with PAHO's Regional Verification Commission in the coming months to review the U.S. data and verify measles elimination status. TX-DSHS-19-1309-A-002754 For more information, contact CDC 1-800-CDC-INFO {232-4636) TTY: 1-888 -232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-002755 National Center for Immunization & Respiratory Diseases 4- 1coc FAQs from health departments on mumps outbreak response and use of a 3 rd dose of MMR during outbreaks JessicaLeung, MPH Epidemiologist VPD All-Jurisdiction October 15, 2019 Call TX-DSHS-19-1309-A-002756 ELCTier II Mumps Activities ■ There is no data submission scheduled at this time. ■ At the end of October, the mumps team will send information on Date of the ELCTier II mumps activities kickoff call, FY19activities (including an updated data collection tool/spreadsheet), Data submission deadlines TX-DSHS-19-1309-A-002757 Current mumps epidemiology in the United States ■ From Jan 2016-Jun 2017, health departments reported 150 outbreaks with >9,000 cases 7,000 "' ~ Reported mumps cases - United States , 200~2019* ~ .,, ~- 6,000 Ill u - Reported from 3 7 stat es and Washington DC Median outbreak size = 10 (range: 3-2,954) - 75 univer sity, 19 schools, 48 community ci 5,000 E ~ 4,000 o,_ IJ . 3000 E 2.•000 ::, z 1,000 0 -----~ ~ N ~ N 8 N8 N X .,, ~ ~ ~ 8 N~ N N N ~ ~ ~ N N 8 ~ ~ N~ o ~ N m • ,n ~ ~ II ~ S NS N8 S S NS S S 8N N N N N N , ~ 0 N - 70% of cases were fully vaccinated Yea r TX-DSHS-19-1309-A-002758 Frequently asked questions from health departments on mumps Should we do lgG testing to see if people in the outbreak setting have presumptive immunity? ■ No, should not use mumps lgG testing to assess presumptive immunity for mumps ■ A positive lgG for mumps does not indicate whether or not a person is protected from mumps (i.e. there is no level of antibodies that would indicate a person is protected from disease) ■ Everyone who is part of the group(s) determined by the health department to be at increased risk should get a MMR dose, regardless of presumptive evidence of immunity TX-DSHS-19-1309-A-002760 What is the isolation period for a case that does not have parotitis? ■ In patients with parotitis or other salivary glands swelling, isolate for 5 days after swel Iing onset ■ Mumps complications can occur without parotitis (e.g. orchitis) ■ In patients without parotitis, isolate for 5 days after first symptom onset (e.g. respiratory symptoms, orchitis, etc.) ■ In patients with no symptoms who were tested and found to be mumps positive: If lgM+, isolation not recommended - If buccal PCR+,isolate for 5 days after buccal swab collected TX-DSHS-19-1309-A-002761 Are you seeing suspected mumps cases in fully vaccinated children and adolescents? ■ Yes, among cases reported to NNDSSfrom 2015-2017: 1 in 3 US mumps cases were in children and adolescents I \ 2 in 3 pediatric mumps patients were fully vaccinated TX-DSHS-19-1309-A-002762 A case traveled on a plane - do we need to do a travel contact investigation? ■ No, DGMQ travel/flight contact investigations {Cls) are not conducted for mumps TX-DSHS-19-1309-A-002763 "Our mumps outbreak is becoming a burden on laboratory resources ..." ■ CDCguidance for optimizing mumps testing: https://www.cdc.gov/mu mps/hea lth-depa rtments/opti m ize-testi ng.html ■ Once an outbreak is confirmed, cases that can be epi-linked do not need to be tested and can remain classified as probable cases. TX-DSHS-19-1309-A-002764 Use of a third MMR dose during mumps outbreaks Advisory Committee on Immunization Practices {ACIP) recommendatio ,n for use of a 3 rd dose of MMR vaccine during mum :ps outbreaks - October, 2017 ■ Recommended a 3rd dose of measles, mumps, rubella (MMR) vaccine* for persons at increased risk for mumps during an outbreak ■ 3rd dose provides added short-term protection against mumps disease and related complications ■ Public health authorities determine the group(s) or population(s) at increased risk TX-DSHS-19-1309-A-002766 11 CDCguidance for use of a third dose • https://www.cdc.gov/mumps/hea1th-departments/MMR3.html ■ Note, it is not necessary to wait for 3 cases to make a 3rd dose recommendation; if there is 1 case in a high risk transmission setting, a dose may be recommended for the group at increased risk T.1bleI . Decisionm.Jtrixto ~ publk he.Jlthauthoritieswhendetemmwngif .Jgroup of people is at i:nas.sedriskfor acquiringmumpsduring;in outbreak Likelihoodof transmissionin the setting Evidenceof ITansmissioo in lhe ~ Mg evidence of trammiwon Low Moder.ite Not~ tnerNSed risk Not ~ 1naeased risk Hl&h M gtn be ,H ocre.iwd nsi. Evidence that tranmtissioo i!W.IIIl:d Not~ tnert~ risk M ght be it incre,sed N.~rislt n$1< EvidM, , •• · r HL7 NND Message ~1t_u~ --;_ 1ii. . ll ' ll . 1 . ., •~ .r . ~,,...,,.,,u- ... ····•·~•~,,,.,. .... ..~--i,,.~..,, ,r.,....,_.,,.w,, v;.-.._,,.....11r,"'""' """'"~ · ..."" -=-•· · -::, . .. . ... . . .... .. ~ 'WWI ,n, , , 1, , y, ....1,;,,,wi r,,.,.. .,, ,.,,, ... .. "l•,~--,..... --• • • ~.. .. ... HM, ... . .. . . .. "•j rr .. '-'«/lJIUtO><~ r • _.l!.. A~:::=:2: • ' Case Report Form(s) .1::: . , . 1. >1 •r.f1~~;,. 11r•H t,n.r<,, : . 11;. ~"" · . 11~»> . 'I. • . ) . 1-'l~;,. 1 1 r -m.-2. : .;,•.~) .l. U 41ll ' ~ l ~U~ (-J :V1?•)33 S.2 2!;. 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I. 11' ) .>) . -1. ; _;7~ ; ~ 331 l 'S '.i;;r J ) ~ S1•r~ ! m :.• ~ . l G.N € . :. 11;3sl.~. 1 - : tt a :: ~s 1~n ~r d ~;•,~ t r n : ;, ~~ (h t ( O ...: t l ~3: i cnt . - 1 <.J IU~..~~!' H:1~,~i. 1(· . ~4-t'. 1 , l Dt •t•J' (.., ~, :":ft~l>ln ,1, r ·,,•QI Q•' ~;;, ...-, 1 ~) -'I'" " " I n~i c J t c,;, • ? . l G. ! 4€ . :. ::u.~ ~:. 4 . s .1 1 2' t 'l •.•) 11 'S ~i;;r J ) j Svr~: cr ,:; ! i:a , J : " •" . 1 1·~1·c 1~:; , : ,:, ..µ~ , 1 , 11. 1~~ . l ~ , lJC•l l I :":R~l l ln ,1, ¼~ ll- 1·' ~-eo •.,:1 ~~, ,, 1, , ,.., ; . 1~.~-1t. .. 11; ~~l. f. . 1-··t. 1,•;;,-.~ ;c., , , ,J S,• l ~? U L, .!,: 1-:1'1~ ! , ~ ...: t l l' ~:U nt " . ~ -~~~j":j~ -~~~~~;;~~~- ~~~/ ~~~~ ;•~~ •,:c,,-,. ~I11111~ I n~i ( J t c,;, · l . l G, i 4€ , :. ::u.~::. 4 , S . 11 2' ! "l •!)l !l'S ~ · 1111~ 4 J >j SY~ : e r,; ! >.li, J t " ' ' . ~ TX-DSHS-19-1309-A-002779 4 VPD Page Development § Building the VPD pages in NBS is a collaborative process that involves: CDC NBS Team NMI CDC Program NBSJurisdictions § When a final MMG is released for a condition, a Page Builder data collection form (page) is created that aligns with the data requested in the new MMG. § When building a new page, the following are considered: Previously collected (legacy) data - Case Report form(s) New data elements in the MMG - SME/Program input Jurisdiction-defined data elements (agreed upon by the NBS community) 5 TX-DSHS-19-1309-A-002780 5 VPD Page Development § When a new Page Builder page is being developed for an MMG, input/feedback are collected throughout the process. - § Both NBS Jurisdiction and CDC Program SM Es provide fee This is accomplished via both web meeting walk-throughs, as well as by providing access to the NBS AWS CDC page development site. As needed, the NBS team updates the NBS application and/or the NND Rhapsody route to align with MMG requirements and SME input. Sometimes transformations are required to allow NBS jurisdictions to collect the data in a way that makes sense/is user-friendly for their end users while still being able to send the data as defined in the related MMG. ~ It is important for jurisdictions to provide input on page data elements, data entry flow, and suggestions to improve data quality. You may also volunteer to participate in the pilot activities. 6 TX-DSHS-19-1309-A-002781 6 VPD Legacy Data Porting § Once a page is in final draft form 1 the NBS team creates and tests a legacy data conversion mapping. Because many times data elements that were previously collected are now being asked in a different way or with a different values set, legacy data for the condition is 'ported' to align with the new standard. § When data transformation is required 1 input is often needed from CDC Program SM Es and NBS jurisdictions. This input is many times collected in the NBS weekly SME calls or in special working groups (e.g. FDD Working Group) ~ Participation in SME caf/s and volunteering for special working groups is very helpful for working through issues with porting and page development. 7 TX-DSHS-19-1309-A-002782 7 VPD Page Implementation and Onboarding § Once page development and conversion mapping is complete, the page implementation package is released to one or more pilot jurisdictions. § The purpose of the pilot testing is to: § - Test page installation, porting, HL7 message creation - Obtain additional feedback from end-users/SM Es in a test environment Any needed corrections are made by NBS team and the page package is updated and provided to all jurisdictions ~ When possible, the NBS Team and/or an NBS jurisdiction also creates test messages using a draft page to send to NM/ during the piloting process. You may volunteer to pilot the page implementation package to help identify any potential issues before release to the community. 8 TX-DSHS-19-1309-A-002783 8 VPD Page Implementation and Onboarding § Once an NBS Page Packages has been finalized 1 the package is reviewed and 'handed-off' to the NBS Community on a weekly SME Meeting Call. § When a jurisdiction is ready to implement a new page1 submit a ticket in NBS Central to begin pre-onboarding work. Most pages can be implemented in the system prior to onboarding (only Varicella requires implementation and on-boarding to happen in tandem). When a new page is 'pre-adopted', data is collected in the new format, but Master Message is sent for case notification until HL7 onboarding occurs. Jurisdictions are highly encouraged to wait until the page package is released before implementing a new MMG in their NBS system; not doing so can result in data loss due to legacy data porting gaps and an inability to on board the new MMG. 9 TX-DSHS-19-1309-A-002784 9 Status Update for VPD Page Development § Current VPD and BMIRD Pages in Development MMG MMG Final Current NMI Status Current NBS Status Mumps Pertussis Varicella 5/4/2018 On-Boarding OnHold NBS team to provide updated page packages for each, mainly to implement: • Pilotjurisdiction fee db a ck • Back-conversion updates implemented after meeting with NCIRD Measles Rubella Congenital Rubella Syndrome N/A In Pilot Testing • Page development is in progress for all 3 MMGs. • NBS team is participating in the pilot process. • AL is piloting Measles. RIBD N/A (includes HIB, Meningococcal, IPD, GAS, GBS, Psittacosis, Legionellosis) In Pilot Testing NBS team to start working with SME Sma II Group to develop pages. 10 TX-DSHS-19-1309-A-002785 10 IT NBS Team Key Contacts Michael Wodajo CDC Project Manager (NBS) • o. 404-498-6675 I c. 678-733-4692 • E. gue7@cdc .gov Marion Anandappa CDC Technical Lead (NBS) • 0. 404-498-0575 • Christi Hildebrandt NBS Product Manager 0 470.419.61471 C: 404.386.3780 E zez§@cdc gov Jay Nelson NBS Production Support Manager 0: 470.419.6156 IC: 678-358-6119 E. iio§@cdc gov E. dza4@cdc gov Sumesh Sundareswaran CSRA Project Manager • 0 : 470.419.61641 C. 470-725-7333 • E. sumesh .sundareswaran@g dit.com Jennifer Johnson NBS Product/Public Health SME 0: 865.672.6295 IC. 678-431-516 E jwe5@cd c gov 12 TX-DSHS-19-1309-A-002787 12 For more information, contact CDC 1-800-CDC-INFO (232-4636) TTY: 1-888-232-6348 www.cdc.gov The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. TX-DSHS-19-1309-A-002788 13 NCIRD All-Jurisdiction VPD Surveillance Call: NJ Activities to Prepare for HL7 MMG Implementation SUSAN HANNAGAN, MS, MPH NJDOH SURVEILLANCE SPECIALIST TX-DSHS-19-1309-A-002789 1 General process § Prioritization and implementation spreadsheet § Varicella, Mumps, Pertussis § Review for 1:1 matches § Considerations for additional variables § Work arounds § Feasibility/ease of adding § Questions to CDC for clarification/interpretation TX-DSHS-19-1309-A-002790 2 Example Questions § Was subject vaccinated as recommended by the Advisory Committee on Immunization Practices (ACIP)? § 14 month old without varicella vaccine § Outbreak doses § Was laboratory testing done to confirm the diagnosis? § Any lab test in section = yes § Fever § Varicella: Did the subject have a measured temperature greater than two degrees above normal? (Y/N/U) § Mumps: Fever (Y/N/U) TX-DSHS-19-1309-A-002791 3 Key Points § Important to involve Epi/SMEs § Apply questions to real cases § Time consuming, not straightforward § Consider system and IT constraints § Immunization system Questions: Susan.Hannagan@doh.nj.gov TX-DSHS-19-1309-A-002792 4 From: Centers for Disease Control and Prevention Sent: Thursday, October 17, 2019 12:46 PM EDT To: Garcia,Imelda M (DSHS) Subject: Emerging Infectious Diseases Journal - Volume 25, Issue 11 - November 2019 Issue Now Online WARNING: This email is from outside the HHS system. Do not click on links or attachments unless you expect them from the sender and know the content is safe. EMERGING INFECTIOUS DISEASES® EID Journal Volume 25, Issue 11 - November 2019 Issue Now Online TABLE OF CONTENTS Ahead of Print About the Journal Current Cover Peer Reviewers Search EID Contact EID CDC Synopsis Vaccine-Derived Poliovirus Infection among Patients with Primary Immunodeficiency and Effect of Patient Screening on Disease Outcomes, Iran M. Shaghaghi et al. Research Comparison of Whole-Genome Sequences of Legionella pneumophila in Tap Water and in Clinical Strains, Flint, Michigan, USA, 2016 E. Garner et al. EID Podcasts Clinical and Molecular Epidemiology of Invasive Group B Streptococcus Disease among Infants, China W. Ji et al. Seasonal Influenza and Avian Influenza A(H5N1) Virus Surveillance among Inpatients and Outpatients, East Jakarta, Indonesia, 2011–2014 Research Letters, cont. Ophthalmomyiasis Caused by Chrysomya bezziana after Periocular Carcinoma R. Nabie et al. Dengue Fever in the Darfur Area, Western Sudan A. Ahmed et al. Severe Fever with Thrombocytopenia Syndrome Virus RNA in Semen, Japan S. Koga et al. Canine Distemper Virus in Asiatic Lions of Gujarat State, India D. T. Mourya et al. Routine Culture–Resistant Mycobacterium tuberculosis Rescue and Shell-Vial Assay, France M. Fellag et al. Molecular Epidemiology of Hantaviruses in the Czech Republic K. E. Lafond et al. H. Zelena et al. Nasopharyngeal Pneumococcal Density during Asymptomatic Respiratory Virus Infection and Risk for Subsequent Acute Respiratory Illness Tamdy Virus in Ixodid Ticks Infesting Bactrian Camels, Xinjiang, China, 2018 L. M. Howard et al. Rare Detection of Bordetella pertussis Pertactin-Deficient Strains in Argentina F. Carriquiriborde et al. Molecular and Clinical Comparison of Enterovirus D68 Outbreaks among Hospitalized Children, Ohio, USA, 2014 and 2018 H. Wang et al. Medscape CME Activity Lack of Efficacy of High-Titered Immunoglobulin in Patients with West Nile Virus Central Nervous System Disease J. W. Gnann et al. Serosurvey for Influenza D Virus Exposure in Cattle, United States, 2014–2015 S. Silveira et al. Dispatches High Prevalence of Mansonella ozzardi Infection in the Amazon Region, Ecuador M. Calvopina et al. H. Zhou et al. Introduction of Avian Influenza A(H6N5) Virus into Asia from North America by Wild Birds S. Jeong et al. Human Case of Ehrlichia chaffeensis Infection, Taiwan S. Peng et al. Psittacosis Outbreak among Workers at Chicken Slaughter Plants, Virginia and Georgia, USA, 2018 K. A. Shaw et al. Effectiveness of Immune Checkpoint Inhibitors in Transplant Recipients with Progressive Multifocal Leukoencephalopathy C. Medrano et al. Endemicity of Yaws and Seroprevalence of Treponema pallidum Antibodies in Nonhuman Primates, Kenya D. M. Zimmerman et al. Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2017–2018 Clinical REsearch During Outbreaks (CREDO) Training for Low- and MiddleIncome Countries A. Hakawi et al. N. Kayem et al. B. Pérez de Val et al. Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–Like Disease, Brazil Availability of Injectable Antimicrobial Drugs for Gonorrhea and Syphilis, United States, 2016 S. R. Maruyama et al. Secondary Autochthonous Outbreak of Chikungunya, Southern Italy, 2017 F. Riccardo et al. Fatal Case of Nosocomial Legionella pneumophila Pneumonia, Spain, 2018 D. Vicente et al. Mycobacterium microti Infection in FreeRanging Wild Boar, Spain, 2017–2019 W. S. Pearson et al. Host Switching of Zoonotic Broad Fish Tapeworm (Dibothriocephalus latus) to Salmonids, Patagonia R. Kuchta et al. Letters Swimming Pool–Associated VittaformaLike Microsporidia Linked to Microsporidial Achromobacter xylosoxidans Infections after Prostate Biopsies, France, 2014 Keratoconjunctivitis Outbreak, Taiwan L. Amoureux et al. J. Chen et al. Macrolide-Resistant Mycoplasma TX-DSHS-19-1309-A-002793 J. Chen et al. Isolation of Legionella pneumophila by Coculture with Local Ameba, Canada R. Dey et al. Human-to-Human Transmission of Influenza A(H3N2) Virus with Reduced Susceptibility to Baloxavir, Japan, February 2019 E. Takashita et al. Orolabial Lymphogranuloma Venereum, Michigan, USA S. Ilyas et al. Preventing Sexual Transmission of Zika Virus Infection during Pregnancy, Puerto Rico, USA, 2016 B. Salvesen von Essen et al. Research Letters Drug-Susceptible and Multidrug-Resistant Mycobacterium tuberculosis in a Single Patient Macrolide-Resistant Mycoplasma genitalium in Southeastern Region of the Netherlands, 2014–2017 M. Adelantado et al. Etymologia Etymologia: Serratia marcescens G. Nazzaro About the Cover “Many Things Grow in The Garden That Were Never Sown There” B. Breedlove Books and Media Practical Healthcare Epidemiology, 4th Edition E. Lifshitz Conference Summary 21st International Conference on Emerging Infectious Diseases in the Pacific Rim M. Rao et al. A. Baffoe-Bonnie et al. Mutation and Diversity of Diphtheria Toxin in Corynebacterium ulcerans K. Otsuji et al. Click to explore various ways to search all of EID's articles, contents, & features. Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA 30329 1-800-CDC-INFO (800-232-4636) TTY: 888-232-6348 Questions or Problems Unsubscribe TX-DSHS-19-1309-A-002794