A substantial degree of anxiety hit Maryland's residents last fall when dead birds infected with West Nile virus began appearing around the state. Although mosquitoes are the disease's carrier, the birds were a sign that the virus was in the area.
To respond to the situation, the state Department of Health and Mental Hygiene decided to set up a West Nile virus hotline to allow citizens to report suspicious bird deaths. Leslie Edwards, acting chief of DHMH's Division of Outbreak Investigation, reached for a hotline herself: Here was a job for SORT, the Student Outbreak Response Team from Hopkins' Bloomberg School of Public Health.
Edwards is the coordinator of SORT, a volunteer program sponsored by the DHMH and the Bloomberg School's Department of Epidemiology. Established in 1988, SORT provides students with practical field experience in investigating disease outbreaks as well as an opportunity to meet and interact with epidemiologists working in state and local health departments.
When an outbreak hits the region, or assistance is needed on a certain project, Edwards pages or e-mails the student coordinator, who then contacts the other team members. In the case of the West Nile virus outbreak, several SORT members were asked to go to Annapolis and help staff the dead bird surveillance and serotesting hotline.
Angeline David was one of the students called in. Relatively unfamiliar with the West Nile virus, David and the others were trained on site in order to field questions and to know what to expect from callers. David's job was to determine if the bird was possibly infected, as many of the reported bird deaths were due to natural or other causes. David inquired on the condition of the bird and where it was located, and then passed on that information to the appropriate local health department, which was to pick up the bird for analysis.
David, who will be SORT's 2001-2002 co-coordinator, says that through activities such as the West Nile virus hotline project, the program serves both students and the public.
"It really is fantastic training that we get, to be able to talk to people who are experiencing an outbreak and get their perspective on what is going on," David says. "Some of them ask you some really hard questions, like 'Am I in danger of this?' or 'Am I going to die?' So to be exposed to these situations is very good training for us, and hopefully we can also benefit the people we talk to by allaying fears, or helping them out however we can."
Originally, SORT team members were primarily responsible for assisting a DHMH epidemiologist with data collection and data entry during the outbreak of a disease, such as tuberculosis, Legionnaires' disease or hepatitis A. Activities in recent years, however, have expanded to include long-term studies and investigations of non-outbreak-related illnesses.
"There is always something for them to do. It's an exciting world out there," says Edwards, who received her master's degree from what is now the Bloomberg School of Public Health.
During the 2000 presidential inauguration, three SORT members assisted the bioterrorism surveillance effort surrounding the event. The students first helped construct a database and then collected, entered and analyzed the data.
Other recent SORT projects include a survey of infection-control practices among Maryland's emergency response organizations, an investigation of an outbreak of Norwalk-like virus among guests who had attended a wedding and a survey of employees at state-operated health care facilities to assess reasons why they chose to receive, or not to receive, the influenza vaccination during the 2000-2001 flu season.
One or two members are usually needed for each project. A recent foodborne outbreak, however, required the swift assistance of multiple SORT members, Edwards says. Involvement typically lasts two to three weeks.
SORT, which functions from September to May, has monthly meetings to allow those participating in investigations to share their experience with, and receive feedback from, fellow members. At these meetings, students also hear presentations by DHMH staff and Bloomberg School of Public Health faculty and students on outbreak-related topics.
Nora Chen, who along with David is a student coordinator for SORT, says she finds the monthly meetings "extremely helpful and informative."
"We have speakers come in to talk about specific types of outbreaks or to offer training sessions with a particular statistical package," Chen says.
The average group consists of 20 to 30 students, most of whom are studying on the epidemiology track. Chen says two of the goals for the coming year are to involve students from other disciplines and more faculty.
Although the students are often dealing with serious outbreaks, Edwards says they are kept out of harm's way.
"We would never send a student to an outbreak site where there is a communicable disease going around that they could catch," Edwards says. "For that matter, we would never send in students someplace if we would not go in ourselves."
Students do not receive academic credit for their involvement in SORT, David says, but do gain valuable exposure to the inner workings of state and local health departments. David says that if nothing else, students can determine whether or not this line of work is for them.
"The benefits of SORT go well beyond academic credits," she says.