In Baltimore, we have a special team of detectives working each day to save lives. They are not the usual detectives you may imagine; rather, these public health investigators make up our Acute Communicable Disease (ACD) team, a staff of 12, which examine routine and emerging infectious disease outbreaks, such as food-borne illness, rabies, meningitis, and ebola.

Last summer, when the Zika virus first became public health threat in the United States, the Baltimore City Health Department (BCHD) responded immediately with a collaborative effort to thwart the spread of the mosquito-borne illness. The ACD team, led by Director Mary Grace White, who has been with BCHD for 9 years, worked alongside the BCHD’s Office of Public Health Preparedness and Environmental Health to implement Zika Strike Teams. Baltimore City was one of the first cities in the U.S. to have a Zika response plan, and many other cities across the national have turned to Baltimore for learned lessons. Dr. Wen presented the citywide response plan at the annual Maryland Association of County Officials summer meeting and received a tremendous amount of positive feedback from representatives and elected officials from around the state. 

Zika Strike Teams mobilized throughout Baltimore to provide community outreach and education about the Zika Virus. Staff members like Tanya Bobo-Lenoci (almost 2 years in ACD), Kompan Ngamsnga (almost 9 years in ACD), and McCay Moiforay (almost 3 years in ACD), recalled going door-to-door and speaking with residents to explain how the virus works and the measures communities could take to prevent the spread of the disease, such as dumping out standing water from yards and communal spaces and wearing bug spray.

During one outing, a resident in East Baltimore invited the team into her living room so that she could learn more about Zika and further discuss other public health concerns in her neighborhood. The teams spent hours canvassing neighborhoods in the heat, and were even deployed during the weekends to provide information, eliminate standing water and set mosquito traps.

This summer, the entire ACD team and the rest of our internal Zika partners will be at it again, working around the clock to ensure Baltimore’s residents are safe from Zika.

Going Behind the Scenes to “Patient Zero”

Regardless of the disease that ACD is investigating, the process is more or less standardized to ensure that proper testing, identification, and statistics are collected. The process begins when a lab, hospital, or healthcare provider contacts BCHD to report a positive test result for a reportable communicable disease. At that point, the ACD team jumps to action to find “patient zero” to establish so that the person can be tested and their diagnosis can be verified.

After a confirmed diagnosis, ACD interviews the patient, on the phone or in person, to help them understand the risk factors involved and to determine the history of the patient. These interviews help these public health detectives to understand where and how a person contracted a disease. By determining the point of origin, investigators can prevent the spread of the disease to other people. ACD also cautions people to limit their contact with others – while determining who else may be infected – so that others at risk can be connected to treatment and vaccines.

Staff members, like Linda Dawson-Green (30 years at BCHD), Charlene Wooden (17 years at BCHD), and Irene Stadler (19 years at BCHD) shared stories about interacting daily with Baltimore’s residents to help them navigate infectious diseases like Lyme disease, Hepatitis B, parasites, salmonella, and rabies. Charlene explained the prevalence of rabies in Baltimore, with over one thousand bites per year from infected animals, which tend to be cats and bats. Linda and Charlene spend a lot of their time on the phone, speaking with residents about their infections in order to learn their history to discover where and how they were infected. They also help patients connect with health care and follow-up with them to ensure they get the proper and necessary treatment.

Much of the Zika follow-up is conducted in the same way. The ACD team wants to ensure that any pregnant women who have Zika are monitored to ensure the mother’s and baby’s health. Often, the team will follow up with women to make sure that they get additional testing and treatment. They also inform HealthCare Access Maryland about the pregnant women with Zika to integrate them into their intensive case management services. 

The staff split their time between the office and being in the field. Some days they take phone calls, other days they are out in the community searching a site for potential signs of an infectious outbreak. Many ACD staff have attended neighborhood association meetings to share information with the community so that they may better understand a disease outbreak. 

ACD staff collaborate internally with other BCHD teams, such as restaurant inspection Environmental Health Specialists, to determine causes of foodborne illness and help enforce regulation changes to prevent the spread of disease. Often, ACD collaborates with external teams across city agencies, such as with Baltimore Department of Public Works (DPW), to determine disease outbreaks. Director Mary Grace White shared a story about working with DPW teams on various Legionella cases at hospitals or in apartment buildings with their counseling to sample water at the sites.

Baltimore’s Innovative Public Health Outreach

In Baltimore, there are over 20,000 people who have Hepatitis C, which is mostly associated with intravenous drug use. The high rates and unique challenges that Baltimore faces with the opioid epidemic requires an innovative public health approach to reducing Hepatitis C. Currently, Baltimore is the only city in the U.S. that uses Hepatitis C surveillance data to find infected people and connect them to treatment. The ACD team collaborates with the STD/HIV outreach team to locate residents and ensure that they are connected with the care they need. In the process, staff note that there has been a drastic increase in calls for more information about Hepatitis C testing. The program started two years ago. Since then, over 200 people have been re-engaged with care and treatment.

At BCHD, we are very lucky to have such a dedicated Acute Communicable Disease team that works hard every day and sometimes at night to serve the residents of Baltimore.