Background:  Each year, dozens of infectious disease case reports and outbreaks occur at National Park Service (NPS) units among humans, wildlife species, or both. Responding to these events often requires collaboration across multiple NPS divisions and outside agencies; however, to date, a formal NPS mechanism for investigating such adverse health events has not existed.
Using the concept of One Health, which advocates cooperation between veterinary and human medicine to combat diseases that are shared between people and other animals, we propose the development of a multi-division NPS Disease Outbreak Investigation Team (DOIT) that will assist NPS units and regions in responding to disease threats.

Team Objectives:

1. Facilitate rapid investigation of potential adverse human and/or wildlife health events
2. Establish and streamline communication and response protocols, both within the NPS and with external partners
3. Enhance NPS capacity to respond to adverse health events and to develop interventions for disease control and prevention that are in agreement with NPS mission and policies
4. Foster relationships between the NPS, state/local health departments, and state/federal health, agriculture, and wildlife agencies

Primary Collaborators:
NPS Office of Public Health, Visitor and Resource Protection Directorate
NPS Wildlife Management and Health Program, Natural Resource Stewardship and Science Directorate

Team Description:  The NPS DOIT will consist of 3 core members: a medical epidemiologist and an environmental health officer from the Office of Public Health and a wildlife veterinarian from the Wildlife Management and Health Program. A primary park or region point of contact may be requested to serve as an additional ad hoc core member.

The team will be triggered upon:

1. Written request from a park superintendent or region/WASO division chief and
2. Approval of the request by a DOIT supervisor (CAPT Charles Higgins—Director, Office of Public Health or Dr. Margaret Wild—Lead Veterinarian, Wildlife Management and Health Program).

The DOIT will serve as the initial WASO responders to an adverse health event.  In coordination with the park or region, the team will decide if all members are needed for the response and if/when additional NPS and non-NPS partners and subject matter experts should be included.

For each event (depending on the suspected pathogen and primary population affected), one team member will be designated the lead investigator and will serve as the point of contact for coordination of all communications with the park and cooperating agencies.  In addition, options and recommendations on disease prevention, monitoring, control, and communication will be provided to park management in a timely manner.  Where feasible, assistance in implementing prevention and control measures may also be provided by the team. Briefing statements, presentations, and final reports will be developed by the DOIT and, following appropriate review, will be disseminated to involved parties.

All activities will be coordinated with park superintendents, management teams, regional offices, and appropriate WASO divisions.

Examples of Health Events Possibly Warranting Team Response

1. Single case reports in humans (employees, concessioners, or visitors) or wildlife
e.g. highly pathogenic avian influenza (HPAI), hantavirus cardiopulmonary syndrome, Legionnaire’s disease, measles, plague, rabies, anthrax, tularemia
2. Multiple case reports or outbreaks involving humans and/or wildlife
e.g. norovirus, Salmonella, Giardia, West Nile virus, chronic wasting disease
3. Unusual wildlife morbidity or mortality events
e.g. large or unexplained bird or marine mammal die-offs
4. Health events with unknown causes
e.g. unexplained employee deaths, novel diseases/syndromes in humans or wildlife
5. Concern for events outside park boundaries
e.g. plague or HPAI diagnosed on neighboring lands

Potential Investigative Partners

NPS Biological Resource Management Division
            - Integrated Pest Management Program
            - Threatened and Endangered Species Program
NPS Environmental Quality Division
NPS Park Facility Management Division
NPS Risk Management Division
NPS Concession Program
NPS Regional Offices
U.S. Fish and Wildlife Service
U.S. Geological Survey
            - National Wildlife Health Center
Centers for Disease Control and Prevention
Food and Drug Administration
Other federal/state health, agriculture, and wildlife agencies
State/local Health departments
Universities and academic institutions

Funding:  No line-item funding has yet been identified for this team.  In the interim, anticipated costs (including travel, laboratory testing, supplies, and training) will be covered under current Office of Public Health and Wildlife Management and Health Program budgets. 

Contact Information:
DOIT Supervisors
CAPT Charles Higgins, Director, Office of Public Health, (202) 513-7217, charles_higgins@nps.gov
Dr. Margaret Wild, DVM, PhD, Lead Veterinarian, Wildlife Management and Health Program, (970) 225-3593, margaret_wild@nps.gov

DOIT Core Members
CDR David Wong, MD, Medical Epidemiologist, Office of Public Health, (505) 248-7806, david_wong@nps.gov
Dr. Kevin Castle, Wildlife Veterinarian, Wildlife Management and Health Program, (970) 267-2162, kevin_castle@nps.gov
LCDR Adam Kramer, Environmental Health Officer and Public Health Consultant— Intermountain Region, Office of Public Health, (303) 969-2922, adam_kramer@nps.gov