6 Chapter 6 – Food Regulations Epidemiology and Health Data

Federal Food Code and Pasteurize Milk Ordinance

The U. S. Food and Drug Administration (FDA) publishes the Food Code, a model that assists food control jurisdictions at all levels of government by providing them with a scientifically sound technical and legal basis for regulating the retail and food service segment of the industry (restaurants and grocery stores and institutions such as nursing homes). Local, state, tribal, and federal regulators use the FDA Food Code as a model to develop or update their own food safety rules and to be consistent with national food regulatory policy.

Between 1993 and 2001, the Food Code was issued in its current format, every two years. With the support of the Conference for Food Protection (CFP), FDA decided to move to a four-year interval between complete Food Code editions. During the interim period between full editions, FDA may publish a Food Code Supplement that updates, modifies, or clarifies certain provisions. The 2005 Food Code was the first full edition published on the new four-year interval, and it was followed by the Supplement to the 2005 Food Code, which was published in 2007. The 2017 Food Code is the most recent full edition published by FDA.[1]

A goal of the Food and Drug Administration’s (FDA) Retail Food Safety Initiative1 is to “Encourage widespread, uniform, and complete adoption of the FDA Food Code.” To address this goal, FDA emphasizes benefits that can be realized when State, territorial, local, and tribal governments adopt the Food Code in its entirety. Recognition of these benefits by the retail store, foodservice and vending industries should help to promote complete and widespread Food Code adoption as statutes, codes and ordinances pertaining to retail food safety are updated at all levels of government.

Cross-cutting Benefits for Government and Industry

  1. Promotes uniform national standards for retail food safety to reduce complexity and better ensure compliance.
  2. Ensures food safety regulations reflect the most current science available and evolve to reflect new science and knowledge, emerging technologies and to remain current with other federal laws.
  3. Created through a coordinated and collaborative process (Conference for Food Protection), the Food Code reflects input from all stakeholders: National, state and local regulators, industry, academia and consumers.
  4. Stakeholders can take advantage of scientific and personnel resources expended by FDA and other agencies to ensure the FDA Food Code is complete.
  5. Provides effective controls as a means of reducing the risks of foodborne illnesses within retail establishments, thus protecting consumers and industry from potentially devastating health consequences and financial losses.
  6. Provides a comprehensive approach to food safety management and provides extensive supporting documents and training.
  7. Facilitates and allows for standardization of inspections and inspectors.
  8. May result in cost savings related to the conduct of inspections.
  9. Reduces complexity and the paperwork burden for industry and government alike.
  10. Improves consumers’ understanding of food safety expectations.
  11. Creates a common/standardized food safety language that can improve communication between regulators and industry operators.
  12. Uniformity of using the same Food Code allows comparison of performance across national chains by providing standardized inspection criteria. Thereby an establishment can target resources according to science and risk to improve the public health performance of restaurants.
  13. State and local agencies usage of FDA interpretations of Food Code reduces the work load associated with development of interpretations.
  14. Creates a common/standardized language between regulators and industry.
  15. Fosters a common understanding of risk, risk control/management and food safety between industry and regulators.
  16. Reduces industry Food Safety training costs by allowing the utilization of training materials which can be used across all jurisdictions.

Regulatory Benefits

  1. Ensures conformance with Standard No .1 – Regulatory Foundation of FDA’s Voluntary National Retail Food Regulatory Program Standards.
  2. Avoids errors caused when State and Local jurisdictions adopt only selected sections of the FDA Food Code (cross references may be missed or overlooked or incorrectly referenced).
  3. Makes the process for updating laws and regulations at the State and Local level more efficient through elimination of redundant food code creation processes at the state and local regulatory level.
  4. Conserves resources by allowing regulatory software providers to develop inspection tools that work at all jurisdictions.
  5. Demonstrates food safety commitment and therefore increases eligibility for federal training, grants, cooperative agreements and other resources.[2]

 

Potentially Hazardous Foods

What is a Potentially Hazardous Food? The Food Code defines a potentially hazardous food (PHF) as a natural or synthetic food that requires temperature control because it is capable of supporting:

·         The rapid and progressive growth of infectious or toxigenic microorganisms, or

 ·         The growth and toxin production of Clostridium botulinum, or

 ·         In raw shell eggs, the growth of Salmonella enteritidis.

The phrase does not mean a naturally dangerous food (for example: a poisonous mushroom).

 

Which Foods Would be Considered Potentially Hazardous? Microorganisms generally grow rapidly in moist, high protein foods that have not been acidified or otherwise further processed to prevent such growth. Examples of PHFs include, but are not limited to:

1.    Animal foods that are raw or heat treated such as:

·         Milk or milk products including cheese, sour cream, and whipped butter

·         Meats including raw or partially cooked bacon

·         Shell eggs

·         Fish

·         Poultry and poultry products

·         Shellfish

 

2.    Food derived from plants that are heat treated including:

·         Onions (cooked and rehydrated)

·         Cooked rice

·         Soy protein products (example:Tofu)

·         Potatoes (baked or boiled)

 

3.    Food derived from plants that consist of:

·         Cut melons, or

·         Raw seed sprouts.

 

4.    Garlic-in-oil, and other vegetable-in-oil mixtures that are not treated to prevent the growth and toxin production of C. botulinum;

 

5.    Certain sauces, breads, and pastries containing potentially hazardous food (examples: meat, cheese, cooked vegetables or cream)

 

How Should a PHF be Handled? Both time and temperature must be carefully controlled to ensure the safety of these foods.

Time

 Mark ready-to-eat PHF with the date of discard if these foods are held under refrigeration for more than a cumulative total of 24 hours before sale or service. Sections 3-501.17 – 18 of the 1999 Food Code and the MDA fact sheet entitled “Date Marking” describe required procedures.

 

Temperature

Hold hot cooked PHF at 140°F or above and cold PHF at 41°F or lower.

Meet required internal temperatures when cooking or reheating PHF.

What is Not a PHF?

  •  An air cooled hard boiled egg with shell intact;
  • A food with water activity of 0.85 or less;
  • A food with a pH of 4.6 or below when measured at 75°F;
  • A food in a hermetically sealed container commercially processed to achieve and maintain sterility;
  • A food for which laboratory evidence has demonstrated that rapid and progressive growth of pathogens or the slower growth of C. botulinum cannot occur.

Food establishment managers are responsible for accurately determining which of the foods they serve or sell are potentially hazardous and therefore require strict temperature control.

Assistance in determining if food meets these requirements is generally available from food industry consultants, independent consulting laboratories certified to conduct microbiological testing of foods, and university-based food scientists.

Verifying that Foods are not Potentially Hazardous

 Regulatory personnel verify that foods maintained without temperature control are not potentially hazardous. Actions regulators take may include, but are not limited to:

  • Requesting a copy of analytical testing results;
  • Requiring written assurance that a food is not potentially hazardous. Relevant information normally includes:
  • ► Name and address of the independent agency or laboratory that conducted the evaluation.
  • ► Procedure/methodology used
  • ► Conclusions and scientific basis for those conclusions
  • Taking a sample of the food for analysis at any given time to verify its safety.

If a Food Is Not a PHF, Could It Still Cause Foodborne Illness?

 Yes. Although a food does not support the growth of microorganisms, it can still be contaminated at levels to cause illness.

Example: an outbreak of Salmonella agona was caused by contamination of dry breakfast cereal.[3]

Grade “A” Pasteurized Milk Ordinance

The Grade “A” Pasteurized Milk Ordinance (PMO) is recognized by the Public Health Agencies, the milk industry, and many state regulatory bodies as the national standard for milk processing regulation. The PMO provides uniform regulations for the dairy industry that are created by the dairy industry, government, and academic representatives.

The Grade “A” Pasteurized Milk Ordinance is considered the gold standard and is an invaluable resource on all aspects of dairy production and processing. Some sections of the PMO apply to all dairy food processors, such as processing plant requirements and drug residue testing, while other sections apply to those producing pasteurized, Grade “A” products. Other key features of the PMO include information on inspections, the standards for milk and milk products, pasteurization conditions, equipment and testing specifications, dairy farm and milk plant facility specifications, and the HACCP and Preventive Controls food safety programs. The PMO contains many illustrations to assist farmers and processors with the correct set up for items such as buildings, wells, ventilation systems, and pasteurizer flow diagrams.

Regardless of what type of dairy food you are making, the PMO is the standard reference for processing facility and equipment requirements. It is often used by local milk inspectors and regulatory agencies as the guidelines for processing plant approval and inspection. It is well worth your time to become familiar with the information in the PMO.

Obtaining a Copy of the PMO

The PMO is easy to find electronically, and usually difficult to get in printed format. The PMO and other related documents can be found on the National Conference on Interstate Milk Shipments (NCIMS) website.  Alternatively, doing an internet browser search for “Pasteurized Milk Ordinance” and the year of the most current revision will bring up a link that automatically downloads the document in a pdf format. The PMO is over 400 pages and is always free of charge.

PMO Revisions

The PMO is revised every 2 years, in odd-numbered years, by the U.S. Department of Health and Human Services, Public Health Service, Food and Drug Administration. Changes to the PMO are based on the outcome of proposals, discussions, and votes by representatives of the dairy industry, government, and academia from all 50 states and U.S. territories, that occur at the biannual meeting of the National Conference on Interstate Milk Shipments.

The process of updating the PMO after each conference takes time before the new PMO is released in electronic and paper format to FDA personnel, local inspectors, and the dairy industry. The changes that were made at 2019 conference were released in spring 2020, as the 2019 PMO, which is the most recent version. Because of the COVID-19 pandemic, the 2021 NCIMS conference and PMO revision is being delayed until 2022. Thus, the next revision is expected to be made available to the public in the spring of 2023.

PMO Table of Contents

The scope and importance of this document warrants including the Table of Contents of the 2019 version here for reference, particularly for those who are unfamiliar with this resource. Many of the sections below contain detailed subsections but are not listed here. For example, Section 7 contains subsections on the constructions of floors and wall, the water supply, handwashing facilities, pasteurization condition, storage of containers, etc.

Table of Contents

List of Previous Editions of USPHS/FDA Milk Ordinance

Foreword

Preface

Introduction

Table of Contents

  • Illustrations
  • Tables
  • Abbreviations and Acronyms

Grade “A” Pasteurized Milk Ordinance (Grade “A” PMO) 2019 Revision

Section 1. Definitions

Section 2. Adulterated or Misbranded Milk and/or Milk Products

Section 3. Permits

Section 4. Labeling

Section 5. Inspection of Dairy Farms and Milk Plants

Section 6. The Examination of Milk and/or Milk Products

Section 7. Standards for Grade “A” Milk and

  • Standards for Grade “A” Raw Milk for Pasteurization, Ultra-pasteurization, Aseptic Processing and Packaging, Retort Processed After Packaging or Fermented High-Acid, Shelf-Stable Processing and Packaging
  • Standards for Grade “A” Pasteurized, Ultra-pasteurized, Aseptically Processed and Packaged Low-acid Milk and/or Milk Products, Retort Processed After Packaged Low-acid Milk and/or Milk Products and Fermented High-Acid, Shelf-Stable Processed and Packaged Milk and/or Milk Products

Section 8. Animal Health

Section 9. Milk and/or Milk Products Which May be Sold

Section 10. Transferring; Delivery Containers; and Cooling

Section 11. Milk and/or Milk Products from Points Beyond the Limits of Routine Inspection

Section 12. Plans for Construction and Reconstruction

Section 13. Personnel Health

Section 14. Procedure When Infection or High Risk of Infection is Discovered

Section 15. Enforcement

Section 16. Penalty

Section 17. Repeal and Date Effect

Section 18. Separability Clause

Footnotes

Appendix A. Animal Disease Control

Appendix B. Milk Sampling, Hauling and Transportation

Appendix C. Dairy Farm Construction Standards and Milk Production

Appendix D. Standards for Water Sources

Appendix E. Examples of 3-Out-Of-5 Compliance Enforcement Procedures

Appendix F. Cleaning and Sanitization

Appendix G. Chemical and Bacteriological Tests

Appendix H. Continuous-Flow Pasteurization Systems (Equipment and Procedures) and Other Equipment

Appendix I. Pasteurization Equipment and Controls – Tests

Appendix J. Standards for the Fabrication of Single-Service Containers and/or Closures for Milk and/or Milk Products

Appendix K. HACCP Program

Appendix L. Applicable Regulations, Standards of Identity for Milk and Milk Products, The Federal Food, Drug, and Cosmetic Act, and the Federal Insecticide, Fungicide and Rodenticide Act

Appendix M. Reports and Records

Appendix N. Drug Residue Testing and Farm Surveillance

Appendix O. Vitamin Fortification of Fluid Milk Products

Appendix P. Performance-Based Dairy Farm Inspection System

Appendix Q. [Reserved]

Appendix R. Determination of Time/Temperature Control for Safety Milk and/or Milk Products

Appendix S. Aseptic Processing and Packaging Program, Retort Processed After Packaging Program and Fermented High-Acid, Shelf-Stable Processing and Packaging Program

Appendix T. Preventive Controls for Human Food Requirements for Grade “A” Milk and Milk Products

Index

This video shows how a dairy can milk up to 10,000 head of cows per day using a particular system called a carousel.

The PMO and Food Safety Modernization Act (FSMA)

Dairy products have long known to be associated with pathogens and the industry has long participated in a voluntary food safety system to control these hazards and produce safe dairy products. This system follows the principles of a Hazard Analysis and Critical Control Point (HACCP) system, including required prerequisite programs. The requirements of a dairy HACCP system, prerequisite programs, records, training, and implementation are listed in Appendix K of the PMO.

The federal Food Safety Modernization Act (FSMA) requires food facilities to have a food safety plans that are broader in scope than the traditional HACCP plans. The FSMA requirements for Good Manufacturing Practice, Hazard Analysis and Risk-Based Preventive Controls for Human Food (21 CFR 117) contains more preventive controls (process, sanitation, allergen) to manage hazards than are defined as critical control points (CCPs) under a HACCP system. Additionally, these requirements include supply-chain control programs and recall plans.[4]

FOREWORD to PMO
The milk sanitation program of the United States Public Health Service (USPHS) is one of its oldest and most respected activities. The interest of the USPHS in milk sanitation stems from two important public health considerations. First, of all foods, none surpasses milk as a single source of those dietary elements needed for the maintenance of proper health, especially in children and older citizens. For this reason, the USPHS has for many years promoted increased milk consumption. Second, milk has a potential to serve as a vehicle of disease transmission and has, in the past, been associated with disease outbreaks of major proportions.


The incidence of milk-borne illness in the United States has been sharply reduced. In 1938, milkborne outbreaks constituted twenty-five percent (25%) of all disease outbreaks due to infected foods and contaminated water. Our most recent information reveals that milk and fluid
milk products continue to be associated with less than one percent (<1%) of such reported outbreaks. Many groups have contributed to this commendable achievement, including Public
Health and Agricultural Agencies, dairy and related industries, several interested professional groups, educational institutions and the consuming public. The United States Public Health Service/Food and Drug Administration (USPHS/FDA) is proud to have contributed to the protection and improvement of the milk supply of the nation through technical assistance, training, research, standards development, evaluation and certification activities.
Despite the progress that has been made, occasional milkborne outbreaks still occur, emphasizing the need for continued vigilance at every stage of production, processing, pasteurization and distribution of milk and milk products.

Problems associated with assuring the safety of milk and milk products have become extremely complex because of new products, new processes, new materials and new marketing patterns, which must be evaluated in terms of their
public health significance. The Grade “A” Pasteurized Milk Ordinance (Grade “A” PMO), 2017 Revision translates this new knowledge and technology into effective and practicable public health practices and incorporates the provisions of the Grade “A” Condensed and Dry Milk Ordinance–Supplement I to the Grade “A” Pasteurized Milk Ordinance.

The responsibility for insuring the ready availability and safety of milk and milk products is not confined to an individual community or a State, or to the Federal Government, it is the concern of the entire nation. With the continued cooperation of all engaged in assuring the safety of milk and milk products, including Government and industry, this responsibility can be accepted with confidence.

PREFACE
USPHS activities in the area of milk sanitation began at the turn of the century with studies on the role of milk in the spread of disease. These studies led to the conclusion that effective public health control of milkborne disease requires the application of sanitation measures throughout the production, handling, pasteurization, and distribution of milk and milk products. These early studies were followed by research to identify and evaluate sanitary measures, which might be used to control disease, including studies that led to improvement of the pasteurization process.

To assist States and Municipalities in initiating and maintaining effective programs for the prevention of milkborne disease, the USPHS, in 1924, developed a model regulation known as the Standard Milk Ordinance for voluntary adoption by State and Local Milk Control Agencies.


To provide for the uniform interpretation of this Ordinance, a n accompanying Code was published in 1927, which provided administrative and technical details as to satisfactory compliance. This model milk regulation, now titled the Grade “A” Pasteurized Milk Ordinance (Grade “A” PMO), 2017 Revision, incorporates the provisions governing the processing, packaging, and sale of Grade “A” milk and milk products, including buttermilk and buttermilk products, whey and whey products, and condensed and dry milk products and represents the 31st revision and incorporates new knowledge into public health practice.
The USPHS/FDA alone did not produce the Grade “A” PMO. As with preceding editions, it was developed with the assistance of Milk Regulatory and Rating Agencies at every level of Federal, State, and Local Government, including both Health and Agriculture Departments; all segments of the dairy industry, including producers, milk plant operators, equipment manufacturers, and associations; many educational and research institutions; and with helpful comments from many individual sanitarians and others. The USPHS/FDA’s recommended Grade “A” PMO is the basic standard used in the voluntary Cooperative State-USPHS/FDA Program for the  certification of Interstate Milk Shippers; a program participated in by all fifty (50) States, the District of Columbia and U.S. Trust Territories.

The National Conference on Interstate Milk Shipments (NCIMS) in accordance with the Memorandum of  Understanding with the Food and Drug Administration (FDA) has at its biennial conferences recommended changes and modifications to the Grade “A” PMO. These changes have been incorporated into this 2017 revision. The counsel and guidance rendered by the Conference in preparation of this edition of the Grade “A” PMO is deeply appreciated.
The Grade “A” PMO is incorporated by reference in Federal specifications for procurement of milk and milk products; is used as the sanitary regulation for milk and milk products served on interstate carriers; and is recognized by the Public Health Agencies, the milk industry, and many others as the national standard for milk sanitation. The Grade “A” PMO adopted and uniformly applied will continue to provide effective public health protection without being unduly
burdensome to either Regulatory Agencies or the dairy industry. It represents a “grass-roots” consensus of current knowledge and experiences and as such represents a practical and equitable milk sanitation standard for the nation.

Within the 2017 Grade “A” PMO, the administrative and technical requirements for the manufacture of condensed and dry milk products and condensed and dry whey included in the Grade “A” Condensed and Dry Milk Ordinance-Supplement I to the Grade “A” Pasteurized Milk Ordinance have been incorporated as directed by the 2001 NCIMS.

INTRODUCTION
The following Grade “A” PMO, with Appendices, is recommended for legal adoption by States in order to encourage a greater uniformity and a higher level of excellence of milk sanitation practice in the United States. An important purpose of this recommended standard is to facilitate the shipment and acceptance of milk and milk products of high sanitary quality in interstate and intrastate commerce.

When this Ordinance is adopted, its enforcement becomes a function of the Regulatory Agencies. Consequently, the Ordinance should be adopted only if adequate provisions can be made for qualified personnel and for suitable laboratory facilities. The charter and the legal counsel of the government unit involved should be consulted for information or advice on proper legal procedures, such as the recording and advertising of the Ordinance after passage.
Adoption: In the interest of national uniformity, it is recommended that not any changes be made in this Ordinance when adopted by a State, unless changes are necessary to avoid conflict with State law. Modifications should be contemplated with extreme caution so as not to render the Ordinance unenforceable. In order to promote uniformity, it is recommended that all of the ADMINISTRATIVE PROCEDURES be adopted as well.
[5]

Epidemiology and Health Data

06.02 Module 06 Discussion Forum Salmonella Outbreak InvestigationLink to Blackboard Site

For this discussion, you will review the Central District Health Department’s final report on the Salmonella outbreak that occurred at a local food establishment. The name of the establishment has been redacted from the final report for the purpose of this discussion.

Pre-Discussion Work

To begin this assignment, review the following resources:
  • Materials in this Chapter on Epidemiology

Drafting Your Response

Next, prepare your forum post by creating a Google document. On your document, answer the following questions:
  • Do you believe that the health district responded within an appropriate time frame? Why or why not?
  • Do you believe that it was appropriate to close the establishment? Why or why not?
  • What was the major public health issue that resulted in the outbreak?
  • What might be a complicating factor in the investigation?
  • What is your general opinion of the investigation?
Be sure to support your responses by referencing materials from this module. Also, once you have answered the questions, be sure to proofread what you wrote before you share it.

Discussing Your Work

To discuss your findings, follow the steps below:
Step 01. After you have finished writing and proofreading your response, click on the link to your group under the My Groups link in the main menu on the left side of this page.
Step 02. Once in your group, click on the Group Discussion Board link and locate the Module 03 Discussion Forum 2.
Step 03. In the Module 03 Discussion Forum 2, create a new thread and title it using the following format: Yourname’s Salmonella Outbreak Post.
Step 04. In the Message field of your post, copy and paste the text of your composition from the Google Document you created– please do not provide a link to that Google Doc.
Step 05. Correct the formatting using the text-editing tools in the Message field. Add bolding, underlining, or italics where necessary. Also, correct any spacing and other formatting issues. Make sure your post looks professional.
Step 06. When you have completed proofreading and fixing your post formatting, click on the Submit button.

 

What is Epidemiology?

Epidemiology comes from the Greek word pi, meaning ‘on’ or ‘upon’; ‘demos’, meaning ‘people’; and ‘logos,’ meaning ‘the study of.’ It’s the study of what comes upon—or befalls—a population, according to the Centers for Disease Control and Prevention (CDC)External link:open_in_new. But what does epidemiology mean in a modern context? According to the CDC, “epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” Put simply, epidemiology can be defined as the study of patterns, causes, and effects of health.

What is Epidemiology in Public Health?

The principles of epidemiology can be applied across a variety of industries, but epidemiology in public health has its own unique role. By studying and controlling health determinants, distribution disparities, and public health disruptions, epidemiology in public health applies the principles of the field to populations around the world. These professionals pinpoint discrepancies, discover information, and take necessary steps and interventions to close public health gaps and improve overall health outcomes.

Bachelor’s in Epidemiology Programs

There are no specific bachelor’s programs for the field of epidemiology. However, a bachelor’s program in a related field can teach the foundational theories, principles, and research methods required for a career as a public health epidemiologist. Earning a bachelor’s degree in a major like nursing, biostatistics, or health sciences can provide a firm foundation in the science of diseases. With a strong introductory knowledge of the field and its function in the wider realm of public health, students will be well positioned to pursue a master’s in public health—and be on their way to the field of epidemiology.

Bachelor of Science in Public Health

Women with 17+ prior college credits or an associate degree: Complete your bachelor’s degree in a supportive women’s online public health BS program.

  • Up to 96 transfer credits accepted, plus credit for life experience
  • Degree programs are designed for working professionals and can be completed part time
  • CEPH-accredited

Curriculum for a Bachelor’s Degree in Epidemiology

Again, you can’t actually earn a Bachelor’s of Epidemiology. However, some common courses you can take in undergrad to prepare you for a master’s degree include:

Health Policy in a Global World

This course introduces students to key concepts in health policy formation, implementation, and evaluation on a global scale. Students will learn about the organization, financing, and delivery of global health care services and systems, and examine the role of governmental, private, and non-profit agencies in these processes.

Epidemiology for Global Health

An overview of epidemiology in a global context, this course will examine the distribution and determinants of health and illness in human populations around the world, while introducing students to the core principles and methods of the field.

Biostatistics for Public Health

An introduction to the basic concepts, methods, and techniques of analyzing public health data, this course will emphasize—and apply—the uses, interpretations, and limits of statistical analysis.

Master’s in Epidemiology Programs

A Masters degree is a typical degree requirement for an Epidemiologist working in the field.

A master’s degree in epidemiology can take the form of a Master of Science (MS) in Epidemiology or a Master’s of Public Health (MPH) with a concentration in epidemiology. While the typical curriculum varies by the actual program, both an MS or MPH in epidemiology offer coursework in foundational concepts of epidemiology and public health, as well as a slew of skills-based, policy-based, and research-specific courses. All of these courses can empower students with confidence in their abilities to take a quantitative approach to address public health issues through an epidemiological lens. For many students of public health, a master’s degree in epidemiology is the first step to pursuing a hands-on, high-impact career in the field.

Curriculum for a Master’s Degree in Epidemiology

Master’s in Epidemiology courses may include the following:

Analytic Methods for Epidemiology

This course will familiarize you with many of the most commonly used analytic methods for epidemiologists, equipping you with the tools you need to measure and assess risk factors of certain health outcomes.

Introduction to Epidemiology & Biostatistics

Incorporating another key area of public health, this course will introduce the basic principles and methods of both epidemiology and biostatistics. You’ll learn how to apply this knowledge to relevant public health issues and questions—developing the skills to evaluate and analyze them through both lenses.

Study Designs for Epidemiologist

This course reviews the main study designs and frameworks used to describe, predict and understand the causes of adverse health outcomes in humans across a wide range of geographies and demographics.

Systematic Review and Meta-Analysis

As an introduction to research synthesis, this course will teach the core principle and methods for conducting a systematic and quantitative review. Much of this will be illustrated through relevant case studies of public health issues.

Medical Degrees with Epidemiology Focus

Some individuals who work as epidemiologists hold a dual degree in medicine. This allows for further specialization in clinical research. Dual degrees are options for those seeking to minimize their time in school while maximizing their career potential. Dual degrees include PhD/MD and MPH/MD programs. Individuals with dual degrees may choose to specialize in clinical studies, population education, and/or pursue careers in academia.

Concentration Areas for a Master’s in Epidemiology

As you explore different master’s in epidemiology programs, you’ll find that some programs feature additional concentrations or specializations. A search of the Council on Education for Public Health’sExternal link:open_in_new (CEPH) website reveals a variety of concentrations or minor tracks in epidemiology, including applied epidemiology that emphasizes the application of epidemiologic tools and frameworks, environmental epidemiology that explores the ways environmental factors (physical, chemical and biological) affect the health of populations, social epidemiology that focuses on exploring the effects of social-structural factors on health, and more. Some schools also offer programs that combine epidemiology with biostatistics and teach students statistical methods to identify and evaluate risk factors associated with disease outcomes.

If you have specific career goals, then choosing a program with a corresponding concentration or specialization can give you additional training in this specific area.

Timeline and Coursework Example of MPH Epidemiology

Each MPH program is structured to help you first learn the basic skills and background information you’ll need to understand upper-level courses and concepts later on. For example, during your first year, you’ll take some broader, introductory-level courses in topics like an introduction to public health, principles of epidemiology and an introduction to research methods. The second year will build on what you’ve learned with more advanced courses, like level-two courses in epidemiology and biostatistics. Depending on the program, you may be able to incorporate elective courses during your first and second years. Elective courses could cover various topics, such as cancer, cardiovascular or nutrition epidemiology.

Many programs require an internship or a capstone project during the second year. You’ll rely on the information you learned during your first year to complete these milestones, and your capstone project may focus on an area of interest you discovered during your earlier coursework.

Below is a sample 42-credit curriculum of an MPH in Epidemiology program. If your programs require more than 42 credits, you may need to either take extra courses or enroll in more semesters.

Semester 1 Semester 2 Semester 3 Semester 4
Foundations of Public Health
Epidemiology Methods II
Design and Analysis of Surveys
Capstone
Epidemiology Methods I
Intermediate Epidemiology
Categorical Data Analysis
Elective or Field Placement
Health Systems, Policy and Management
Computer Applications for Public Health Researchers
Epidemiology Methods III
N/A
Design Strategies for Public Health Programs
Social Epidemiology Methods & Theory
Epidemiologic Data Analysis & Interpretation
N/A

MPH Epidemiology Program List

MPH epidemiology degree programs prepare you to help improve public health, but each program takes a slightly different approach. From specialized courses to electives and more, the following programs deliver a comprehensive education. We’ve compiled a list of online MPH epidemiology programs that are accredited by the CEPH

Doctorate in Epidemiology Programs

A doctorate, or PhD in Epidemiology program, provides public health professionals specializing in epidemiology with the highest level of education and degree standing possible. Some doctoral students go on into the field as independent, innovative, and leading research scientists in the field of epidemiology. Others with a PhD in epidemiology may choose to go into academia. The curriculum for a PhD in Epidemiology will include various advanced courses that cover study design, research and analytical methods, and data, trial, and testing skills.

Curriculum for a Doctorate Degree in Epidemiology

PhD in Epidemiology courses may include the following:

Advanced Epidemiology

This course will build upon students’ epidemiological foundations from prior years of study, teaching them to analyze and interpret epidemiologic studies using advanced methods. In addition, students learn to understand, analyze, and explain the theoretical underpinnings of both new and traditional epidemiological study designs.

Novel Analytical Methods for Epidemiology

Broadening well beyond the basics of epidemiological analytics, this course will teach the most advanced and novel analytical techniques and methods in the field. Students will gain expertise in data collection, data analysis, statistical analysis, and summarization.

Epidemiology Careers and Industries

Career options for those with degrees in epidemiology are finite—mainly because of the precise nature of the field. A bachelor’s degree in an epidemiological subject may allow you to work as a biostatistician, social scientist, medical administrative assistant, research assistant, or another similar career.

Those with a master’s degree in epidemiology will qualify for a wider selection of roles within the field. They may pursue roles in epidemiology, clinical research, or data analysis—working in government, hospital, laboratory, or university settings. The majority of government jobs for epidemiologists are at the state and local levels. In hospitals, laboratories, and university settings, epidemiologists tend to work as medical scientists, conducting infection surveillance and prevention.

Epidemiologist is still one of the higher paying public health careers. According to the U.S. Bureau of Labor Statistics, the median annual pay for epidemiologists in 2019 was $70,990External link:open_in_new. Overall, epidemiologists are likely to have good job prospects. The employment of epidemiologists is projected to grow 5% from 2018 to 2028External link:open_in_new, which is as fast as the average for all occupations.

What Can You do with an Epidemiology Degree?

Careers in epidemiology and adjacent fields with the similar educational requirements include:

Epidemiologist

The most straightforward application of your epidemiology degree is to enter a career as an epidemiologist. As described above, this is a growing and lucrative occupation, and you will have the opportunity to work in a variety of exciting roles.

Statisticians

Statisticians can work in government, hospital, pharmaceutical, or even non-profit settings, developing studies that will be presented in a variety of applications. A fast-growing field, the median annual pay for statisticians in 2019 was $91,160.

Community Health Workers

Community health workers assist communities and individuals in adopting healthy behaviors through outreach, screening, and data collection. Community health workers are in high demand with a faster-than-average projected job growth of 11% from 2018 to 2028.

Who Should Consider an Epidemiology Degree?

Epidemiology may be a good fit for someone with an interest in interpersonal relations, data analysis, and research. While much of an epidemiologist’s work is done at computers analyzing and manipulating data, a fair amount of work involves surveying and educating people. Epidemiologists are often responsible for taking complex health and medical data and relaying that information to individuals in policy or to the general public.

Skills needed for a career in epidemiology include: critical thinking, data analysis, understanding of statistical, medical, and biological concepts, research analysis, and proficiency with statistical software. Epidemiologists should also have strong communication and teaching skills.

Epidemiology Organizations to Know

Some epidemiology organizations include:

Society for Healthcare Epidemiology of America (SHEA)

The Society for Healthcare Epidemiology of America (SHEA) is a professional society for individuals around the world with a self-described “expertise and passion in healthcare epidemiology, infection prevention, and antimicrobial stewardship.” SHEA partners with public health professionals and policy makers across a wide range of fields to achieve better healthcare outcomes.

Centers for Disease Control and Prevention (CDC)

The Centers for Disease Control and Prevention (CDC) is the nation’s leading health protection agency, conducting critical scientific research and providing the necessary information to populations to protect the U.S. against health threats—both at home and abroad.

Frequently Asked Questions about Epidemiology Degrees

Etiology vs Epidemiology – What are the differences?

While epidemiology can be considered the foundational study of public health, etiology refers to a more specific area of the field. Etiology hones in on the causation of a disease or condition—referring to the study of the source and origins of the pathology or illness itself—rather than its large-scale implications.

MPH in Epidemiology vs MS in Epidemiology

An MPH in Epidemiology will introduce the full spectrum of public health, including related fields like biostatistics, environmental health sciences, and health policy. This degree can prepare someone looking to influence public policy. Alternately, an MS in Epidemiology focuses on epidemiological science—teaching specific analytical skills and research methods students can apply directly to research. This degree may be the right fit if you are interested in the academic side of epidemiology.

Is an Epidemiology Degree Worth it?

An epidemiology degree can prepare students for a wide variety of career paths in the public health, medical sciences, and health research fields. If you’re interested in pursuing a career in epidemiology or public health, an advanced degree in epidemiology can help expand your options. It can qualify you for more roles and higher compensation—and hopefully set you on a path of success and fulfillment.[6]

Sources of Epidemiological Data

MMWR  Weekly

06.05 Module 06 Assignment MMWR Review-Link to Blackboard Site

For this assignment, you will look at one source of health data: the Centers for Disease Control’s Morbidity and Mortality Weekly Report. You will select a topic that interests you that is within the last 4 weeks, review the related material, and answer questions related to the topic that you selected.
In addition to reviewing the sources, you will make a copy of the assignment worksheet and compose an essay which you will submit using the assignment link in this folder.

Downloading and Saving Your Worksheet

Download the Module 06.09  Assignment worksheet and add your name to it. Then, save your worksheet to a folder for this course on your computer using the following naming convention: Mod_06.09 Assignment_YourLastName_FirstNameInitial.

Reviewing Sources About the CDC Morbidity and Mortality Weekly Report

With the goal of responding to the essay questions on the Module 06.09 Assignment Worksheet, go to the index of the Morbidity and Mortality Weekly Report If you click on the More tab in the current week box it will lead you to back issues.  Then, look back over the last 4 weeks of the reports and select a topic that you are interested in and read about it.

Writing Your Essay

Write your original responses to the prompts on your copy of the Module 06.09 Assignment Worksheet. When you write your essay, be sure to address the requirements as described in the worksheet directions. After you write your essay, proofread it thoroughly making sure there are no spelling, grammatical, punctuation, or other errors. Also, make sure that the tone of your writing is professional in style, and that you add citations where appropriate.

Submitting Your Worksheet

To submit your Module 06.09 Assignment Worksheet, click on the assignment link below. Then, click on the Browse My Computer button and locate and select your completed Module 06.09  Assignment Worksheet to attach it to your assignment. Once your worksheet is attached, submit your assignment.

 

The Morbidity and Mortality Weekly Report (MMWR)    Series is prepared by the Centers for Disease Control and Prevention (CDC). Often called “the voice of CDC,” the MMWR  series is the agency’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations. MMWR  readership predominately consists of physicians, nurses, public health practitioners, epidemiologists and other scientists, researchers, educators, and laboratorians.

The data in the weekly MMWR  are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday.

MMWR  Recommendations and Reports

The MMWR  Recommendations and Reports   contain in-depth articles that relay policy statements for prevention and treatment on all areas in CDC’s scope of responsibility (e.g., recommendations from the Advisory Committee on Immunization Practices).

CDC Surveillance Summaries

The CDC Surveillance Summaries    provide a means for CDC programs to disseminate surveillance findings, permitting detailed interpretation of trends and patterns based on those findings.

Supplements

The MMWR  Supplements    present information that does not easily conform to the format or content of an MMWR  Recommendations and Report or Surveillance Summary, such as compilation of historic events or accomplishments and reports or proceedings from national conferences.

Summary of Notifiable Infectious Diseases and Conditions

The Summary of Notifiable Diseases — United States   contains the official statistics, in tabular and graphic form, for the reported occurrence of nationally notifiable infectious diseases in the United States.

These statistics are collected and compiled from reports sent by state and territorial health departments to the National Notifiable Diseases Surveillance System (NNDSS), which is operated by CDC in collaboration with the Council of State and Territorial Epidemiologists (CSTE).

Summary of Notifiable Noninfectious Conditions and Disease Outbreaks

The Summary of Notifiable Noninfectious Conditions and Disease Outbreaks — United States, provides official statistics for the occurrence of nationally notifiable noninfectious conditions and disease outbreaks in the United States.

 

On Epidemiology and Geographic Information Systems: A Review and Discussion of Future Directions

Geographic Information Systems is a helpful tool for testing the hypothesis of the cause or source of an outbreak.

Geographic information systems (GIS) are “automated systems for the capture, storage, retrieval, analysis, and display of spatial data” (1). Common to all GIS is a realization that spatial data are unique because their records can be linked to a geographic map. The component parts of a GIS include not just a database, but also spatial or map information and some mechanism to link them together. GIS has also been described as the technology side of a new discipline, geographic information science (2), which in turn is defined as “research on the generic issues that surround the use of GIS technology, impede its successful implementation, or emerge from an understanding of its potential capabilities.” Recently, GIS has emerged as an innovative and important component of many projects in public health and epidemiology, and this disciplinary crossover is the focus of this review.

Few would argue that GIS has little to offer the health sciences. On the other hand, like other new technologies, GIS involves concepts and analytic techniques that can appear confusing and can lead to misunderstanding or even overselling of the technology. In this article, we attempt to bridge the gaps between the principles of geographic information science, the technology of GIS, the discipline of geography, and the health sciences. Our intent is to introduce to the epidemiologist a set of methods that challenge the “visual” half of the scientist’s brain.

Computers were first applied to geography as analytical and display tools during the 1960s (3). GIS emerged as a multidisciplinary field during the 1970s. The discipline’s heritage lies in cartography’s mathematical roots: in urban planning’s map overlay methods for selecting regions and locations based on multiple factors (4); in the impact of the quantitative revolution on the discipline of geography; and in database management developments in computer science.

Several factors combined in the 1970s to reinforce GIS development. First, computers became more accessible and less costly. Second, mainframe computers gave way to minicomputers and then workstations, which gave great power to the user and included the access to networks that has led to its own revolution in technology. Third, the types of user interface required to operate technical software changed from batch, command-line, and remote access to windowing systems and “point and click” graphic interaction. What had been expensive, slow, and difficult has rapidly become inexpensive, fast, and easy to use. A final but essential precondition to GIS development was the broad availability of public domain digital map data, in the form of maps of the landscape from the U.S. Geologic Survey and for census areas from the U.S. Census Bureau. The current GIS World Source book (5) lists hundreds of system suppliers and sources of information and catalogs system capabilities. In short, GIS has now come of age, to the extent that the contributions of a growing number of parallel disciplines have both influenced and been influenced by GIS. Other disciplines now affecting GIS include forestry, transportation planning, emergency services delivery, natural hazards planning, marketing, archeology, surveying, and criminal justice. A wide array of capabilities and information awaits the health scientist ready to pursue an interest in GIS.

In this article, we consider the functional capabilities of GIS and how they can relate to epidemiology. We then review studies in epidemiology and health science where GIS has already made a contribution and introduce the technologic and analytic background. We review spatial analytic methods and concepts of use in epidemiology and conclude by examining what the near future holds for technologic changes and what these changes mean for the study of emerging infectious diseases and other health applications.

GIS Functional Capabilities

GIS definitions usually focus on what tasks a GIS can do rather that what it is. GIS functional capabilities follow the standard GIS definitions; therefore, GIS can bring together the elements necessary for problem solving and analysis.

Data capture implies that 1) data can be input into the GIS from existing external digital sources; this is particularly the case when no data exist for a project, and the base data must be assembled from other studies, public domain datasets, and images. This usually means that GIS must be able to import the most common data formats both for image-type (raster) and line-type (vector) maps. 2) GIS can capture new map data directly; this means either that the user can scan the map and input it into the GIS or trace over a map’s features using a digitizing tablet and enter them into the GIS map database. 3) The GIS can accomplish everything that a regular database system can, such as enter and edit data and update information in the existing database.

Data storage implies storage of both map and attribute data. Attribute data are usually stored in a relational database management system contained within the GIS and accessed by a spreadsheet or query-driven user interface. For storage, map data must be encoded into a set of numbers so that the geometry of the map is available for query, but also so that the map is stored digitally in one or more files. Image maps are usually stored as gridded arrays. Line maps are encoded by any one of several systems, but usually by using both the coordinate information and encoded topology, so that the relationships between points, lines, and areas, such as the adjacency of regions or the connectedness of lines, are known in advance. The more efficient and flexible these data formats or structures, the more operations can be performed on the map data without further processing.

Data records in GIS can be retrieved in one of two ways. The relational database manager allows searching, reordering, and selecting on the basis of a feature’s attributes and their values. For example, the user may wish to select out and order alphabetically the names of all health clinics that had positive results in more than 10% of their tests. GIS also allows spatial retrieval. The user could select all clinics by region, by their latitude, or by their distance from the capital. The user could also select all clinics that are more than 10 km from a major road and within 100 m of a river or lake. In addition, combining searches is possible. There could be several data “layers,” for example vegetation, rivers, transportation, and population of villages. A single retrieval could combine data from each of these layers in a single query. Layers can also be weighted, so that rivers, for example, are twice as important as roads in selecting villages with a population under 500 surrounded by forest.

Display functions include predominantly the making of maps. Tools must exist for constructing many types of maps, such as contours, symbols, shading or choropleth, and sized symbols. Formal map display often follows a series of more temporary map images, usually without a strict map composition, and the result of a test, an analysis, or a query. In addition, the GIS must be able to output finished format of maps to a medium, such as PostScript, on a plotter or printer, or onto photographic film.

Many tools exist to support field data collection. Tasks in which ancillary demographic information needs to be input and coregistered are simple. Habitat associated with a vector (e.g., a snail or a mosquito) may need remotely sensed data, such as vegetation cover or weather data. If these data are georegistered, integration is possible. One of the most useful functions is called address matching, in which street addresses with house numbers and street names are automatically placed into an administrative unit or placed as a dot on the map. Thus a digital phone list or mailing list of patients can be merged with the remainder of the data. In the United States, the Census Bureau’s TIGER files can usually match 70% to 80% of unedited address records, and higher percentages if the address files are proofed and/or the more detailed and up-to-date commercial street files are used. In some field projects, the GIS’s ability to make maps became the mainstay of the effort, allowing planning of truck and jeep routes, sequencing field clinics for optimal routes for visits, and even for local navigation. The ability to display maps often goes far beyond their final or use in the laboratory. Often a GIS image map is more accurate and up to date than anything available locally.

Existing Applications of GIS in Epidemiology

Epidemiologists have traditionally used maps when analyzing associations between location, environment, and disease (6). GIS is particularly well suited for studying these associations because of its spatial analysis and display capabilities. Recently GIS has been used in the surveillance and monitoring of vector-borne diseases (79) water borne diseases (10), in environmental health (1113), modeling exposure to electromagnetic fields (14), quantifying lead hazards in a neighborhood (15), predicting child pedestrian injuries (12), and the analysis of disease policy and planning (16).

In a recent study in Baltimore County, Maryland, GIS and epidemiologic methods were combined to identify and locate environmental risk factors associated with Lyme disease (7). Ecologic data such as watershed, land use, soil type, geology, and forest distribution were collected at the residences of Lyme disease patients and compared with data collected at a randomly selected set of addresses. A risk model was generated combining both GIS and logistic regression analysis to locate areas where Lyme disease is most likely to occur.

GIS allows analysis of data generated by global positioning systems (GPS). Combined with data from surveillance and management activities, GIS and GPS provide a powerful tool for the analysis and display of areas of high disease prevalence and the monitoring of ongoing control efforts. The marrying of GIS and GPS enhances the quality of spatial and nonspatial data for analysis and decision making by providing an integrated approach to disease control and surveillance at the local, regional, and/or national level.

GIS is being used to identify locations of high prevalence and monitor intervention and control programs in areas of Guatemala for onchocerciasis (9) and in Africa for trypanosomiasis (17). Spatial and ecologic data are combined with epidemiologic data to enable analysis of variables that play important roles in disease transmission. This integration of data is essential for health policy planning, decision making, and ongoing surveillance efforts. For example, as part of the guinea worm eradication effort, the United Nation’s Children’s Emergency Fund placed pumps in villages most infected with the disease to ensure access to a safe water supply (18). GIS enabled researchers to locate high prevalence areas and populations at risk, identify areas in need of resources, and make decisions on resource allocation (16). Epidemiologic data showed a marked reduction in prevalence in villages where pumps were introduced.

GIS was used in designing a national surveillance system for the monitoring and control of malaria in Israel (19). The system included data on the locations of breeding sites of Anopheles mosquitoes, imported malaria cases, and population centers. The GIS-based surveillance system provided means for administrative collaboration and a network to mobilize localities in the case of outbreaks.

In 1985, the National Aeronautics and Space Administration (NASA) established the Global Monitoring and Disease Prediction Program at Ames Research Center in response to the World Health Organization’s call for the development of innovative solutions to malaria surveillance and control (20). A major aspect of the program was to identify environmental factors that affect the patterns of disease risk and transmission. The overall goal of the program was to develop predictive models of vector population dynamics and disease transmission risk using remotely sensed data and GIS technologies.

Remotely sensed data have been used in many vector disease studies (8,17,2124). Remote sensing and GIS were used to identify villages at high risk for malaria transmission in the southern area of Chiapas, Mexico (8). An earth environmental analysis system for responding to fascioliasis on Red River Basin farms in Louisiana was developed by integrating LANDSAT MSS imagery with GIS (22). In Kwara State, Nigeria, a temporal analysis of Landsat Thematic Mapper (TM) satellite data was used to test the significance of the guinea worm eradication program based on changes in agricultural production (21).


  1. https://www.fda.gov/food/retail-food-protection/fda-food-code
  2. https://www.fda.gov/food/fda-food-code/benefits-associated-complete-adoption-and-implementation-fda-food-code
  3. https://www.michigan.gov/-/media/Project/Websites/mdard/documents/food-dairy/laws/potentially_hazardous_food.pdf?rev=0bdac96e77454873bdb27d2ec87d22d0
  4. https://extension.psu.edu/the-grade-a-pasteurized-milk-ordinance
  5. https://www.fda.gov/media/114169/download
  6. https://www.publichealthdegrees.org/specializations/epidemiology/

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