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Applied Research, Surveillance and Rapid Responses—20-plus years of Public Health Successes for YSPH’s Emerging Infections Program

June 22, 2017

Back in 2003, the Centers for Disease Control and Prevention recommended only certain populations get annual flu vaccinations; healthy children under 5 were not among them.

But did that make sense? The CDC-fundedEmerging Infections Programs (EIP) decided to find out. During the winter of 2003-04, the 10 EIP sites, including the Connecticut EIP at the Yale School of Public Health, tracked flu hospitalizations of young children and discovered that nearly three quarters of those admitted to the hospital were otherwise healthy and were not in a group recommended to receive the vaccine. Four of the five children who ultimately died of the flu had not been immunized. Those findings led the Centers for Disease Control and Prevention to recommend the following year that young children receive annual flu vaccinations.

Yale School of Public Health Associate Professor Linda M. Niccolai, Ph.D., cited that case study at a June 9 colloquium on the state’s EIP to illustrate its impact and effectiveness. “It’s incredible to me that in such a short period of time, such a significant policy change could happen,” she said of the study.

Niccolai, involved with EIP since 2008, was the featured speaker at the event sponsored by the Yale Journal of Medicine and Biology. The Connecticut EIP is a collaboration between the School of Public Health and Connecticut Department of Public Health.

Emerging Infections Programs grew out of federal health officials’ concerns about recognizing new diseases and monitoring infections that were thought to be under control, Niccolai said. The programs, initiated in Connecticut and California 22 years ago and now in eight additional states, team local and state health officials with universities to collect and analyze data, do research and influence public policy and recommendations, where warranted, she explained.

In its first two-plus decades, Connecticut’s program has addressed SARS, West Nile virus, food-borne illnesses and many other infectious diseases, Niccolai said. In addition to flu vaccination, she highlighted the program’s work on Lyme disease and the HPV vaccine.

“They are great stories and historical examples of the work that EIPs do, surveillance, applied research and rapid response,” Niccolai said.

In the case of HPV, the most common sexually transmitted disease in the Untied States, EIP set out to determine if the vaccine introduced in 2006 has reduced rates of HPV-related cervical infections in Connecticut, Niccolai said. Analysis showed the rate falling precipitously for women under 26, strong evidence the vaccine is having real-world impact, she said.

At the same time, there was less of a decline in areas where high proportions of black, Hispanic and poor women live, indicating the need for further research and possible interventions, Niccolai said.

Regarding Lyme disease, Niccolai said that the program’s research using public health surveillance data and epidemiologic methods led the CDC to add bathing after possible exposure to illness-bearing ticks to its list of recommended preventive measures.

The program’s success embodied Niccolai’s larger message of always endeavoring to translate research and clinical findings into public policy.

“Whether we work at the bench or the bedside or in the community, we should all share at some level in the ultimate goal of informing policy,” she said.

To learn more about the Emerging Infections Program at the Yale School of Public Health, visit

Submitted by Denise Meyer on June 22, 2017