October 2019 - The Epidemiology Monitor by The Epidemiology Monitor

Cause(s) Of Vaping Lung Injury Outbreak Still A Mystery Cases Considered A Public Health Crisis As Numbers Continue To Increase The outbreak of lung injury illness associated with the use of e-cigarettes or vaping products continues to increase each week and has reached 1,479 cases and 33 deaths as of midOctober, according to the Centers for Disease Control and Prevention (CDC). “I can’t stress enough the seriousness of these lung injuries associated with the use of e-cigarette or vaping products. This is a critical issue…We are not seeing a meaningful drop-off in new cases,” said CDC’s Anne Schuchat speaking at a recent press telebriefing and a Congressional hearing. In fact, cases increased by 20% in just one

week in early October. This increase is occurring despite all the publicity about the vaping associated outbreak. Latest patterns So far the outbreak has been widespread involving 49 states, the District of Columbia and the US Virgin Islands. Cases have also been widespread across age groups ranging from 13-75 years. The median age of cases is 24 years. - Vape con't on page 2

In This Issue -3Vaping Outbreak Investigation -5Remembering John Last -8Notes on People

Measles Epidemiology Shows Striking Contrast Congo Outbreak Kills 4,000 Children - None in 2019 US Outbreak “Measles has caused so much damage in my village…there were deaths in almost every house. Some families have lost two, three, or even four children.” That’s how one resident of Kasai Province in the Democratic Republic of the Congo (DRC) has described the impact of the ongoing measles October 2019

outbreak in the Congo, according to Doctors Without Borders. Measles virus in 2019 has provided a striking revelation of the difference between the current epidemiology of the disease in the US and a developing African country with different health systems and vaccination programs. - Measles cont'd on page 4 •

Volume Forty

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Number Ten

-10Near Term Epidemiology Event Calendar -11Marketplace

-Vape cont'd from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA.

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Among the patients with age and sex data, CDC reports that 70% are male and 79% are under age 35, including 15% who are under 18 years of age. In seeking to understand the products patients have been exposed to, CDC reports that among 849 patients with information on both nicotine and tetrahydrocannabinol (THC) use in the 3 months preceding symptom onset, 78% reported using the THC containing products with or without nicotine containing products, 58% used nicotine products with or without THC containing products, 31% reported exclusive use of THC containing products, and 10% reported exclusive use of nicotine-containing products. THC is the principal psychoactive component of cannabis.

presence of oils and other compounds. He added at the telebriefing that if FDA determines that someone is manufacturing or distributing illicit vaping products that cause illness or death for personal profit, FDA would consider that a criminal act. CDC’s Schuchat thinks there will be multiple causes and potentially more than one root cause. Clinical Aspects The vast majority of patients are reporting respiratory symptoms such as cough, chest pain or shortness of breath. A large proportion also have gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and diarrhea. Almost half of the patients needed a transfer to intensive care units and 22% needed to receive the assistance of a breathing machine.

Off the Street Actions to Take Of special concern to CDC are the THC containing products obtained off the street or from informal sources such as friends, family members, and illicit dealers. According to the Food and Drug Administration’s Mitch Zeller, “This is an extraordinarily complicated investigation. With a great diversity of products and intervening acts or actors that could be modifying these products along the way, especially for the great majority of the cases that involve THC and the

CDC now recommends against the use of e-cigarette or vaping products that contain THC or any type of product bought off the street. Individuals should not modify or add any substance to products not intended by the manufacturer. Since it is not possible to exclude a role for nicotine-containing products, CDC also recommends that people consider refraining from using ecigarette, or vaping, products that contain nicotine. ■

2020 Epidemiology Event Calendar We are currently gathering events for The Epidemiology Monitor's annual calendar issue that will be published in late December. To ensure that your event is included please submit it on our website at: http://epimonitor.net/Post-an-Event.htm

Vaping Outbreak Investigation Called “Extraordinarily Complex” - Here's Why “The country is facing a new public health crisis with these lung injuries,” CDC Principal Deputy Director Anne Schuchat told a Congressional committee in mid-October. Both the CDC and the FDA have warned of the “extraordinary complexity” of this investigation and “the identification of the cause or causes for the outbreak may take substantial time and continuing effort.” Based on recent CDC and FDA remarks, we compiled a list of some of the key challenges identified so far both in the field and the lab. Undoubtedly, there are still others. Utmost Complexity 1. Prevalence: There is currently an epidemic level of e-cigarette use by young people. Use increased an astonishing 78% from just 2017-2018. More than a quarter of high school students report e-cigarette use in the past 30 days. 2. Geography: the investigation spans almost all states and the US Virgin Islands. 2. Product diversity: There is a multitude of products, a wide array of ingredients, and the inclusion of other substances such as marijuana. 3. Limited product knowledge: People using these products do not know what is in the liquid solutions. 4. Chemical change: The substances within these products may change when aerosolized in the e-cigarette or other vaping device. .

5. Variety of devices: There is a large number of different vehicles for delivering the aerosols. Some ecigarettes are made to look like regular cigarettes, cigars, or pipes. Some resemble pens, USB sticks, and other everyday items. Larger devices such as tank systems, or “mods,” do not resemble other tobacco products

“Use increased an astonishing 78% from just 20172018."

6. Modifiability: Many of the products and substances can be modified by the distributor or the user. 7. Multiple sources or suppliers: Products can be obtained from stores, online retailers, on the street, or through social sources such as friends or family members. 8. Reliability: Information about the use of devices and products relies largely on self-report, and interviewees may be hesitant to share information about the use of marijuana or illicit drugs when applicable. 9. Consistency: State laws vary regarding THC and cannabis use so that it is difficult to collect consistent types of information from patients. 10. Interpretation: It is difficult to understand the results when there is a multitude of chemicals and a wide variety of products

“...interviewees may be hesitant to share information about the use of marijuana or illicit drugs when applicable."

12. Lab analyses: A large number of chemicals are involved in the product liquids or the additives which themselves are numerous. - Investigation cont'd on page 9

-Measles cont'd from page 1 Congo Outbreak

“...despite having a much higher mortality rate, the Ebola virus has caused only about half of the deaths associated with measles (~2,000)."

The outbreak declared in June in the DRC has evolved to become the world’s largest and fastest moving outbreak, according to the WHO regional office in Africa. To date the number of suspected cases has gone beyond 203,000 with more than 4,000 deaths, almost all of them children. The Congolese government and WHO have launched measles vaccination campaigns which are expected to reach over 800,000 children aged 9-59 months. A goal is to protect the children who were not vaccinated through the routine immunization program and therefore achieve the needed high levels of population immunity. The exacting toll in the Congo stems both from failure to vaccinate and from inability to adequately treat children affected by the disease. Barriers

“In 2019, closeknit Orthodox Jewish communities in New York accounted for 75% of all the cases."

Doctors Without Borders reports that several factors are responsible for the surge in cases in 2019. These factors include 1) low immunization coverage, 2) irregular supply or even stock-outs of vaccines, 3) a weakened surveillance system, 4) limited logistical means that undermine the cold chain needed for vaccines, 5) armed conflicts and displacement that paralyze the health system in some areas, and 6) financial or geographic barriers limiting or even preventing patients’ access to health facilities. Ebola Contrast

The measles situation is in striking contrast to the situation with Ebola also raging in DRC in 2018-19. It is the

second largest outbreak of the disease on record, and despite having a much higher mortality rate, the Ebola virus has caused only about half of the deaths associated with measles (~2,000). Better Approaches What is needed to battle vaccine preventable disease according to international aid organizations is more focus on giving resources that can create or improve overall health care infrastructure which in turn can provide decentralized capacity to provide care to all communities. US Outbreak The United States registered 1,249 measles cases in 22 separate outbreaks in 2019 which is the most cases reported in a single year since 1992, according to the Centers for Disease Control. The virus has been considered eliminated from the US since 2000 because the virus is no longer endemic. Source The outbreaks in 2019 stemmed mostly from travelers who acquired measles outside the United States and subsequently transmitted the infection to unvaccinated persons back in the US. The unusually large number of cases for the US were widespread in 17 states and generated considerable publicity throughout the year mostly centered on pockets of unvaccinated persons who refuse or neglect to have their children vaccinated for religious or philosophical reasons. In 2019, close-knit Orthodox Jewish communities in New York accounted for 75% of all the cases. State public health officials moved to strengthen the laws governing any exemptions from school vaccination - Measles cont'd on page 9

A Tribute

Remembering John Last With Humor And A Smile And Giving Him The “Last Word” We learned this month of the passing of John Last, a beloved colleague (see Notes on People, this issue). He is often credited with having developed the metaphor of “tip of the iceberg” in epidemiology. As defined in the Dictionary of Epidemiology he helped to create, the “iceberg phenomenon” is “that portion of disease which remains unrecorded or undetected despite physicians’ diagnostic endeavors and community disease surveillance procedures [and] is referred to as the ‘submerged portion of the iceberg’” Suggestion Letter The Epidemiology Monitor received a letter several years ago crediting John Last with an “invaluable contribution to the terminology of epidemiology” but complaining that the metaphor was awkward or inappropriate to use in tropical climates. The writer (Michel Thuriaux) challenged our readers to suggest an equivalent metaphor for “iceberg” less obviously limited to polar or subpolar climes. We obliged and ran a contest with a $100 prize for the best substitute metaphor that readers could suggest. Last Letter One of the submissions was from John Last himself who wrote to say that although he was the author of the paper called “The Iceberg”, he did not actually invent the term but credited it to former Lancet editor Robbie Fox. Nevertheless, his name is associated

with the metaphor and so we thought it would be appropriate to honor John this month by reprinting some of the entries in our metaphor contest from way back in 1993, including the favorites selected by the editors at the time. It was a fun contest that many readers enjoyed. Sample Entries Below is a sample of the entries.

“...the metaphor was awkward or inappropriate to use in tropical climates."

1. Dear Editor: I would like to suggest “fin of the shark” as an equivalent for the more commonly used metaphor “tip of the iceberg”. …It refers to the small portion of a dangerous entity that can be readily seen. This metaphor would be understood around the globe. --Kathleen Daly, 2. Dear Editor: Twenty years ago, Barker suggested a substitute for “tip of the iceberg” better suited for Africa, Indonesia, and all places that have zoos in the following paragraph. “For such reasons, (e.g., unreported and unrecognized cases) the extent of many epidemics is not clearly defined at first. Only the ears of the hippopotamus are visible but the bulk lies below the surface of the water!” (Barker DJP. Practical epidemiology. Edinburgh. Churchill Livingstone, p. 138. 1973. I think the prize should go to Barker. --George Comstock,

“...he did not actually invent the term..."

3. Dear Editor: I question the suggestion in your February issue that sharks would be more familiar than - Last cont'd on page 6

-Last cont'd from page 5

“I challenge your readers to identify a place on earth where you could find the Epi Monitor but not icecubes."

“The Broad Street pump handle could be considered the “tip of the iceberg” for the cholera epidemic in London..."

icebergs to residents in Switzerland, Burkina Faso, or Tibet. I also tend to believe that hippopotamuses keep their nostrils, rather than their ears, out of the water. I suggest “tip of the icecube”. The ratio of the tip to the whole is the same as the iceberg, and the part under the surface can be seen through most liquids, making the metaphor more didactic; it is also portable for easier use in the field, and I challenge your readers to identify a place on earth where you could find the Epi Monitor but not icecubes. --Bernard Moriniere

7. Dear Editor: An equivalent metaphor for “tip of the iceberg” not restricted to one part of the globe but found in every zoo is “the tail of the elephant” or “the camel’s hump”. It imparts the same idea, i.e., small parts of a larger body. --Michele Alexander

4. Dear Editor: Instead of “tip of the iceberg” I would like to suggest “the peak of the curve”. --Paul Etkind

8. Dear Editor: I would like to suggest “cover of the book” as a generic yet effective equivalent to the more colloquial metaphor “tip of the iceberg”. The cover of the book is the prelude (tip) to a greater story which lies ahead. This metaphor would be understood around the globe as most areas, including third world countries that I have traveled to are aware of what a book is and what it contains. --Patrick Scott Alban

5. Dear Editor: My suggestion is only the “first raindrops of the rainstorm”. I don’t think the shark fin has meaning to inhabitants inland, or the hippopotamus to non-Africans. --Andrew Brunskill

9. Dear Editor: In response to your announcement, I would suggest “front of the parade” for a global equivalent to “tip of the iceberg” used in an epidemiologic context. --Daniel Fife

6. Dear Editor: My suggestion for “tip of the iceberg” is “the handle on the pump” or “the pump handle”. The Broad Street pump handle could be considered the “tip of the iceberg” for the cholera epidemic in London as 1) if it hadn’t been there, the water could not have been consumed, or 2) its removal was one of the first of many instances of primary prevention. Further, the entire Broad street incident could be considered the “tip of the iceberg” of the science of epidemiology itself. Of course, reflecting on the contribution of John Snow, I’m not so sure the “tip of the iceberg” is totally inappropriate anyway. --Beverly J Volicer

10. Dear Editor: As a tropical alternative (Puerto Rican to be specific) to the “tip of the iceberg” I’ve been using for years the “Antillean phenomenon”. The Antilles, from Cuba to the Virgin Islands, are the visible tips of ancient mostly submerged volcanoes. Everybody knows that in these parts. --Jose G Rigau 11. Dear Editor: I would like to suggest “event horizon of a black hole” as a metaphor to replace “tip of the iceberg”. An event horizon of a black hole is the edge of the black hole before everything disappears into it. This metaphor is certainly not restricted to one part of the globe. - Last cont'd on page 7

-Last cont'd from page 6 Indeed, one might say that it has universal applicability! --Tim Rohan

of an iceberg. Unless you come from Greenland, of course. --Lars Ake Persson

12. Dear Editor: I have listed several metaphors that may be universally equivalent to “tip of the iceberg”. Each begins with an incomplete/deceptive description of something too great and complex to be one-dimensional:  Beauty of a woman  Eye of the hurricane  Calm before the storm  Rattle of a snake  Rash of syphilis  Cough of TB  Dance of a cobra  Title of a book  Campaign promises of a candidate  First aches of labor (in childbirth)  Brilliance of lightning  Goodness of God/Wrath of God  Happiness in a marriage

15. Dear Editor: My suggestion for an equivalent metaphor for “tip of the iceberg” would be “first zephyr of the typhoon” since this is both melliphorous and menacing. --Tony Boxwell

--Barbara W Harrell 13. Dear Editor: In reference to the “tip of the iceberg” question, I suggest avoiding clichés in general. When, in a specific context, one needs to convey the idea that what is unknown or unseen is much greater than what is known or seen, simply describe the situation. This should be “easier than falling off a log.” --J Mac Crawford 14. Dear Editor: Re: No Icebergs in the Tropics, there is a relevant metaphor already in use in Africa: the head of the hippo. Even if western epidemiologists haven’t got a hippo in the backyard, I think the appearance of this animal is more familiar than that

Editor’s Challenge: Readers are invited to remember or guess which new suggested metaphor was selected as the winner of the contest back in 1993. Send us your guess at editor@epimonitor.net. Whoever guesses right or remembers right will be recognized in a Letters to the Editor feature in a future issue.

“This should be 'easier than falling off a log.'"

Last With The Last Word It is worth pointing out that while John Last gave credit to a Lancet Editor for coming up with the term iceberg, he did however display some possessiveness about the metaphor and his sense of humor when in his same letter to The Epidemiology Monitor he added “It would be sad to discard the image of the iceberg. The concept is widely understood, even by dwellers in hot places with whom I’ve discussed it. The Saudis, after all, or was it the Kuwaitis, did consider towing icebergs from Antarctica to solve their water shortage problem.”

“...he did however display some possessiveness about the metaphor..."

We’ll remember that John! ■

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Notes on People Do you have news about yourself, a colleague, or a student? Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net Established: Allison Milner Early Career Research Fellowship by the University of Melbourne to honor the legacy of a former 36 year old social epidemiologist and the deputy head of the disability and health unit at the Centre for Health Equity at the University of Melbourne. Dr Millner died accidentally earlier this year when she was hit by a falling tree. The fellowship will allow a talented early career researcher to develop a program of research to reduce inequities, in line with Professor Milner's values and interests.

Died: John Last, age 92 on September 11 2019. He was professor of epidemiology and community medicine at the University of Ottawa beginning in 1969 and Emeritus Professor at the time of his death. He worked in multiple areas of public health and was perhaps best known in epidemiology for his work as the editor of the first four editions of The Dictionary of Epidemiology. He also edited four editions of Public Health and Preventive Medicine and a leader in the development of ethical standards for epidemiology and public health. We always found him to be a cheerful, knowledgeable, and interesting colleague to talk with over the years at multiple epidemiology conferences. Winner: Thomas Peterman, of the Epidemiology Monitor’s Ten Commandments contest last month. Peterman told the Monitor he works mostly on public health but tries to include some epidemiology whenever possible. Asked about his winning entry, Peterman said “The contest got me thinking about the essence of epidemiology—how epidemiologists hope to work, and what their values are. Plus, it was fun! Peterman generously donated his $500 prize to help support the mission of the Epidemiology Monitor.

Still Learning: Adrienne Lebailly, at the Epidemiology for Public Health class at Colorado State University. Dr Lebailly served as the Larimer County Public Health Director for 31 years and recently retired from that position. She is participating in the Life Long Learner program at Colorado State University free of charge for those over 55 years of age. She chose epidemiology as her first class after meeting the instructor and said “I figured that there were certainly new things to learn since I took my last epidemiology class in 1982.”

Notes on People, con't from page 8 Do you have news about yourself, a colleague, or a student? Please help The Epidemiology Monitor keep the community informed by sending relevant news to us at this address for inclusion in our next issue. people@epimonitor.net Spotlighted: Ross Brownson, by the Journal of Public Health Management and Practice. He is the Bernard Becker Professor of Public Health at both the George Warren Brown School of Social Work and the Alvin J. Siteman Cancer Center at Washington University School of Medicine in St. Louis. He has been a member of the journal’s editorial board since 2007. Brownson has had a long standing interest in achieving greater use of data for public health practice and policy. In a recent paper in the journal on Disseminating Public Health Science published last year he quoted Goethe “Knowing is not enough; we must apply. Willing is not enough; we must do.”

-Measles cont'd from page 4 requirements. Ten percent or 119 measles cases were hospitalized in the US and no deaths were reported to CDC. Characteristics The majority of outbreaks in the US were small and of limited duration because of high population level immunity and rapid outbreak control responses.

The New York oubreaks were larger and lasted longer because of the size of the pockets of susceptibles in the affected religious communities. Nevertheless, outbreak control measures were sufficient to halt the outbreaks before they had lasted 12 months and allowed the US to retain its status as a country where measles has been eliminated because the cases did not persist longer than one year. ■

-Investigation cont'd from page 3 13. Rapid collection and analysis: Public health data collection and reporting systems are antiquated and fragmented and often reliant on paper-based systems and fax machines and this works against the investigators learning what they need to know when they need to know it.

product or substance involved in all of the cases. Source in one part of the country may not be the same as in another. 15. Privacy protection: Safeguarding privacy when trying to collect data rapidly is challenging. ■

14. Cause(s): There may be more than one cause of the outbreak. There does not appear to be one

Near Term Epidemiology Event Calendar Every December The Epidemiology Monitor dedicates that issue to a calendar of events for the upcoming year. However that often means we don't have full information for events later in the year. Thus an online copy exists on our website that is updated regularly. This year we will print upcoming events in the Monitor monthly. To view the full year please go to: http://www.epimonitor.net/Events

November 2019 November 2-6 https://bit.ly/2B9Z8S3 Conference: APHA Annual Meeting & Expo / American Public Health Association / Philadelphia, PA November 20-23 https://bit.ly/2EiSQCC Conference: 12th European Public Health Conference / European Public Health Association / Marseilles, France November 27-29 https://bit.ly/2v4ps08 Conference: ESCAIDE 2019 / European Scientific Conference on Applied Infectious Disease Epidemiology / Stockholm, Sweden November TBA https://bit.ly/2ruDmE9 Short Course: Principles in Causal Inference / Erasmus MC / Rotterdam, The Netherlands November TBA https://bit.ly/2UDM5B4 Short Course: Clinical Epidemiology / Erasmus MC / Rotterdam, The Netherlands

December 2019 No events scheduled

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Post-Doctoral Fellow – Vaccine Safety & Effectiveness Research The Center for Vaccine Safety and Effectiveness Research at the Department of Research and Evaluation (R&E) of Kaiser Permanente Southern California (KPSC) is seeking a Post-Doctoral Research Fellow interested in studying vaccine safety and effectiveness. The KPSC Center for Vaccine Safety and Effectiveness Research conducts high-quality research involving large, diverse populations, providing timely evidence to decision-makers and the public. The Center is part of the Department of Research & Evaluation, based in Pasadena, California. The research team has expertise and experience in performing a vast array of vaccine research studies, ranging from epidemiologic studies of vaccine preventable diseases to Phase IV post-licensure observational studies. The research team works with partners from government, industry, academia, and other health care systems to conduct important research on topics such as vaccine safety and effectiveness, vaccines in special populations (e.g., pregnant women, immunocompromised individuals), vaccine uptake and compliance with recommendations, and methodologies for vaccine studies. Findings from the Center’s studies guide immunization policy and regulatory decisions and provide the public with information regarding risks and benefits of immunization. This position will provide mentored experience in field work, proposal development and scientific publication, designed to prepare the incumbent for a productive career as an independent researcher. Essential Responsibilities:  Designs, develops, and directs well-defined research with supervision from a R&E Research Scientist.  Prepares grant proposals and publications independently and collaboratively.  Provides consultation and direction to programmer/analysts with regard to data management and analysis strategies.  May perform subject assessments or chart reviews or provide direction to research support staff performing these tasks.  Submits abstracts to and presents papers at national scientific meetings.  Seeks consultation from research scientists for specific scientific and administrative issues.  Participates in R&E department meetings and projects as appropriate. Qualifications:  Doctoral degree (Ph.D., Dr.P.H., Sc.D.) in epidemiology or clinical doctoral degree (M.D.) plus master's degree with formal research training in epidemiology.  Research experience in vaccines or infectious diseases.  Publication in the peer-reviewed literature and grant-writing experience.  Competent in advanced research methods, including statistical techniques and study designs commonly used in epidemiologic research or related fields. KPSC is a leading managed health care organization with 4.6 million members of diverse race/ethnicity living throughout Southern California. They are attended by over 6,000 physicians practicing in an integrated, pre-paid delivery system that provides comprehensive health care and pharmaceutical benefits to members of the non-profit Kaiser Foundation Health Plan and Hospitals. KPSC has deployed an extensive clinical information system, including a fully automated medical record system. A description of R&E is available on the web (http://www.kp-scalresearch.org/). The Department is located in Pasadena, a community of 143,000 residents and the home of the California Institute of Technology, the Rose Bowl, the Jet Propulsion Lab, and other historical and cultural sites. Information about the community can be found online at www.visitpasadena.com. Pasadena is in the San Gabriel Valley 15 minutes north of downtown Los Angeles in sunny southern California. For more information or to apply for this position, please visit the Kaiser Permanente job website at http://www.kaiserpermanentejobs.org/jobs.aspx and search Job Number: 820334 in the keyword field. Please also email your CV with a cover letter to Research-Recruitment@kp.org KPSC is an Equal Opportunity/Affirmative Action Employer and offers competitive salary and comprehensive benefit packages.

Assistant Professor - Epidemiology Background: Baylor University is a private Christian university and a nationally ranked research institution that is consistently listed with highest honors among The Chronicle of Higher Education’s “Great Colleges to Work For.” Chartered in 1845, Baylor is the oldest continually operating university in Texas. The university provides a vibrant campus community for over 16,000 students from all 50 states and more than 80 countries by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Baylor is actively recruiting new faculty with a strong commitment to the classroom and an equally strong commitment to discovering new knowledge as we pursue our bold vision, Pro Futuris (www.baylor.edu/profuturis/) and academic strategic plan, Illuminate (https://www.baylor.edu/illuminate/). Our Department of Public Health (https://www.baylor.edu/publichealth/), accredited by the Council on Education for Public Health, is rapidly growing. We currently offer a Bachelor of Science in Public Health degree and a Master of Public Health degree with two concentrations: Community Health and Epidemiology. The successful applicant will join a strong core of public health faculty engaged in cross-disciplinary partnerships across campus and in local and global settings. We invite you to come discover the vision and excitement at Baylor as we seek to fill this position in the Robbins College of Health and Human Sciences (https://www.baylor.edu/chhs/). Qualifications and Responsibilities: An earned doctorate in epidemiology is required. Required research qualifications include 5 years of experience in leading an independent research program, a track record of obtaining NIH (or comparable) peer-reviewed funding, and at least 30 peer-reviewed publications. Required teaching qualifications include previous experience mentoring graduate students and/or junior faculty, and 5 years of experience developing/teaching public health and epidemiology courses. The successful candidate will assume responsibility for coordinating the MPH in Epidemiology concentration and demonstrate an ability to work in multidisciplinary research and teaching teams; develop and teach undergraduate and graduate public health/epidemiology courses in both on-campus and online settings; develop and submit funding proposals to support research training and infrastructure; build local and global public health partnerships; recruit, retain, and mentor a diverse student body; work collaboratively with epidemiology faculty, community health faculty, and Baylor leadership; engage in the programmatic work and activities of the Baylor Department of Public Health; and serve the university and public health profession. Applicants whose philosophy is compatible with the stated mission of the University to be a top-tier institution dedicated to Christian principles and ideals will be given consideration. This person must move to Waco, Texas, and be part of our residential faculty. Salary and Review Date: Salary is commensurate with professional experience and qualifications. The review of completed applications will commence on December 3, 2019 and continue until the position is filled. Date of Appointment: August 2020 Application: Applicants must submit an initial application packet that contains a formal letter of application (specifically address how you meet qualifications and fulfill responsibilities); a full curriculum vitae; an unofficial transcript of the doctoral degree; 2 sample research publications; 3 recommendation letters; and a list of three references (include names, titles, and contact information; references may be the same recommendation letter authors). All required materials must be submitted as PDF (portable document format) files at the following link: https://apply.interfolio.com/67132 A selected pool of candidates will then be asked to complete a brief questionnaire about one’s philosophy and compatibility with Baylor’s Christian mission (https://www.baylor.edu/about/index.php?id=88781) and send an official doctoral degree transcript. Information contact:

. Information contact: Dr. Eva Doyle, Search Committee Chair: Eva_Doyle@baylor.edu, 254-710-4023

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