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Medicine Grand Rounds - Outbreaks in the Anthropocene: Public Health Relevant to New Hampshire Clinicians

Dr. Talbot defines many of the terms used when assessing a suspected or reported outbreak of illness, including the difference between a cluster, an outbreak and an epidemic. She discusses elements that define each occurrence, such as agents, reservoirs, cases and mode(s) of transmission that dictate how to manage the situation with patients and the public. To illustrate the investigative steps taken for an effective containment and resolution process, Dr. Talbot uses three examples of local outbreaks that required action in New Hampshire in 2018: Legionnaire’s Disease in Hampton Beach, cryptosporidiosis from a local farm and leptospirosis from the Puppies from Puerto Rico rescue project. She is concerned that climate change is having a real effect on the frequency of disease outbreaks around the world. As our climate changes, more natural disasters create more reservoirs for climate sensitive pathogens to thrive locally such as mosquito borne viruses, as well as those that cause global issues such as malaria and Zika.

Activity Details

Start Date: November 9, 2018
End Date: November 9, 2020

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  • Elizabeth A. Talbot, MD
    Associate Professor of Medicine
    Geisel School of Medicine at Dartmouth
    Medical Director, Dartmouth-Hitchcock International Health Clinic
    Co-Chair, Readiness and Response to Epidemic Infectious Disease Threats Subcommittee
    Dartmouth-Hitchcock Medical Center

    Dr. Elizabeth Talbot is an infectious diseases and tropical medicine trained internist, with a focus on mycobacterial infections, who has had extensive experience in international and domestic infectious disease control through outbreak investigation, clinical projects, research, and consultation. She is a graduate of the Robert Wood Johnson Medical School, completed her residency in internal medicine and fellowship in infectious disease at Duke University, and served as an Epidemic Intelligence Service Officer with the Centers for Disease Control. She was then stationed in Botswana with the CDC’s Division of TB Elimination and seconded to the World Health Organization before coming to Dartmouth. 

    Since 2003, she has been funded by a US Public Health Emergency Preparedness grant to serve as the Deputy State Epidemiologist for the New Hampshire Department of Health and Human Services. 

    Dr. Talbot’s global research activities are primarily in tuberculosis control through improved diagnostics, translational research toward TB prevention, and outbreak investigations. She was the Training Coordinator during the 2014 West African Ebola epidemic. Dr. Talbot has participated in the writing of state, national, and international disease control guidelines.
Learning Outcome

At the conclusion of this activity, participants will be able to summarize how to investigate suspected and reported outbreaks, assess the local risk of global emerging infectious diseases and analyze recent outbreak events for lessons relevant to local clinicians.


Dartmouth-Hitchcock is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Dartmouth-Hitchcock designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Requirements for Successful Completion

In order to receive credit for this Continuing Medical Education (CME) activity, you must:

  • View the entire presentation
  • Complete the online Attestation of Attendance & Evaluation Form (you must register to access).

In accordance with the disclosure policy of Dartmouth-Hitchcock/Geisel School of Medicine at Dartmouth as well as standards set forth by the Accreditation Council on Continuing Medical Education and the Nursing Continuing Education Council standards set forth by the American Nurses Credentialing Center Commission on Accreditation, continuing medical education and nursing education activity director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content have been asked to disclose any financial relationship* they have to a commercial interest (any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on patients). Such disclosure is not intended to suggest or condone bias in any presentation, but is elicited to provide participants with information that might be of potential importance to their evaluation of a given activity.

The following Activity Physician Director(s), planning committee member(s), speaker(s), author(s) or anyone in a position to control the content for Outbreaks in the Anthropocene: Public Health Relevant to New Hampshire Clinicians (Medicine Grand Rounds) have reported the following financial interest or relationship* with various companies/organizations. The Activity Director and Planning Committee member roles were resolved by altering the individual’s control over content about the products or services of the commercial interest by the Associate Dean for CME and the Department of Medicine Chair. The speaker role has been resolved by validating the activity content through independent peer review by the Activity Director. All potential conflict(s) were resolved.

* Kelly Kieffer, MD ~ her spouse is a consultant for OcculoBio. 

* Richard I. Rothstein, MD ~ has research support from Baranova (research grant to Dartmouth-Hitchcock Medical Center) and has other financial interest from Takeda. 

* Elizabeth A. Talbot, MD ~ is a consultant to Oxford Immunotec.

Other planning committee member(s), speaker(s), activity director(s), author(s) or anyone in a position to control the content for this program report no financial interest or relationship* with any company(ies) or organizations whose product may be germane to the content of their presentations.

*A “financial interest or relationship" refers to an equity position, receipt of royalties, consultantship, funding by a research grant, receiving honoraria for educational services elsewhere, or to any other relationship to a company that provides sufficient reason for disclosure, in keeping with the spirit of the stated policy.

Provider Contact Information

Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
Dartmouth-Hitchcock Medical Center

Type:     Internet Activity (Enduring Material)
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