As a doctor of veterinary medicine, Victoria Hall wouldn’t seem a natural fit for investigating human epidemics. However, it’s her background in agriculture and animal sciences that make her a valuable part of the Centers for Disease Control and Prevention.
The Mississippi State alumna is what’s known as a “disease detective” in the CDC’s Epidemic Intelligence Service. Chosen from a highly competitive pool of applicants that include physicians, scientists and skilled nurses from across the country, these young professionals chase down outbreaks and disease to sleuth out what is happening and how to keep the public safe.
“We rely on veterinarians in applied epidemiology because they are trained to assess the health of an individual as well as the health of the population,” explained Eric Pevzner, chief of the Epidemic Intelligence Service program. “These skills contribute to our multidisciplinary approach to addressing public health.”
The CDC uses a concept called “one health” to serve the public good. It is the idea that human, animal and environmental health are all closely related and that addressing emerging health problems requires collaborative efforts across these disciplines. Hall said she began to really embrace this idea during a semester studying wildlife management in Kenya.
“During that semester, it became very apparent you couldn’t ask people to care about elephants when the elephants were stomping on crops and causing families to go hungry,” Hall recalled. “I really became aware that if you helped people grow healthier animals and have safer food supplies you could really help grow a community and its capacity to do a lot of things. That was my first introduction to improving community health.”
A native of Cincinnati, Ohio, Hall came to Mississippi State as part of the College of Veterinary Medicine’s early entry program, which pre-admits students to its ranks in an effort to smooth their transition from undergraduate to medical degree. She completed a bachelor’s in animal and dairy sciences in 2011 and finished the vet program in 2014.
During that time, she also completed a number of international placements, including time with the Food and Agriculture Organization of the United Nations in Italy and Vietnam, a One Health summer school program in Uganda, a World Vets project in Nicaragua, and a summer aboard a Navy ship in the South Pacific—all of which inspired her to continue her studies at Mississippi State and complete a master’s in veterinary medical sciences in 2015.
“It was such a blessing to be in an environment like Mississippi State University that was so supportive of me pushing the limits of what a vet can do in the public-health world,” Hall explained.
“My time at Mississippi State sparked this desire to serve,” she continued. “It became about how to find the best information and the best science to put into the community and drive good policy, decisions and programs to help it succeed.”
Now in her final year of the two-year CDC training program, she is stationed with the Minnesota Department of Health. There she works with the state’s Unexplained Deaths and Critical Illness Program to investigate fatalities that have no clear cause.
“With emerging health threats, people are getting affected by disease before we even know it exists,” Hall explained. “Since death represents the most severe manifestation of disease, this system allows us to look into unexplained deaths to find rare illnesses or common illnesses that present uncommonly and identify growing threats.”
Basically, it’s Hall’s job to expect the unexpected. And it’s this way of thinking that helps her find the reason behind many of Minnesota’s unexplained deaths and how they might be interconnected—like those related to the habitual use of opioid-based painkillers such as morphine, hydrocodone or oxycodone.
Take the case of a middle-aged Minnesota man who died suddenly and at home. He regularly took prescription medication for back pain, and in the two days prior to his death had shown mild indications of feeling ill and began slurring his words. Testing from the medical examiner diagnosed influenza pneumonia and revealed a high level of opioids in his system.
In this instance, it was a common illness presenting uncommonly that raised the red flag for Hall and her colleagues. Pneumonia wouldn’t ordinarily be fatal to an otherwise healthy man in his 40s, but Hall said it’s likely his use of opioid painkillers made him more susceptible to the infection or allowed it to become more severe.
“With the number of opioids being prescribed quadrupling in the last decade, it makes for a very complex public health threat that we need to address from a lot of different angles.” ~ Victoria Hall
“By using this unexplained-deaths program we’ve been able to look at the opioid epidemic from the infectious disease standpoint,” Hall said. “We know opioids can impact the immune system and have side effects that make it easier for something like pneumonia to set in. What we’ve seen is that even prescribed levels of these drugs can be deadly if combined with infectious disease.
“We’ve seen a good number of cases with such profound infectious disease it was the only thing written on the death certificate,” Hall continued. “With no mention of the very high levels of morphine, these deaths don’t get counted in opioid-related death surveillance, which means the problem could be underestimated.”
Hall reports that more than half of the opioid-related fatalities identified through her work were not captured in the statewide opioid surveillance data. Because Minnesota is low on the list of severity when it comes to states facing an opioid crisis, it’s possible the problem is much greater nationwide.
“Ninety-one Americans die each day from an opioid overdose and in 2015, there were over 33,000 deaths related to opioids, more than any year on record,” Hall explained. “Opioids don’t discriminate against the young or the old, men or women, rural or urban. We find it in all areas.
“With the number of opioids being prescribed quadrupling in the last decade, it makes for a very complex public health threat that we need to address from a lot of different angles.”