This scenario presents a professionally challenging situation due to the inherent complexities of diagnosing and treating rare oncological conditions in companion animals, compounded by the ethical imperative to provide the best possible care within the bounds of available resources and scientific evidence. The veterinarian must navigate diagnostic uncertainty, potential treatment side effects, owner financial constraints, and the emotional distress of the animal’s guardian. Careful judgment is required to balance aggressive treatment with quality of life considerations and to ensure informed consent. The best professional approach involves a thorough diagnostic workup to establish a definitive diagnosis and staging, followed by a discussion with the owner about all available evidence-based treatment options, including their potential benefits, risks, costs, and impact on the animal’s quality of life. This approach prioritizes a client-centered, ethically sound decision-making process that is grounded in the latest scientific understanding of species-specific oncology. It ensures that the owner is fully informed and can make a decision aligned with their values and the animal’s best interests, adhering to the principles of veterinary professional responsibility and client communication. An incorrect approach would be to recommend a treatment based on anecdotal evidence or a single case report without a comprehensive diagnostic evaluation. This fails to establish a definitive diagnosis, potentially leading to inappropriate or ineffective treatment, and neglects the crucial step of staging the disease, which is vital for prognosis and treatment planning. Ethically, this approach breaches the duty of care by not pursuing the most accurate diagnostic pathway and by offering treatment without sufficient evidence of efficacy or safety for the specific condition. Another incorrect approach would be to focus solely on aggressive treatment protocols without adequately assessing or discussing the animal’s quality of life and the potential for treatment-related morbidity. This disregards the ethical obligation to consider the animal’s well-being and can lead to unnecessary suffering. It also fails to engage the owner in a holistic discussion about the goals of care, potentially leading to a disconnect between veterinary recommendations and owner expectations. Finally, an incorrect approach would be to defer treatment decisions entirely to the owner without providing sufficient expert guidance and evidence-based information. While client autonomy is important, veterinarians have a professional and ethical responsibility to guide owners through complex medical decisions by presenting all relevant information, including the scientific rationale for different therapeutic strategies and their likely outcomes. Failing to do so can result in the owner making a decision based on incomplete or inaccurate information, which may not be in the animal’s best interest. The professional reasoning framework for such situations should involve a systematic approach: 1) Gather comprehensive patient history and perform a thorough physical examination. 2) Initiate appropriate diagnostic tests to achieve a definitive diagnosis and staging. 3) Research and consult current literature and specialists regarding evidence-based treatment options for the specific species and condition. 4) Engage in open and honest communication with the owner, presenting all diagnostic findings, treatment options (including palliative care), potential outcomes, risks, benefits, and costs. 5) Collaboratively develop a treatment plan that aligns with the animal’s best interests, owner’s capabilities, and ethical considerations. 6) Continuously monitor the animal’s response to treatment and adjust the plan as needed, prioritizing quality of life.

The scenario presents a professional challenge rooted in the inherent tension between a veterinarian’s commitment to animal welfare and the financial realities faced by pet owners. The veterinarian must navigate the ethical imperative to provide the best possible care while also acknowledging the owner’s capacity to afford such care, especially when considering advanced, potentially experimental treatments. This requires a delicate balance of empathy, clear communication, and adherence to professional standards. The correct approach involves a comprehensive discussion with the owner about all available treatment options, including their potential benefits, risks, costs, and the likelihood of success. This discussion should explicitly address the purpose and eligibility criteria for advanced fellowship programs as a potential avenue for specialized, potentially more accessible, or research-driven treatment. The veterinarian must act as a trusted advisor, empowering the owner to make an informed decision that aligns with their financial situation and their pet’s prognosis. This aligns with the ethical principles of beneficence (acting in the animal’s best interest), non-maleficence (avoiding harm), and autonomy (respecting the owner’s decision-making capacity). Furthermore, transparency about the fellowship’s purpose – to advance knowledge and provide specialized care – is crucial. An incorrect approach would be to immediately dismiss the possibility of advanced treatment due to perceived financial limitations without a thorough discussion. This fails to uphold the principle of beneficence by potentially withholding beneficial options and undermines the owner’s autonomy by making a unilateral decision about their pet’s care. It also neglects the potential role of fellowship programs in offering alternative pathways for treatment. Another incorrect approach would be to proceed with advanced treatment without fully exploring the owner’s understanding of the costs and potential outcomes, or without ensuring their informed consent. This could lead to financial strain for the owner and potential distress if the treatment is unsuccessful or incurs unexpected expenses. It also fails to adequately consider the owner’s capacity to manage post-treatment care. Finally, an incorrect approach would be to solely focus on the most expensive or experimental options without considering more conservative, yet still effective, treatments that might be more financially feasible for the owner. This prioritizes a narrow definition of “best” care over a holistic approach that considers the owner’s circumstances and the overall well-being of the pet and family. Professional reasoning in such situations requires a structured approach: first, thoroughly assess the animal’s condition and prognosis. Second, engage in open and honest communication with the owner, exploring their understanding of the situation, their financial constraints, and their goals for their pet. Third, present all viable treatment options, including the purpose and eligibility for advanced fellowship programs, detailing benefits, risks, costs, and expected outcomes for each. Fourth, collaboratively develop a treatment plan that respects the owner’s decisions and financial capacity while prioritizing the animal’s welfare.

This scenario presents a significant ethical challenge due to the conflict between the owner’s wishes, the veterinarian’s professional judgment regarding the animal’s prognosis and quality of life, and the potential for financial strain on the owner. Navigating this requires a delicate balance of compassion, clear communication, and adherence to professional ethical standards. The best approach involves a comprehensive and empathetic discussion with the owner, focusing on shared decision-making informed by objective data and realistic expectations. This approach prioritizes the animal’s welfare by presenting all viable options, including palliative care and euthanasia, with a clear explanation of the potential benefits and burdens of each. It respects the owner’s autonomy by empowering them to make an informed decision, while also fulfilling the veterinarian’s ethical obligation to prevent suffering. This aligns with veterinary professional codes of conduct that emphasize client communication, animal welfare, and the humane termination of suffering when necessary. An approach that solely focuses on aggressive treatment without thoroughly discussing the animal’s prognosis and potential quality of life risks prolonging suffering and incurring significant financial burden for the owner, potentially against the animal’s best interests. This fails to uphold the veterinarian’s duty of care to consider the animal’s overall well-being and can lead to a breakdown in trust. An approach that immediately pushes for euthanasia without exploring all reasonable treatment options or fully understanding the owner’s perspective and capacity for care, even if the prognosis is guarded, can be perceived as dismissive of the owner’s bond with their pet and their desire to explore all avenues. While euthanasia is a valid option, it should be a considered decision, not an immediate default. An approach that prioritizes the owner’s financial concerns over the animal’s medical needs, by withholding potentially beneficial treatments due to cost without exploring alternatives or discussing the implications of foregoing treatment, is ethically problematic. While financial realities must be acknowledged, the primary focus must remain on the animal’s welfare. Professionals should approach such situations by first establishing a strong rapport with the client, actively listening to their concerns and understanding their values. They should then present a clear, objective assessment of the animal’s condition, including prognosis, potential treatment outcomes, and associated costs and burdens. This should be followed by a collaborative discussion of all available options, including palliative care and euthanasia, allowing the owner to ask questions and express their feelings. The veterinarian’s role is to guide the owner towards the most humane and welfare-focused decision for their pet, respecting their autonomy while upholding professional ethical obligations.

This scenario presents a professional challenge because it requires balancing the desire to support a colleague with the imperative to uphold the integrity and fairness of the examination process. The examination blueprint, scoring, and retake policies are critical components designed to ensure consistent standards and objective evaluation of candidates. Deviating from these established policies, even with good intentions, can undermine the credibility of the fellowship and potentially disadvantage other candidates. The best professional approach involves adhering strictly to the established examination blueprint, scoring rubric, and retake policies. This means that the candidate’s performance is evaluated solely based on the criteria outlined in the blueprint, and any request for special consideration outside of these policies must be formally reviewed and approved by the examination board according to established procedures. This approach ensures fairness and objectivity for all candidates, maintaining the integrity of the Advanced Pan-Asia Companion Animal Oncology Fellowship. It aligns with ethical principles of impartiality and transparency in assessment. An incorrect approach would be to unilaterally adjust the scoring or allow a retake based on a personal assessment of the candidate’s overall potential or perceived unfairness in the examination. This bypasses the established policies and introduces subjective bias, compromising the standardized nature of the evaluation. Such an action could be seen as a breach of professional ethics by creating an uneven playing field for other candidates and potentially devaluing the fellowship’s standards. Another incorrect approach would be to dismiss the candidate’s concerns without a thorough review of the examination process and scoring against the blueprint. While adherence to policy is crucial, ignoring a candidate’s genuine distress or perceived procedural error without investigation is unprofessional and can lead to accusations of unfairness or lack of due process. This fails to uphold the principle of providing a fair and transparent assessment process. Finally, an incorrect approach would be to share specific details of the candidate’s performance or the examination’s scoring with other faculty members without proper authorization. This violates candidate confidentiality and can lead to speculation or gossip, undermining the professional environment and the trust placed in the examination committee. Professionals should approach such situations by first understanding the established policies and procedures. If a candidate raises concerns, the professional response is to listen empathetically, explain the existing policies, and, if necessary, initiate the formal review process outlined by the examination board. Decision-making should be guided by principles of fairness, transparency, objectivity, and adherence to established regulations, ensuring that all candidates are treated equitably.

This scenario presents a professional challenge because it requires balancing the immediate need for specialized knowledge with the ethical imperative of ensuring adequate preparation and avoiding misrepresentation of expertise. The candidate is under pressure to demonstrate readiness for an advanced fellowship exit examination, but their current preparation level is uncertain. Careful judgment is required to navigate this situation ethically and professionally. The best approach involves honest self-assessment and proactive communication with the fellowship program. This entails acknowledging the perceived gaps in preparation and requesting a realistic timeline extension or additional resources. This approach is correct because it upholds academic integrity and demonstrates a commitment to achieving the required competency before undertaking the examination. It aligns with the ethical principles of honesty and responsibility in professional development, ensuring that the candidate is truly prepared to practice at the advanced level expected of a fellowship graduate. This proactive stance allows for a structured and supported path to readiness, rather than risking failure or inadequate performance due to insufficient preparation. An incorrect approach would be to proceed with the examination without addressing the perceived preparation gaps, hoping to “wing it” or rely on prior general knowledge. This is professionally unacceptable as it risks failing the examination, which could have implications for future career opportunities. More importantly, it demonstrates a lack of commitment to the rigorous standards of the fellowship and a disregard for the ethical obligation to be fully competent before seeking advanced certification. Another incorrect approach would be to seek unauthorized assistance or to misrepresent the extent of preparation to program faculty. This is a serious ethical breach, undermining the integrity of the examination process and the fellowship program itself. It constitutes academic dishonesty and can lead to severe disciplinary action, including disqualification from the program and damage to professional reputation. A further incorrect approach would be to withdraw from the examination without clear communication or a plan for future preparation. While withdrawal might seem like a way to avoid immediate failure, it lacks the proactive and responsible engagement expected of a fellow. It fails to address the underlying preparation issues and does not demonstrate a commitment to overcoming challenges and achieving the fellowship’s objectives. The professional reasoning process for similar situations should involve a candid self-assessment of knowledge and skills against the examination’s requirements. If deficiencies are identified, the next step is to communicate these concerns transparently with the fellowship director or relevant faculty. This should be followed by a collaborative discussion to develop a realistic plan, which may include a revised study schedule, access to specific resources, or a request for a deferred examination date. This process emphasizes honesty, responsibility, and a commitment to achieving genuine competence.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in diagnostic presentations and treatment responses across different companion animal species. A veterinarian must navigate this complexity while adhering to ethical standards of care and ensuring client communication is clear and informed. The pressure to provide a definitive diagnosis and treatment plan quickly, without compromising thoroughness, requires careful judgment. Correct Approach Analysis: The best professional practice involves a systematic approach that acknowledges and leverages comparative species knowledge. This means carefully reviewing the patient’s history, performing a thorough physical examination, and then formulating a differential diagnosis list that considers species-specific predispositions, common presentations, and typical pathological processes. Diagnostic imaging, laboratory tests, and biopsies should be selected based on their utility in differentiating these species-specific differentials. Treatment plans must then be tailored to the individual patient and the diagnosed condition, taking into account species-specific pharmacokinetics, pharmacodynamics, and potential toxicities. This approach ensures that diagnostic and therapeutic decisions are grounded in the best available scientific understanding for each species, thereby maximizing the likelihood of a positive outcome and fulfilling the veterinarian’s duty of care. Incorrect Approaches Analysis: One incorrect approach involves immediately defaulting to a treatment protocol commonly used in the most frequently encountered species (e.g., dogs) without a thorough species-specific differential diagnosis. This fails to account for significant physiological and pathological differences that can lead to misdiagnosis, ineffective treatment, or adverse drug reactions in other species. It represents a failure to apply appropriate comparative knowledge and can be considered a breach of the standard of care. Another incorrect approach is to rely solely on broad-spectrum treatments without attempting to identify the specific underlying pathology. While some broad-spectrum agents may offer temporary relief, they do not address the root cause and can mask developing issues or contribute to antimicrobial resistance. This approach neglects the ethical imperative to provide accurate diagnoses and targeted therapies. A further incorrect approach is to dismiss the possibility of a specific condition in a less common species simply because it is rare. While rarity should be noted, it should not preclude consideration if the clinical signs are suggestive. This can lead to delayed or missed diagnoses, significantly impacting patient prognosis and client trust. Professional Reasoning: Professionals should employ a structured diagnostic and therapeutic decision-making process. This begins with a comprehensive patient assessment, followed by the generation of a differential diagnosis list informed by comparative species knowledge. Diagnostic tests should be chosen strategically to narrow down differentials. Treatment plans must be individualized, considering species-specific factors and potential risks. Continuous learning and consultation with specialists are crucial for managing complex or unusual cases.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate needs of individual companion animals with the broader implications for population health and the responsible use of veterinary resources. The veterinarian must navigate potential conflicts between owner expectations, economic realities, and the ethical imperative to promote disease prevention and control within the broader community of companion animals. Effective biosecurity protocols are not merely technical procedures but are deeply intertwined with client education, trust, and the veterinarian’s role as a public health advocate. Correct Approach Analysis: The best professional practice involves a comprehensive, multi-faceted approach to preventive medicine, herd health, and biosecurity that is tailored to the specific risks and context of the practice. This includes implementing robust internal biosecurity measures within the clinic, such as strict disinfection protocols, isolation of sick animals, and staff training on hygiene. Externally, it necessitates proactive client education on responsible pet ownership, vaccination schedules, parasite control, and the importance of reporting potential infectious disease signs. Furthermore, it involves engaging with local animal welfare organizations and shelters to promote standardized health assessments and vaccination protocols for incoming animals, thereby creating a network of disease prevention. This approach aligns with the ethical principles of beneficence (acting in the best interest of animal health) and non-maleficence (preventing harm), as well as the professional responsibility to contribute to public health by mitigating the spread of zoonotic and animal-specific diseases. It also reflects a commitment to evidence-based practice by prioritizing interventions with proven efficacy in disease prevention and control. Incorrect Approaches Analysis: One incorrect approach focuses solely on reactive treatment of sick animals without a strong emphasis on proactive prevention or broader biosecurity measures. This fails to address the root causes of disease spread and neglects the veterinarian’s role in preventing outbreaks. Ethically, this approach can be seen as a failure of beneficence by not actively working to prevent illness in the first place. It also falls short of professional responsibility to safeguard animal populations. Another incorrect approach prioritizes client convenience and economic considerations above all else, potentially leading to the relaxation of strict biosecurity protocols or the downplaying of essential preventive measures like vaccination or parasite control. This can create a false sense of security and increase the risk of disease transmission within the clinic and the wider community. This approach risks violating the principle of non-maleficence by exposing animals to unnecessary risks due to compromised biosecurity. A third incorrect approach involves implementing a rigid, one-size-fits-all biosecurity protocol that does not account for the varying risks associated with different animal populations (e.g., shelter animals versus privately owned pets) or the specific epidemiological context of the region. This can lead to either over-application of resources for low-risk situations or insufficient protection for high-risk scenarios, ultimately undermining the effectiveness of the overall preventive medicine strategy. This approach lacks the nuanced, risk-based decision-making essential for effective public health interventions. Professional Reasoning: Professionals should adopt a risk-based, proactive, and collaborative approach. This involves continuously assessing potential disease threats, implementing evidence-based preventive strategies, and fostering strong communication channels with clients, colleagues, and relevant organizations. Decision-making should be guided by ethical principles, regulatory requirements, and a commitment to the highest standards of animal welfare and public health. Regular review and adaptation of protocols based on emerging scientific knowledge and local epidemiological data are crucial.

This scenario presents a professionally challenging situation due to the inherent unpredictability of emergency oncology cases in companion animals. The veterinarian must balance immediate life-saving interventions with the long-term prognosis and the owner’s capacity to consent and afford treatment, all within the ethical framework governing veterinary practice. Careful judgment is required to prioritize patient welfare while respecting client autonomy and resource limitations. The best professional approach involves a rapid, multi-modal assessment to stabilize the patient and gather critical diagnostic information, followed by a transparent and empathetic discussion with the owner regarding prognosis and treatment options. This approach prioritizes immediate patient needs by addressing the acute crisis, such as severe pain or respiratory distress, through appropriate medical or surgical stabilization. Concurrently, it upholds ethical obligations by ensuring informed consent through clear communication about the diagnostic findings, potential outcomes, associated risks, and financial implications of further interventions. This aligns with the principles of beneficence (acting in the best interest of the animal) and non-maleficence (avoiding harm), while respecting client autonomy. An incorrect approach would be to proceed with extensive surgical intervention without first stabilizing the patient or thoroughly discussing the prognosis and financial realities with the owner. This could lead to unnecessary suffering for the animal if the underlying condition is untreatable or if the owner cannot afford post-operative care, potentially violating the principle of non-maleficence and failing to respect client autonomy. Another incorrect approach would be to recommend euthanasia solely based on the initial presentation without attempting stabilization or providing the owner with a comprehensive understanding of potential treatment pathways and their likelihood of success. This prematurely dismisses the possibility of improving the animal’s quality of life and fails to adequately explore all reasonable options, potentially contravening the veterinarian’s duty to provide care within the bounds of professional judgment and client agreement. A further incorrect approach would be to delay critical interventions while awaiting definitive diagnostic results that may not significantly alter the immediate management plan for an unstable patient. While diagnostics are crucial, in an emergency, stabilization often takes precedence to allow for a more accurate assessment and to prevent irreversible deterioration. Professionals should employ a structured decision-making process that begins with a rapid assessment of the patient’s vital signs and immediate threats. This is followed by a tiered approach to diagnostics, prioritizing those that will most impact immediate management. Throughout this process, open and honest communication with the owner is paramount, ensuring they are informed participants in the decision-making, understanding the risks, benefits, and costs associated with each potential course of action. Ethical guidelines and professional standards of care should always guide the veterinarian’s recommendations and actions.

Scenario Analysis: This scenario presents a common challenge in companion animal oncology: interpreting complex diagnostic data to formulate an effective treatment plan. The professional challenge lies in synthesizing information from multiple sources – imaging, laboratory results, and potentially histopathology – to arrive at a diagnosis and prognosis that is both accurate and ethically sound, considering the owner’s wishes and the animal’s welfare. Misinterpretation can lead to inappropriate treatment, delayed diagnosis, financial strain on the owner, and compromised animal welfare, all of which carry significant ethical and professional implications. The need for a systematic and evidence-based approach is paramount. Correct Approach Analysis: The best professional approach involves a comprehensive review of all available diagnostic data, integrating findings from imaging (CT, MRI, ultrasound), laboratory tests (hematology, biochemistry, urinalysis, specific tumor markers if applicable), and any available histopathological or cytological reports. This integrated interpretation allows for a more definitive diagnosis, staging of the disease, and prediction of prognosis. This approach is correct because it adheres to the principles of evidence-based veterinary medicine, ensuring that treatment decisions are informed by the most complete and accurate picture of the patient’s condition. Ethically, it prioritizes the animal’s welfare by seeking the most precise diagnosis to guide appropriate and potentially curative or palliative care, while also providing the owner with the most accurate information for informed consent regarding treatment options and prognosis. This aligns with professional standards of care that mandate thoroughness and diligence in diagnostic workups. Incorrect Approaches Analysis: Relying solely on imaging findings without correlating them with laboratory results or histopathology is professionally unacceptable. This approach risks misdiagnosis, as imaging can be suggestive but not definitive for many conditions. For example, a mass seen on imaging could be benign or malignant, inflammatory or neoplastic, and laboratory values or a biopsy are often required for differentiation. This failure to integrate all available data can lead to inappropriate treatment, potentially causing harm or unnecessary expense. Prioritizing laboratory results over imaging and histopathology is also professionally flawed. While laboratory tests provide crucial information about systemic health and can indicate the presence of inflammation or organ dysfunction, they rarely provide a definitive diagnosis of a specific tumor type or its extent. Imaging and histopathology are typically essential for localizing and characterizing neoplastic lesions. This approach risks overlooking critical information about the tumor’s size, location, and potential for metastasis. Making a presumptive diagnosis based on a single, striking imaging finding without further investigation or correlation with other data is a significant ethical and professional failing. This can lead to a superficial understanding of the disease process, potentially missing concurrent conditions or underestimating the severity of the primary issue. It bypasses the rigorous diagnostic process expected of a veterinary oncologist and can result in a suboptimal or even harmful treatment plan. Professional Reasoning: Professionals should adopt a systematic diagnostic workflow. This begins with a thorough history and physical examination, followed by the judicious selection of diagnostic modalities. When interpreting results, a holistic approach is crucial, integrating findings from all tests. This involves cross-referencing imaging findings with laboratory values and histopathology to build a comprehensive understanding of the disease. If there are discrepancies or uncertainties, further diagnostic steps should be considered. Open communication with the owner about the diagnostic process, findings, and potential implications for treatment and prognosis is essential for informed consent and shared decision-making. This process ensures that decisions are evidence-based, ethically sound, and prioritize the animal’s well-being.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of managing a potential zoonotic disease outbreak in companion animals that has public health implications. The veterinarian must balance the immediate needs of the animal patient with the broader responsibility to protect human health and adhere to public health reporting mandates. Failure to act appropriately can lead to the spread of disease, public panic, and regulatory penalties. The challenge lies in navigating the intersection of veterinary medicine, public health policy, and inter-agency communication. Correct Approach Analysis: The best professional practice involves immediate notification of the relevant public health authorities, specifically the local or regional public health department, and the designated veterinary public health agency. This approach is correct because it directly addresses the core public health interface of zoonoses. Regulatory frameworks in most jurisdictions mandate reporting of suspected or confirmed zoonotic diseases to prevent their spread. This proactive communication allows public health officials to initiate epidemiological investigations, implement control measures, and inform the public, thereby fulfilling the veterinarian’s ethical and legal obligations. Prompt reporting is crucial for timely intervention and minimizing public health risk. Incorrect Approaches Analysis: One incorrect approach is to solely focus on treating the animal without informing public health authorities, assuming the risk to humans is minimal or that the owner will manage it. This fails to acknowledge the veterinarian’s role in public health surveillance and the potential for asymptomatic shedding or rapid transmission of zoonotic agents. It bypasses critical regulatory reporting requirements and leaves the public vulnerable. Another incorrect approach is to only inform the owner about the potential zoonotic risk and advise them to seek human medical attention if they develop symptoms. While owner education is important, it is insufficient on its own. This approach abdicates the veterinarian’s responsibility to report to the authorities, which is a legal and ethical imperative for managing public health threats. The owner may not fully grasp the severity or may not seek medical attention, allowing the disease to spread undetected. A third incorrect approach is to delay reporting until a definitive diagnosis is confirmed, especially if diagnostic tests are time-consuming or unavailable. While diagnostic certainty is ideal, public health reporting often requires notification of *suspected* zoonotic diseases based on clinical signs and epidemiological context. Delaying notification based on diagnostic uncertainty can allow a dangerous pathogen to spread widely before any public health intervention can occur, undermining the purpose of surveillance and control programs. Professional Reasoning: Professionals facing such situations should employ a risk-based decision-making process. This involves: 1. Identifying potential zoonotic agents based on clinical presentation, species, and epidemiological history. 2. Consulting relevant national and local public health guidelines and reporting requirements for suspected zoonotic diseases. 3. Prioritizing immediate notification of public health authorities when a significant zoonotic risk is identified, even in the absence of definitive laboratory confirmation. 4. Simultaneously providing appropriate veterinary care and client education regarding potential risks and precautions. 5. Cooperating fully with public health investigations and control measures.