Biosecur Bioterror
· 2014 · PMID 25254910
·
Full text
The biosurveillance capabilities needed to rapidly detect and characterize emerging biological threats are an essential part of the Global Health Security Agenda (GHSA). The analyses of the global public health system's...The biosurveillance capabilities needed to rapidly detect and characterize emerging biological threats are an essential part of the Global Health Security Agenda (GHSA). The analyses of the global public health system's functioning during the 2009 H1N1 pandemic suggest that while capacities such as those identified in the GHSA are essential building blocks, the global biosurveillance system must possess 3 critical capabilities: (1) the ability to detect outbreaks and determine whether they are of significant global concern, (2) the ability to describe the epidemiologic characteristics of the pathogen responsible, and (3) the ability to track the pathogen's spread through national populations and around the world and to measure the impact of control strategies. The GHSA capacities-laboratory and diagnostic capacity, reporting networks, and so on-were essential in 2009 and surely will be in future events. But the 2009 H1N1 experience reminds us that it is not just detection but epidemiologic characterization that is necessary. Similarly, real-time biosurveillance systems are important, but as the 2009 H1N1 experience shows, they may contain inaccurate information about epidemiologic risks. Rather, the ability of scientists in Mexico, the United States, and other countries to make sense of the emerging laboratory and epidemiologic information that was critical-an example of global social capital-enabled an effective global response. Thus, to ensure that it is meeting its goals, the GHSA must track capabilities as well as capacities.
Gronvall G, Boddie C, Knutsson R
… +1 more, Colby M
Biosecur Bioterror
· 2014 · PMID 25254909
·
Full text
The objectives of the Global Health Security Agenda (GHSA) will require not only a "One Health" approach to counter natural disease threats against humans, animals, and the environment, but also a security focus to count...The objectives of the Global Health Security Agenda (GHSA) will require not only a "One Health" approach to counter natural disease threats against humans, animals, and the environment, but also a security focus to counter deliberate threats to human, animal, and agricultural health and to nations' economies. We have termed this merged approach "One Health Security." It will require the integration of professionals with expertise in security, law enforcement, and intelligence to join the veterinary, agricultural, environmental, and human health experts essential to One Health and the GHSA. Working across such different professions, which occasionally have conflicting aims and different professional cultures, poses multiple challenges, but a multidisciplinary and multisectoral approach is necessary to prevent disease threats; detect them as early as possible (when responses are likely to be most effective); and, in the case of deliberate threats, find who may be responsible. This article describes 2 project areas that exemplify One Health Security that were presented at a workshop in January 2014: the US government and private industry efforts to reduce vulnerabilities to foreign animal diseases, especially foot-and-mouth disease; and AniBioThreat, an EU project to counter deliberate threats to agriculture by raising awareness and implementing prevention and response policies and practices.
Biosecur Bioterror
· 2014 · PMID 25014894
·
Full text
Children represent nearly a quarter of the US population, but their unique needs in chemical, biological, radiological, and nuclear (CBRN) emergencies may not be well understood by public health and emergency management...Children represent nearly a quarter of the US population, but their unique needs in chemical, biological, radiological, and nuclear (CBRN) emergencies may not be well understood by public health and emergency management personnel or even clinicians. Children are different from adults physically, developmentally, and socially. These characteristics have implications for providing care in CBRN disasters, making resulting illness in children challenging to prevent, identify, and treat. This article discusses these distinct physical, developmental, and social traits and characteristics of children in the context of the science behind exposure to, health effects from, and treatment for the threat agents potentially present in CBRN incidents.
The Centers for Disease Control and Prevention recommends using open points of dispensing (PODs) and alternative modalities, such as closed PODs, for mass dispensing of medical countermeasures. However, closed POD existe...The Centers for Disease Control and Prevention recommends using open points of dispensing (PODs) and alternative modalities, such as closed PODs, for mass dispensing of medical countermeasures. However, closed POD existence has not been assessed. In 2013 we sent an online questionnaire to US Cities Readiness Initiative (CRI) and non-CRI public health disaster planners. Chi-square tests were used to determine differences between CRIs and non-CRIs when comparing having at least 1 closed POD, and to compare having a closed POD and perceived mass dispensing preparedness. A total of 301 disaster planners participated. Almost all (89.3%, n=218) jurisdictions have considered establishing a closed POD, and three-quarters (74.2%, n=181) currently have at least one. CRIs were more likely than non-CRIs to have a closed POD (85.0% vs 58.5%, X(2)=21.3, p<.001). Those with 1 or more closed PODs were more likely to believe their jurisdiction could distribute medical countermeasures within 48 hours compared to those without a closed POD (78.5% vs 21.5%; X(2)=10.8, p=.001). Half had a written plan and/or written standing orders (59.1% and 52.5%, respectively). Almost half (42%, n=72) have done no preevent training for POD staff in the past 2 years; almost 20% (18%, n=32) do not plan to offer any just-in-time training. Nearly 40% (n=70) have conducted no exercises in the past year. Closed PODs contribute to community preparedness; their establishment should be followed by development of written plans, worker training, and exercises.
In 2011, an EF5 tornado hit Joplin, MO, requiring complete evacuation of 1 hospital and a patient surge to another. We sought to assess the resilience of healthcare workers in these hospitals as measured by number report...In 2011, an EF5 tornado hit Joplin, MO, requiring complete evacuation of 1 hospital and a patient surge to another. We sought to assess the resilience of healthcare workers in these hospitals as measured by number reporting to work, willingness to work, personal disaster preparedness, and childcare responsibilities following the disaster. In May 2013, a survey was distributed to healthcare workers at both Joplin hospitals that asked them to report their willingness to work and personal disaster preparedness following various disaster scenarios. For those with childcare responsibilities, scheduling, costs, and impact of hypothetical alternative childcare programs were considered in the analyses. A total of 1,234 healthcare workers completed the survey (response rate: 23.4%). Most (87.8%) worked the week following the Joplin tornado. Healthcare workers report more willingness to work during a future earthquake or tornado compared to their pre-Joplin tornado attitudes (86.2 vs 88.4%, t=-4.3, p<.001; 88.4 vs 90%, t=-3.1, p<.01, respectively), with no change during other scenarios. They expressed significantly higher post-tornado personal disaster preparedness, but only preevent preparedness was a significant predictor of postevent preparedness. Nearly half (48.5%, n=598) had childcare responsibilities; 61% (n=366) had childcare needs the week of the tornado, and 54% (n=198) required the use of alternative childcare. If their hospital had provided alternative childcare, 51% would have used it and 42% felt they would have been more willing to report to work. Most healthcare workers reported to work following this disaster, demonstrating true resilience. Disaster planners should be aware of these perceptions as they formulate their own emergency operation plans.
Biosecur Bioterror
· 2014 · PMID 24988432
·
Full text
Previous articles in this series have provided funding information for federal civilian biodefense programs and programs focused on radiological and nuclear preparedness and consequence management. This year the authors...Previous articles in this series have provided funding information for federal civilian biodefense programs and programs focused on radiological and nuclear preparedness and consequence management. This year the authors have expanded the focus of the analysis to US federal funding for health security. This article provides proposed funding amounts for FY2015, estimated amounts for FY2014, and actual amounts for FY2010 through FY2013 in 5 domains critical to health security: biodefense programs, radiological and nuclear programs, chemical programs, pandemic influenza and emerging infectious disease programs, and multiple-hazard and preparedness programs.
This study presents data showing the performance of 6 commercial detection assays against ricin around concentrations specified as detection limits by the producers. A 2-fold dilution series of 20 ng/ml ricin was prepare...This study presents data showing the performance of 6 commercial detection assays against ricin around concentrations specified as detection limits by the producers. A 2-fold dilution series of 20 ng/ml ricin was prepared and used for testing the lateral-flow kits: BADD, Pro Strips™, ENVI, RAID DX, Ricin BioThreat Alert, and IMASS™ device. Three of the 6 tested field assays (IMASS™ device, ENVI assay, and the BioThreat Alert assay) were able to detect ricin, although differences in the measured detection limits compared to the official detection limits and false-negative results were observed. We were not able to get the BADD, Pro Strips™, and RAID assays to function in our laboratory. We conclude that when purchasing a field responder assay, there is large variation in the specificity of the assays, and a number of in-house tests must be performed to ensure functionality.
Biosecur Bioterror
· 2014 · PMID 24963648
·
Full text
According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among l...According to the Institute of Medicine, the local health department workforce is at the hub of the public health emergency preparedness system. A growing body of research has pointed to troubling attitudinal gaps among local health department workers, a vital response cohort, regarding willingness to respond to emergent infectious disease threats, ranging from naturally occurring pandemics to bioterrorism events. A summary of relevant literature on the empirical evidence, ethical norms, and legal standards applicable to the willingness of public health professionals to respond to an infectious disease emergency is presented. Recommendations are proposed for future work to be done to bring the relevant empirical, ethical, and legal considerations together to develop practical guidance for the local response to infectious disease emergencies.
Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to...Using a simulated anthrax scenario, the Philadelphia Department of Public Health tested the readiness of a nonmedical closed point-of-dispensing (POD) site to see how rapidly and accurately it could provide medication to its internal population. This closed POD had developed and exercised its mass prophylaxis plan in conjunction with the local health department twice before, and the department was interested in assessing the impact of having no onsite department involvement. Two sessions were conducted as part of the overall exercise. In session 1, agency staff ran POD operations with no department involvement. During session 2, department staff provided an hour-long training session and oversaw POD operations. Mean throughput and accuracy rates of the 2 sessions were then compared to a previous health department public POD exercise staffed by department personnel and medical volunteers. The closed POD would be able to process the entire internal population in an estimated mean time of 23.9 hours. The accuracy rates for dispensing the correct medication during session 1 was 84.7% and 92.4% during session 2 (p=0.0012). Overall accuracy was significantly higher in a previous local health department public POD exercise (88.6% vs. 96.9%, p < 0.0001), as was pediatric dosing accuracy (p < 0.0001). We concluded that nonmedical closed PODs are a valuable strategy during a public health emergency that requires large segments of a population to receive medication rapidly. They must be activated judiciously, however, as their use may increase adverse events and potentially result in discontinuation of antibiotic prophylaxis should people choose not to finish the course. Local health department training and oversight reduce errors but may not always be available.
Health departments use after-action reports to collect data on their experience in responding to actual public health emergencies. To address deficiencies in the use of such reports revealed in the 2009 H1N1 influenza pa...Health departments use after-action reports to collect data on their experience in responding to actual public health emergencies. To address deficiencies in the use of such reports revealed in the 2009 H1N1 influenza pandemic and to develop an effective approach to learning from actual public health emergencies, we sought to understand how the concept and operations of a "critical incident registry," commonly used in other industries, could be adapted for public health emergency preparedness. We conducted a workshop with public health researchers and practitioners, reviewed the literature on learning from rare events, and sought to identify the optimal characteristics of a critical incident registry (CIR) for public health emergency preparedness. Several key critical characteristics are needed for a CIR to be feasible and useful. A registry should: (1) include incidents in the response in which public health agencies played a substantial role, are "meaningful," test one or more emergency preparedness capabilities, and are sufficiently limited in scope to isolate specific response issues; (2) be supported by a framework and standard protocols for including reports based on rigorous analysis of individual incidents and methods for cross-case analysis; and (3) include explicit incentives for reporting, to overcome intrinsic disincentives. With proper incentives in place, a critical incident registry can be a useful tool for improving public health emergency preparedness. Standard protocols for reporting critical events and probing analysis are needed to enable identification of patterns of successes and failures.
The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remai...The importance of health security in the United States has been highlighted by recent emergencies such as the H1N1 influenza pandemic, Superstorm Sandy, and the Boston Marathon bombing. The nation's health security remains a high priority today, with federal, state, territorial, tribal, and local governments, as well as nongovernment organizations and the private sector, engaging in activities that prevent, protect, mitigate, respond to, and recover from health threats. The Association of State and Territorial Health Officials (ASTHO), through a cooperative agreement with the Centers for Disease Control and Prevention (CDC) Office of Public Health Preparedness and Response (OPHPR), led an effort to create an annual measure of health security preparedness at the national level. The collaborative released the National Health Security Preparedness Index (NHSPI(™)) in December 2013 and provided composite results for the 50 states and for the nation as a whole. The Index results represent current levels of health security preparedness in a consistent format and provide actionable information to drive decision making for continuous improvement of the nation's health security. The overall 2013 National Index result was 7.2 on the reported base-10 scale, with areas of greater strength in the domains of health surveillance, incident and information management, and countermeasure management. The strength of the Index relies on the interdependencies of the many elements in health security preparedness, making the sum greater than its parts. Moving forward, additional health security-related disciplines and measures will be included alongside continued validation efforts.
Gilman JK, Wright M, Clifford Lane H
… +1 more, Schoomaker EB
Biosecur Bioterror
· 2014 · PMID 24819736
·
Full text
The terrorist attacks of September 11 and the anthrax mailings a month later prompted a sweeping response by the federal government to improve the preparedness of the US to meet the potential threat posed by a terrorist...The terrorist attacks of September 11 and the anthrax mailings a month later prompted a sweeping response by the federal government to improve the preparedness of the US to meet the potential threat posed by a terrorist using a biological agent. This response transcended traditional interagency boundaries, creating new opportunities while producing unique fiscal and leadership challenges. The National Interagency Confederation for Biological Research has made significant progress over the past 12 years because of its ability to adapt to the need for interagency cooperation and overcome many of these challenges. As construction of the National Interagency Biodefense Campus at Fort Detrick nears completion, the US has the capability to pursue a unique whole-of-government approach to the development of medical measures to counter the threat of bioterrorism. In addition to the high-level support of many in the federal government, the key success factors for this effort have been (1) a critical mass of leaders with the right leadership characteristics, (2) development of a compelling vision and accompanying narrative understood and articulated by all partnering organizations, and (3) recognition of the need for a partnership office to do the important communication and collaboration work in the organization to synchronize the information available to all the partners. The major barrier to interagency cooperative efforts of this kind is the inability to comingle funds from different appropriations.
Increasing threats of bioterrorism and the emergence of novel disease agents, including the recent international outbreaks of H7N9 influenza and MERS-CoV, have stressed the importance and highlighted the need for public...Increasing threats of bioterrorism and the emergence of novel disease agents, including the recent international outbreaks of H7N9 influenza and MERS-CoV, have stressed the importance and highlighted the need for public health preparedness at local, regional, and national levels. To test plans that were developed for mass prophylaxis scenarios, in April 2013 the Cook Country Department of Public Health (CCDPH) and the Triple Community (TripCom) Medical Reserve Corps (MRC) executed a full-scale mass prophylaxis exercise in response to a simulated anthrax bioterrorism attack. The exercise took place over 2 days and included the TripCom Point-of-Dispensing (POD) Management Team, volunteers from the TripCom MRC, and neighboring public health departments and MRCs. Individuals from the community volunteered as actors during the exercise, while local municipal, police, and fire personnel coordinated their responses to create the most realistic simulation possible. The exercise was designed to test the capacity of TripCom and CCDPH to implement plans for organizing municipal staff and volunteers to efficiently distribute prophylaxis to the community. Based on results from POD clinic flow, accuracy of prophylaxis distribution, and observations from evaluators, the exercise was successful in demonstrating areas that were operationally efficient as well as identifying areas that can be improved on. These include improvements to the just-in-time training for POD staff, the health screening and consent forms handed out to patients, the physical setup of the POD, and the command structure and communication for the management of POD operations. This article demonstrates the need for full-scale exercises and identifies gaps in POD planning that can be integrated into future plans, exercises, and emergency response.
The Medical Reserve Corps (MRC) was established in the Office of the Surgeon General in response to the spontaneous but disorganized outpouring of medical volunteers following the terrorist attacks of 2001. The mission o...The Medical Reserve Corps (MRC) was established in the Office of the Surgeon General in response to the spontaneous but disorganized outpouring of medical volunteers following the terrorist attacks of 2001. The mission of the federal MRC office is to provide organizational structure and guidance to the nearly 1,000 locally organized and funded MRC units that have grown up across the country and the more than 200,000 volunteer health professionals that staff these units. Despite the large size of this program and its numerous activations over the past decade, including in the Boston Marathon bombing and Hurricane Sandy, relatively little is known about the MRC, including the make-up of the units, the ways units have been used, and the challenges faced by MRC units and their volunteers. Here we report the results of a mixed-methods investigation of MRC unit organization, activities, and challenges.
Response to public health emergencies requires coordination across multiple sectors and effective use of existing resources in communities. With the expanded role of community pharmacists in public health during the past...Response to public health emergencies requires coordination across multiple sectors and effective use of existing resources in communities. With the expanded role of community pharmacists in public health during the past decade, their participation in response to emergencies has become increasingly important. Local health departments play a lead role in local public health emergency responses, and their ability to develop and leverage partnerships has become increasingly vital given their funding and personnel shortages. This article offers insight and recommendations on how local health departments can most effectively develop and maintain relationships with community pharmacies and pharmacists that will allow for a more coordinated and resourceful public health response to emergencies, and specifically to pandemic influenza outbreaks. Additionally, state and local health departments should reach out to pharmacies in a synchronized way to incorporate them into their pandemic influenza planning and response efforts. As pharmacists continue to expand their role as part of the public health system, pharmacy staff can be active participants with public health agencies to improve community public health emergency response.