Preparedness E-newsletter Archive - 2010

2010 News Icons

 

Back to School Update - 2010

Published: September 2010
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

Back to School

Jumbotron Video

It seems hard to believe that is has been a year since we geared up for the "back to school" onslaught of H1N1 influenza. Although the virus was relatively "mild", it was widespread, and very much out of season. In addition to influenza, the United States is experiencing increased cases and numerous outbreaks of pertussis ("whooping cough") in Pennsylvania and other states, including in California a number of fatalities in infants. It is possible that many if not all of these deaths were preventable with standard vaccines.

It is so important to remember that immunization protects both the people who receive it AND people who have not, and that when the percentage of vacinees falls too low, outbreaks occur. Typically, the people who are most affected are often those who can't be vaccinated - in the case of pertussis or measles, infants who were too young to complete the full series, and in the case of influenza, seniors for whom the vaccine may not always be fully effective. There's a wonderful PA-based prevention/vaccination video with a baseball theme which can be viewed at http://www.youtube.com/watch?v=W3faEh5N7ko.

While it is not known what kind of a flu season we will have this year, CDC does anticipate continued novel H1N1 (the pandemic virus from last year) activity, along with possible H3N2 and influenza B activity. There have already been summer outbreaks of a new H3N2 variant ("Perth"), which has not previously circulated widely in the United States. In other words, previous vaccination will not be protective against this strain. However, the current vaccine is protective against this variant and is highly recommended. This year's vaccine also includes protection against the novel H1N1 variant, as well as influenza B ("Brisbane").

The US Advisory Committee on Immunization Practices (ACIP) has issued new guidelines this year calling for the routine vaccination of "all persons aged > 6 months". That's right - no more thinking about which groups you should or should not vaccinate. It's EVERYONE now, unless specifically contraindicated. This means YOU, in part for your individual protection, and in part to help protect others with whom you may come in contact. In particular, there is increasing emphasis on the importance of vaccinating health care workers, and numerous groups are encouraging mandatory vaccination policies for those who work in health care facilities.
The vaccine is already widely available in the United States in both injection and nasal mist form. There is a new "high dose" inactivated vaccine called "Fluzone High-Dose" specifically for persons > 65, though they may continue to receive "regular" flu vaccine if that is what is available. Detailed recommendations and policies can be viewed at http://www.cdc.gov/mmwr/pdf/rr/rr59e0729.pdf.

CDC has not yet begun their fall surveillance (you can find it at www.cdc.gov/flu starting in October). PA DOH will also be active - the state Influenza Field Surveillance Coordinator for Pennsylvania is Owen Simwale, and he can be reached at owsimwale@state.pa.us for updates and recommendations. He is very knowledgeable and very helpful.

September is also "National Preparedness Month", and we also mark the 5th anniversary of Hurricane Katrina and the 9th remembrance of the 9/11 attacks. President Obama emphasized the importance of individual and community preparedness in his August 27th proclamation, and encouraged all of us to be involved, whether through individual actions such as putting a preparedness kit in your car or through participation in volunteer group activities such as community response teams or statewide groups (SERVPA). More details on these and many more activities can be found at the sites listed below. Remember to be informed, be involved, and volunteer!

 

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Antibiotic Resistance

Published: August 2010
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness
 

antibiotic resistance

The "Judicious Use" of Medically Important Antimicrobial Drugs in Food-Producing Animals: When Public Health concerns and Food Industry Priorities Conflict

Pandemics of drug-resistant organisms are increasingly common and of increasing importance. Recent examples are almost too numerous to list: "XDR" or extremely-drug resistant Tuberculosis (in 49 countries as of 2008); Gonorrhea which has become nearly untreatable; the spread of drug-resistant Malaria in many countries; the loss of most treatment choices for Influenza; and resistance to standard treatments for HIV/AIDS.

Although these trends are worrisome, resistance in each of the infectious diseases mentioned above is being addressed through careful planning and programming. This doesn’t mean the plan will work, but at a minimum the problem is recognized, the causes of drug resistance are either known or being investigated, and data is being shared at local, state, national, and international levels.

In one case however accurate data is nearly impossible to come by, and this makes intelligent and informed decision-making essentially impossible. This case is antibiotic usage in farm animals. This topic is important because of three known facts: 1) the more frequently and widely antibiotics are used (especially in healthy human or animal populations), the greater the risk of development of resistance; 2) most antibiotics used in animals are the same as or in the same class as antibiotics used by humans; and 3) resistance factors and pathogenic microorganisms spread between people and animals, even if the antibiotics themselves are no longer present.

The Pew Charitable Trusts estimate that "up to 70 percent of all antibiotics sold in the United States are given to healthy food animals on industrial farms", however the true number is not known as this information is not publicly available. A critically important first step in improving any plan to address this threat is to better understand the "input" side of the equation; that is, how many antibiotics of what types are given to which animals, when, and for how long. Comprehensive surveillance is an essential part of any effective plan, and understanding antibiotic usage in farm animals is required. In additional, actual information will help reduce the "language" debate, wherein words like "judicious use" as referenced by the FDA , American Veterinary Medical Association, and others are argued from ideological perspectives.

The next question is to what extent has this extensive use of antibiotics in farm animals adversely affected the health of people and animals. The European Union banned in 1998 the use of a number of antibiotics of human importance in farm animals for non-treatment purposes, followed in 2006 by a ban on the feeding of all antibiotics and related drugs to livestock for growth promotion purposes.  Denmark began the process 12 years ago and numerous studies have shown positive public health effects at minimal cost. Past history has shown that highly successful public health interventions such as seat belts and airbags are nearly always resisted by manufacturers as being too costly, and yet years later they are an essential part of our lives.

The United States has not taken definitive action on this issue, despite the finding of our own General Accounting Office (GAO) in 2005 that as a result, "antibiotic resistant bacteria have been transferred from animals to humans, and many of the studies we reviewed found that this transference poses significant risks for human health." Numerous additional studies have documented similar hazards, including a detailed report from the Humane Society, and, most recently, a 2010 report from Hong Kong showing shared resistance factors between women with e.coli-based urinary infections and stool samples from domestic animals.

Despite these facts, there is not a comprehensive and widely accepted plan to address this threat. The Food and Drug Administration (FDA) has proposed new policies which may or may not improve the situation, depending on the final result. There is currently a big loophole in AVMA policy that "gives a pass" to livestock producers who buy antimicrobials from distributors and feed stores and administer them to animals, with no publicy available information or direction from a veterinarian. In addition, the AVMA policy is that "Veterinarians use antibiotics to fight disease before an outbreak occurs and bacteria spreads through the entire population."

In other words, there is no effective veterinary control over the use of antibiotics in farm animals, and no serious commitment to limiting the usage of antibiotics to animals that are actually sick. Analogies to prevention in human health do not make sense either, as one of the fundamental tenets of reduction in antibiotic resistance in humans is that antimicrobials should be limited to therapeutic use (in other words, saved for those who are sick), except in rare circumstances (severe underlying disease such as AIDS or Cystic Fibrosis, pre-surgery, public health outbreaks, etc.) For humans, the Infectious Diseases Society of America (IDSA) describes a policy called "Antimicrobial Stewardship" which is designed to limit the emergence and transmission of antimicrobial-resistant bacteria and to reduce health care costs without adversely impacting quality of care. What we sorely need is a similar plan for animals.

In addition, there is currently a bill before Congress called the "Preservation of Antibiotics for Medical Treatment Act." PAMTA, H.R. 1549/S. 619 proposes the withdrawal from routine use of seven classes of antibiotics vitally important to human health from food animal production unless animals or herds are sick with disease or unless drug companies can prove that their use does not harm human health. Groups that already support this legislation include the American Medical Association, American Academy of Pediatricians, the Infectious Diseases Society of America, the American Nurses Association and the World Health Organization.

 

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The Gulf Oil Spill

gulf oil disaster fire
Everything you want to know about the spill


 

gulf oil disaster - beach

Kevin Reed of Pensacola looks over the oil-defiled shores
of Pensacola Beach, FL, on June 23 as oil began to wash
ashore from the Deepwater Horizon oil spill in the Gulf.
Edmund D. Fountain/St. Petersburg Times/AP

 

gulf oil disaster map

 

Published: June 2010
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

 

From Adm. Thad Allen: "The greatest challenge in this entire response is unity of effort. Solving this problem is going to transcend the capabilities of the federal government, the state government, local governments, other federal responders—anybody in the country, including volunteers -we’re all going to have to do this together." i

It is clear that the Deepwater Horizon oil spill in the Gulf of Mexico is the largest known environmental disaster in U.S. history. In the original explosion on April 20, 2010, 11 workers were killed and 17 others injured. The Deepwater Horizon platform burned for 36 hours before sinking. The immediate cause was most likely a methane “burp” that ignited, along with failure of the rig’s blowout preventer at the base of the well. Contributions of human error and inadequate technology are suspected and currently being investigated. The gusher continues and the amount of spilled oil is estimated at 100 million gallons or more; already 5–10 times worse than the Exxon Valdez Disaster in Alaska. ii

Perhaps the dominant feeling though, is one of disbelief. Not that the disaster could have happened, but that it has persisted for so many days without surcease. Once the disaster became “worse” (at least in terms of number of barrels of oil) than the Exxon Valdez, it became hard to understand. How bad is 5–10 times as bad? We no longer have a frame of reference by which to gauge the severity of the spill. Having said this, there are numerous ways to describe the extent of the disaster.

The Oil Trajectory Map shows the estimated spread of the spill along the US Gulf coastline, and it is extensive.

Another way to look at the disaster is by ecological and economic effects. As a result of the spill, approximately 33% of the entire Federal Gulf of Mexico waters are closed to fishing as of June 28, 2010. One third. Five hundred eighty-six sea turtles have been found since April 30—439 dead or dying—136 of which are in rehabilitation centers. Fifty-five dolphins have been found—53 dead or dying.

Where are we now?

Response efforts are underway as depicted in the images below. Numerous activities have either failed in part or in whole and/or are inadequate. Skimming, burning, booms, well collection, use of dispersants, and many other techniques are underway.


gulf oil disaster response          gulf oil disaster diagram

Recovery

This disaster highlights what is often the most overlooked phase of public health disasters—recovery. Especially long-term recovery. Preparation is often in the news—are we “ready” for this disaster or that emergency, and this focus is not misplaced since prevention and adequate preparation may ensure that the worst possible outcomes do not occur, which is surely the most efficient and humane approach. However, when prevention and preparation fail, as they have in the Gulf oil disaster, and mitigation is weak, response becomes the phase of the moment. And yet as we have seen in many recent disasters—Hurricane Ivan in Western Pennsylvania, Hurricane Katrina in the Gulf Coast, and now the Deepwater Horizons explosion and leak—prevention, preparation, mitigation, and response may all be inadequate. This leaves recovery, the longest, messiest, most expensive, and least appreciated phase.

Yet it is the recovery phase which may call for the most public health involvement. The leakage of oil and natural gas from a mile underground, along with some of the mitigation activities (such as use of “dispersants”), either are or will put significant pollutants into the air, the water, and the beaches and marshes along the coast. Ecosystems may be disrupted in ways that are impossible to fully predict. Industries both large and small are already disrupted, and it isn’t known when they will be back on line and what the long-term effects will be.

EPA has observed low levels of odor-causing pollutants associated with oil on the shore in the Gulf region. Some of these chemicals may cause short-lived effects like headache, eye, nose and throat irritation, or nausea. Some people may be able to smell several of these chemicals at levels well below those that would cause short-term health problems.

EPA is also conducting additional air monitoring for ozone and airborne particulate matter. The air monitoring conducted through June 28 has found levels of ozone and particulates ranging from the “good” to "unhealthy for sensitive groups" levels on EPA's Air Quality Index.

gulf oil disaster maps

 

gulf oil disaster maps

The recovery phase can be divided into several key areas: Economic effects, which may be short, medium, or long-term, and may be local, regional, national, or international; human health effects, which requires attention to those affected by the disaster AND those affected by the clean-up (remember the long-term pulmonary effects of those cleaning up after 9/11); animal health effects, both in terms of animal systems of immediate economic importance and the broad effects on multiple species and interactions; ecosystem effects; and the recovery itself, which can be disruptive as well depending on the choices we make.

In addition, Mother Nature will continue to weigh in. Hurricane season has begun and Tropical Storm Alex has already become Hurricane Alex, but fortunately is not on a direct course with the oil slick produced by the ruptured BP well. However, even a near miss may generate ocean swells of a magnitude sufficient to affect the containment efforts. But what happens if the next hurricane tracks in a more northerly direction? Mitigation and response activities will be disrupted, barriers may be destroyed, and oil may be dispersed even more widely throughout the Gulf region.

As is not hard to imagine, we do not have the systems to fully gauge the long-term effects of this disaster. Surveillance and testing are of major importance, as we monitor human, animal, ecosystem, and economic injury and health. Scientists who can work across disciplines will be of prime importance, as some of the effects may be reflected in the complex interplay of macroscopic and microscopic phenomena. Mother Nature may turn out to be surprisingly resilient; but in some cases we may reach a “tipping point” where species and/or ecosystems die or are permanently disrupted as a result.

In the end, it would be useful if someone would calculate the cost of the disaster, response, and recovery. This figure could be compared to the money that was saved by not planning effectively in advance, by not having adequate deepwater response capacity, by a rush to deliver barrels of oil without adequate protection. And then perhaps we will learn the lesson (again) that prevention is better (and cheaper) than cure in a myriad of ways, and prioritize activities that truly protect human, animal, plant, and ecosystem health. It only makes economic sense.

References:
White House Website
Disaster Unified Command
Press Briefings by the Incident Commander
Live Feeds of the Oil being Released
EPA Response Page
Via EPA data using Google Earth

Sign Up for Deepwater Horizon Response Text Message Alerts
A new text message alert notification system has been set up for public use to receive alerts of interest from the Deepwater Horizon Response. Members of the public can now sign up for text message alerts organized by information categories, state, or by general news. 
To subscribe, please choose which alerts you would like to receive and follow the subscription information provided below:
For example, to sign up to receive information on beach closures in the Gulf region, type beach@gulf to code 84469.

For information on all Deepwater Horizon Response Gulf and breaking news, text news@gulf to 84469.

  • State-specific information can be obtained by texting the following codes:
    • For Florida alerts, text FL@gulf to 84469
    • For Mississippi alerts, text MS@gulf to 84469
    • For Louisiana alerts, text LA@gulf to 84469
    • For Alabama alerts, text AL@gulf to 84469.
  • Topic specific information can be obtained by texting the following codes:
    • For information on affected wildlife, text wildlife@gulf to 84469
    • For information on beach closures and cleanup, text beach@gulf to 84469
    • For information on air quality monitoring from the EPA, text air@gulf to 84469
    • For information on water quality monitoring, text water@gulf to 8446
    • For fishing information/closures, text fishing@gulf to 84469

 

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Notes from Haiti

Published: June 2010
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness; Patt Sweeney, JD, MPH, RN, Co-director for Legal Preparedness, Center for Public Health Preparedness

 

Port-au-Prince

Street in Port-au-Prince 3 months after the earthquake
Photo: Sweeney/UPCPHP
 

Recently we (Samuel Stebbins and Patricia Sweeney) returned from a week-long reconnaissance mission to Port-au-Prince, Haiti. The Widgeon and National Science Foundations supported the expedition, for the purpose of acquiring a current “snapshot” of Haiti’s recovery and reconstruction.

Words cannot adequately convey the mixture of disaster and “normality” which we observed during our visit. Every morning the streets flooded with people on their way to work, children in uniforms walking to school, street sellers setting up carts and displays, giant trucks transporting water all over the city, “tap taps” carrying passengers in every direction, all in the midst of unimaginable destruction and rubble. Just one example of the cognitive dissonance we experienced is depicted in the fact that we could buy modern conveniences such as a car cell phone charger and electric fans on a street amid huge areas of destruction.

Expedition team members visited water sources, hospitals, schools, internally displaced persons camps, and local businesses to create this snapshot of Haiti’s recovery and reconstruction status. Unfortunately, we observed very few signs of reconstruction. In the five months since the earthquake, roads have gone from bad to nearly unnavigable, with power lines still dangling over busy streets but ignored by all. Trips of only a few kilometers take hours, there are very few standing churches, and ever worsening piles of garbage are accumulating in the streets and water floodways. Graffiti stating “Obama help us,” is visible across the city and anger at the government is palpable. One well-educated woman stated in absolute terms her belief that the country’s president had “sold” Haiti to the United Nations.

By nearly any standard, the Haitian earthquake is the “worst” in the modern era. Prior to the earthquake, Haiti was already the poorest country in the Western Hemisphere, with a 2009 per capita GDP estimated at $7 billion USD, putting it well behind Nicaragua and Guyana, the next lowest countries. The earthquake is estimated to have “cost” the economy approximately $7.8 billion USD, or approximately 120% of the country’s estimated 2010 GDP. This would place it second after the 1988 earthquake in Armenia (estimated to have “cost” the country approximately 140% GDP). However, at that time Armenia was still part of the USSR and compared to the total USSR GDP this percentage drops dramatically, thus leaving Haiti in “first” place.

Another way to assess the severity of this disaster is to calculate the percentage of the population that was killed, injured, or displaced. Mortality and morbidity statistics in Haiti vary depending on the source, but most sources estimate approximately 200,000 dead, 300,000 injured, and up to 1 million displaced. Given Haiti’s estimated population of 9 million, this leads to the conclusion that 2.2% of the population was killed, 3.3% were injured, and perhaps 10% or more of the entire population was left homeless. Compared to recent and historical earthquakes, these are the worst statistics by far. The death rate is approximately on par with the “Great Flu” of 1918–19, but instead of occurring over many months it happened in a single evening.

Analysis of the resources available for response and recovery is also a method that can be employed to assess the severity of a disaster. Although the 1988 Armenia quake was larger on a GDP scale, the country had relatively immediate access to resources from across the USSR. Haiti is an island and thus has no direct road access, and port and air access are limited. It took nine days for the USS Comfort—the first comprehensive medical services to become available—to arrive on station at Haiti, because of the increased logistical challenge of water-borne rescue.

Yet, perhaps the most significant challenges in the response to the earthquake in Haiti are communication and the coordination of response efforts. Immediately following the earthquake, there were reportedly more than one thousand non-governmental organizations (NGOs) registered in the country. Ranging in size from tiny to huge, these NGOs may coordinate a single activity or provide a variety of services. To try and bring some order to this well-meant chaos, the World Health Organization/Pan-American Health Organization are using the “cluster” system recommended in a 2005 UN review of global humanitarian response. Each of the eleven clusters (Protection, Camp Coordination and Management, Water Sanitation and Hygiene, Health, Emergency Shelter, Nutrition, Emergency Telecommunications, Logistics, Early Recovery, Education and Agriculture) is led by a designated agency. During our reconnaissance mission, expedition team member attendance at cluster meetings revealed that efforts to identify the NGOs remaining in country and the services they were providing were ongoing, but meeting significant challenges.

Despite these efforts, the challenges in Haiti remain. The serious disconnect between the Haitian government, the NGOs, and the Haitian people is going to be difficult to resolve. The lack of economic opportunity and acceptable schooling are huge challenges, but are also the areas in which the international community can make the most significant inroads. Reestablishment of public health services is underway, but many activities may not be sustained as they are dependent on NGOs which may not be in Haiti for the long haul. Leadership from the Pan American Health Organization and World Health Organization will be essential in trying to protect the current population from the worst depredations of public health challenges and disasters while others work to resuscitate the economy and education systems for long-term recovery.

 

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The National Health Security Strategy (NHSS)

Published: March 2010
Written by: Sam Stebbins, MD, MPH, Director, Center for Public Health Preparedness

 

Medevac Helicopter


 

The NHSS was released January 2010 by the Office of the Assistant Secretary for Preparedness and Response (ASPR). It is the nation’s first comprehensive strategy focused on protecting people’s health during a large-scale emergency. The strategy sets priorities for government and non-government activities over the next four years, and is a requirement of Pandemic and All-Hazards Preparedness Act (PAHPA). The plan focuses on the importance of health security, defined as “a state in which the nation and its people are prepared for, protected from, respond effectively to, and able to recover from incidents with potentially negative health consequences.”1

Health security is built on a foundation of community resilience, defined as “healthy individuals, families, and communities with access to health care and with the knowledge and resources to know what to do to care for themselves and others in both routine and emergency situations.” Community resilience is based on “strong and sustainable public health, health care delivery, and emergency response systems.”2 Resilience of these systems is emphasized and includes the following descriptors of desired behavior: “durable, robust, responsive, adaptive to changing situations, efficient, and interoperable.”

Also released this past January was the Interim Implementation Guide (IIG) which references the period January–September 2010, after which a biennial Implementation Guide (IG) will be released. It includes a number of important activities, AND three appendices relative to Assessment: Appendix A—Evaluation of Progress; Appendix B—Gap Assessment of Performance Measures; and Appendix C—Status of Performance Measure Development for Capabilities. Appendix A also includes detailed funding information to states from various sources for the years 1999–2009.

The IIG will culminate in a public evaluation progress report, providing a snapshot of the state of health security in the United States, and will “establish a baseline against which future performance can be judged.” This initial report will emphasize measures for which data are already being collected, including: Public Health Emergency Preparedness (PHEP) cooperative agreement data on incident management, crisis, and emergency risk communication with the public, PH labs, and possibly other biosurveillance capabilities; countermeasure delivery capabilities, as measured by the Strategic National Stockpile scores; and data from the Hospital Preparedness Program (HPP) on communications, resource tracking, patient transport, fatality management, and “other capabilities.” Additional measures that are being developed may also be included, including some on community resilience from ASPR, new PHEP measures, Project Public Health Ready, Joint Commission on Accreditation of Healthcare Organizations, and others.

Framework for the NHSS

The NHSS has two main goals: 1) Build community resilience; and 2) Strengthen and sustain health and emergency response systems. These goals are achieved through 10 strategic objectives:

  1. Foster informed, empowered individuals and communities.
  2. Develop and maintain the workforce needed for national health security.
  3. Ensure situational awareness so responders are aware of changes in an emergency situation.
  4. Foster integrated health care delivery systems that can respond to a disaster of any size.
  5. Ensure timely and effective communications.
  6. Promote an effective countermeasures enterprise, which is a process to develop, buy, and distribute medical countermeasures.
  7. Ensure prevention or mitigation of environmental and other emerging threats to health.
  8. Incorporate post-incident health recovery into planning and response.
  9. Work with cross-border and global partners to enhance national, continental, and global health security.
  10. Ensure that all systems that support national health security are based upon the best available science, evaluation, and quality improvement methods.

These strategic objectives are supported by a set of 50 operational capabilities, which are the “building blocks of health security.” These capabilities are organized into eight general areas: Community Resilience and Recovery, Infrastructure, Situational Awareness, Incident Management, Disease Containment and Mitigation, Health Care Services, Population Safety and Health, and Quality Improvement and Accountability. See pp. 20–27 in the NHSS for details.

Systems and Modeling

  • The NHSS states that it takes a “systems approach” to health security, recognizing the many interrelated systems which are involved.
  • The IIG notes in its assessment of current evaluation approaches that “there was a noteworthy lack of attention to outcomes, namely morbidity and mortality. This omission is surely attributable to the difficulty of assessing outcomes outside real-world emergency events or functional exercises designed to simulate emergency events, all of which are fairly infrequent. However, as this field progresses, it is expected that computer-based models that simulate emergency events will aid in the assessment of outcomes in relation to measures of structure and process.” (IIG p. 68)

Performance Measurement and Quality Improvement

  • The IG to be released in September 2010 “will provide a fully elaborated evaluation strategy.”
  • The plan emphasizes “continuation” of previous and on-going HHS and DHS work to “develop and implement a rigorous performance measurement system.”
  • The plan emphasizes the need to “develop an evaluation framework, including plans for performance monitoring and evaluating the impact of investments.”
    • - Performance measures should focus on aspects of health security that are mission critical, likely to fail, and applicable to a broad range of the nation’s communities (ranging from large metropolitan areas to rural communities).
    • - These evaluations must be able to distinguish the impact of investments from other factors.
  • The IIGlays out a concrete plan of action and timeline for ensuring that all communities have a clear set of measures. The IIGalso recommends a design for reporting, development of algorithms for combining the assessments of multiple measures, and data collection to allow for presentation of data in a format that is useful to decision makers and other end users. (NHSS p. 18)
  • The IIG cites a “noteworthy lack of attention to outcomes, namely morbidity and mortality,” and notes “the difficulty of assessing outcomes outside real-world emergency events or functional exercises designed to simulate emergency events, all of which are fairly infrequent.” (IIG p. 68)
  • The IIG notes that ASPR will develop a plan for scaling up quality improvement (QI) in health security, by providing funding, requiring the incorporation of QI into relevant grant guidance and support, and will “embed instruction in QI in education programs.”

Linkage to other Federal Activities

  • The plan notes that health security is an integral part of overall national security, and that the NHSS is intended to complement and support other national strategies and priorities, including target capabilities and Emergency Support Functions as described by DHS.
  • The plan also tries to link to Healthy People 2010 and various bread and butter public health prevention activities as essential to “supporting” community resilience.

The IIG also highlights the following action items (most of which are already well underway):

  • Identify and prioritize investments to enhance capabilities.
  • Conduct a workforce gap analysis and develop workforce competencies for all sectors involved in national health security.
  • Coordinate HHS’s activities with DHS, DoD, and other federal agencies.
  • Identify and develop methods for risk analysis.
  • Develop an evaluation framework, including plans for performance monitoring and evaluating the impact of investments.
  • Promote and implement QI methods for health security on a broader scale.
  • Propose a research agenda.
  • Conduct an assessment of the countermeasures enterprise.

Notes

Definitions

  • “Health Security” (see above)
  • “Community Resilience” (see above)
  • “System Resilience” (see above—though not an actual definition)
  • “Health system (or sector)”: all parts of the health care delivery system and the public health system
  • “Health care delivery system”: includes primary and hospital care, disaster medicine, behavioral health care, and all other health care services
  • “Emergency services system”: police, fire, emergency medical services, and emergency management
  • “Public health system3”: ?
  • “Risk”: the multiplicative product of “threat,” “vulnerability,” and “consequences”

 

DHS Targeted Capabilities List (2007—in the process of being revised)
graph

1 The plan actually uses two slightly different definitions of national health security. This one emphasizes the phases of disasters, the other includes “resilience” but leaves off response and recovery.

2 The IIG also references “law enforcement” in addition to the main three areas.

3 Interestingly, “public health system” is not defined in either the NHSS or IIG. There is a single reference to the 2002 Institute of Medicine (IOM) report, The Future of the Public’s Health in the 21st Century.

 

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The National Association of City and County Health Officials Public Health Preparedness Summit 2010

Kathleen Sebelius, MPA

HHS Secretary Kathleen Sebelius, MPA, kicks
off the Summit's opening session.
 

Nicole Lurie, PhD

HHS Assistant Secretary for Preparedness
and Response Nicole Lurie, PhD, speaks at
the Summit's opening session.
 

Stebbins-Comfort

Samuel Stebbins, MD, MPH, and Louise
Comfort, MA, PhD presenting at the
Strengthening the Functions of Health
Departments in Preparedness and Response
session
 

Bailey-Diesel-Stebbins

Rachel Bailey, MPH, Jill Diesel, MPH, and
Sam Stebbins, MD, MPH, present the
Utilizing Students during Emergencies
poster session.
 

Herrmann

Jack Herrmann, MSEd, NCC, LMHC speaking
rat the main session.
 

Published: March 2010
Written by: Sherrianne Gleason, PhD, Project Coordinator, Public Health Adaptive Systems Studies; Leslie Fink, Preparedness Center Coordinator, Center for Public Health Preparedness;

 

Public health professionals from across the country gathered in Atlanta, Georgia during the third week of February for the 2010 Public Health Preparedness Summit. Each year, the Summit provides an opportunity for preparedness professionals from a variety of disciplines to network, and strengthens and enhances their capabilities by providing a number of interactive and skill-building sessions whose lessons encouraged collaboration development. This year's Summit revolved around the theme Partners in Preparedness: Engaging a Community for a Successful Public Health Response.

A major theme throughout the Summit was the H1N1 influenza virus which struck the nation over the past year, as highlighted during the opening session entitled "The Crash of the Pandemic Wave: the Public Health Response to the H1N1 Influenza Virus." Opening remarks were made by Kathleen Sebelius, MPA, Secretary, Department of Health and Human Services. Speaking to a packed house, Secretary Sebelius talked of how the public health system was tested, but given the previous all-hazards preparedness approach, a unified public health response, and interagency partnerships, there were many successes in meeting the challenge of responding to H1N1. Ninety-seven million doses of vaccine were given to 86 million Americans.

Near the end of her speech Secretary Sebelius talked about how Dr. Lurie and her office would be leading a comprehensive review of their public health countermeasures. Part of this process involves input from the public health professionals in the field. As the Secretary stated:

"This review is not just about flu. The partnerships we've built and the lessons we've learned in the last ten months will be useful in any public health emergency, whether it's a naturally occurring pandemic, an outbreak from contaminated meat, or an anthrax attack. One of our major goals as a department is to always be guided by the best science possible. And that means we need to be constantly studying our response, identifying key lessons, and incorporating these new findings into our plans."

"The best science possible" is also our goal at the University of Pittsburgh Center for Public Health Practice. Faculty, staff, and students from the University of Pittsburgh Center for Public Health Preparedness and Public Health Adaptive Systems Studies were on hand for a variety of presentations, including:

Computational Models to Better Understand and Improve Vaccine Delivery

Bruce Y. Lee, MD, MBA; Tina-Marie Assi, MPH; and Rachel R. Bailey, MPH

Modeling and simulation have been widely employed in industries such as air traffic control, transportation planning, defense, manufacturing, and the financial sector. This session demonstrated how modeling and simulation techniques can be a benefit to public health preparedness planning such as vaccine distribution and preparedness planning.

Pandemic Influenza: Non-Pharmaceutical Interventions versus School Closure

Samuel Stebbins, MD, MPH and Charles Vukotich, Jr., MS

Pandemic influenza poses a substantial threat and non-pharmaceutical interventions (NPIs) may be the only response available in the initial phase of a pandemic until effective vaccines and anti-viral medications become available. The Centers for Disease Control and Prevention recommend numerous NPI options in response to pandemic influenza. School closure is one NPI that may create significant societal and personal disruptions and multilayered interventions, involving infection control measures and behavioral changes. Participants in this interactive session evaluated school closure through a simulated school closure.

Partnerships and Networks for Preparedness

Patricia Sweeney, JD, MPH, RN, Elizabeth Ferrell Bjerke, JD, University of Pittsburgh, et al.

This panel addressed the role of academic institutions in community disaster response and examined the legal and regulatory authorities that drive public health system preparedness and response.

Simulation for Success: Using Models for Preparedness and Response

Margaret Potter, MS, JD, University of Pittsburgh, et al.

This interactive panel session, comprised of panelists from several Preparedness and Emergency Response Centers, shared innovative training and planning approaches and explored how computational modeling can be used to enhance education and as a tool for decision-makers to better plan and allocate resources for outbreaks.

Strengthening the Functions of Health Departments in Preparedness and Response

Samuel Stebbins, MD, MPH; Louise Comfort, PhD; and Robert Skertich, PhD

Decentralized control and complexity of the public health system pose challenges to health department preparedness and emergency response. In this panel discussion investigators described ongoing work for measuring preparedness capacity and the effectiveness of partnerships in response and a framework to develop and assess organizational processes that inform and support coordinated action during a public health crisis.

Utilizing Students during Emergencies

Jill Diesel, MPH, University of Pittsburgh, et al.

At universities nationwide, student epidemiology surge teams collaborate with local, state, and federal health agencies to provide support during emergencies. As chairperson of the Student Public Health Epidemic Response Effort (SPHERE), Diesel shared her personal experience developing a relationship with the Allegheny County Health Department and the benefits that the partnership has brought to SPHERE’s student members as well as the health department. In addition to participating in the panel discussion, Diesel also presented the poster Public Health Graduate Students as Surge Capacity in a Measles Outbreak

 

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