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PubMed2004

Preparing for an era of weapons of mass destruction (WMD)--are we there yet? Why we should all be concerned. Part II.

September 11, 2001 demonstrated dramatic voids in national preparedness, and catalyzed massive efforts to identify and remedy vulnerabilities. Since Part I of this series appeared in August 2002, significant improvements have been achieved especially in bioterrorism and chemical terrorism for first responders and emergency medicine, law enforcement, and public health (surveillance). Such efforts manifested benefits during the SARS outbreaks and monkeypox cases of 2003. Nevertheless, emerging infectious diseases will continue to pose a threat if we do not remain vigilant and continue to invest in training, surveillance, and treatments. As expected, many poison centers and toxicologists have taken leadership roles nationwide. In regions where such leadership existed, preparedness levels are strong and collaborations resulted in the development of valuable response plans and training, including the Advanced Hazardous Life Support (AHLS) and Basic Disaster Life Support (BDLS) courses. Early success notwithstanding, experts suggest that current national preparedness has improved slightly from "1" (9/11) to "3" out of "10". Increasingly it has become evident that the nuclear threat, including radiation terrorism, is significant, against which the US remains inadequately prepared. Arguably the nuclear threat-whether accidental or planned-remains our highest consequence vulnerability, and we must rapidly improve our readiness across disciplines. Special populations including the elderly and children remain marginalized in preparedness protocols. Local vulnerabilities including chemical manufacturing and transportation--not just a risk for terrorism but industrial accidents--continue unabated. Our early success is not an endpoint; much work remains and time is fleeting. This report examines vulnerabilities that must be addressed to enhance preparedness.

Disaster Planning↗
PubMed2006

International cooperation and preparedness in responding to accidental or deliberate biological disasters: lessons and future directions.

Preparations for international cooperation in response to disease disasters at the regional or continental levels are poorly coordinated and cooperation is limited, although intergovernmental and international organisations have been advocating for years that emergency responses to infectious disease outbreaks should be planned for and prepared at the national level. National governments are responsible for contingency planning to protect the public; however, this responsibility needs to be broadened to encompass regional and international approaches. Little public domain information is available on international coordinated responses to the deliberate introduction of biological pathogens. Terrorist events in the early 21st Century have increased awareness of the risks, but solid commitment and internationally resourced initiatives are still lacking. The current avian influenza disaster has largely been addressed by the three global agencies: Food and Agriculture Organization (FAO), World Organisation for Animal Health (OIE) and World Health Organization (WHO), using the underlying precepts that shape the Global Framework for the Progressive Control of Transboundary Animal Diseases (GF-TADs). The GF-TADs offers a substantial base to improve regional epidemiological and environmental information, diagnostic networking, trend analysis and intervention against the important epidemic animal diseases. International prevention, preparedness and response require multidisciplinary teams working in an environment of intergovernmental cooperation that encompasses numerous ministries and agencies. This paper focuses on known international aspects of collaboration on emergency preparedness and addresses the FAO/OIE initiative to strengthen veterinary and public health systems involved in controlling and preventing serious health threats.

Animal Welfare↗
PubMed2006

Global surveillance for chemical incidents of international public health concern.

OBJECTIVE: In December 2001, an expert consultation convened by WHO identified strengthening national and global chemical incident preparedness and response as a priority. WHO is working towards this objective by developing a surveillance and response system for chemical incidents. This report describes the frequency, nature and geographical location of acute chemical incidents of potential international concern from August 2002 to December 2003. METHODS: Acute chemical incidents were actively identified through several informal (e.g. Internet-based resources) and formal (e.g. various networks of organizations) sources and assessed against criteria for public health emergencies of international concern using the then proposed revised International Health Regulations (IHR). WHO regional and country offices were contacted to obtain additional information regarding identified incidents. FINDINGS: Altogether, 35 chemical incidents from 26 countries met one or more of the IHR criteria. The WHO European Region accounted for 43% (15/35) of reports. The WHO Regions for Africa, Eastern Mediterranean and Western Pacific each accounted for 14% (5/35); South-East Asia and the Americas accounted for 9% (3/35) and 6% (2/35), respectively. Twenty-three (66%) events were identified within 24 hours of their occurrence. CONCLUSION: To our knowledge this is the first global surveillance system for chemical incidents of potential international concern. Limitations such as geographical and language bias associated with the current system are being addressed. Nevertheless, the system has shown that it can provide early detection of important events, as well as information on the magnitude and geographical distribution of such incidents. It can therefore contribute to improving global public health preparedness.

Bioterrorism↗
PubMedDate not supplied

Planning for the next pandemic of influenza.

Worldwide influenza pandemics have occurred at irregular and unpredictable intervals throughout history and it is confidently expected that they will continue to occur in the future. It is now recognised that these pandemics result when avian influenza A viruses succeed in adaptation to and transmission between humans. The impact of pandemic influenza is substantial in terms of morbidity, mortality and economic cost and there is the potential for serious social disruption. Influenza vaccines remain the most effective defence against influenza but will be in short supply during a pandemic, as will the new specific anti-influenza drugs, due to the lead-time required for production and rapid spread of the virus. To minimise the impact of pandemics it is imperative to maximise the availability of both vaccines and antivirals and to ensure that they are used optimally. This requires planning at both the international and national levels. The World Health Organization has, therefore, developed a staged plan for responding to a pandemic threat which is based principally on its surveillance program. It has also prepared guidelines to assist national agencies in their planning. However, there may be further options for increasing our preparedness which should also be considered.

Antiviral Agents↗
PubMed2005

Early warnings: health care preparedness.

As nurses, we represent the backbone of the health care system. It is essential that we have a core understanding of infectious disease emergencies and begin to use the strengths that characterize nursing. These strengths include the ability to evaluate situations and use evidence on which to base our actions. Early identification of an infectious disease emergency is one example of using nursing skills to strengthen emergency preparedness. During an infectious disease emergency, nurses certainly will bear the burden of patient management. Because of this, the need for infectious disease emergency preparedness has become a national priority and a moral imperative for all nurses. One topic necessary for ED and OH nurses' preparedness has been discussed in this article, but nurses must take the initiative to learn more about disaster preparedness and incorporate these skills into everyday practice.

Animals↗
PubMed2006

Technology, public policy and control of transboundary livestock diseases in our lifetimes.

There are no technological barriers to eliminating major transboundary livestock diseases. 'Elimination' means that diseases no longer threaten livestock in the developed world nor the livelihoods of hundreds of millions of small farmers elsewhere. The problem is not lack of technology but failure of public policy. Developed country policy should actively combat accidental and intentional introductions; protect livestock against future advanced biological weapons; minimise the economic impacts after introduction by any means; abandon mass slaughter as a control tool; engage in disease removal in pursuit of a global economic, societal, and environmental agenda; and make appropriate national and cooperative investments. This is the moment for policy change because transboundary livestock disease elimination now involves powerful government ministries outside ministries of agriculture that are concerned about disease threats from many sources. Change can acquire support from the public and many organisations with shared interests. New policy is needed to change the belief that government is solely responsible for excluding disease, responding to introductions, and compensating farmers for losses during eradication. Effective border control and domestic preparedness programmes depend upon government and industry working together with costs falling upon those responsible in the form of 'user fees'. Compensation for stock slaughtered during outbreak control should be covered by private insurance. Government and industry should share the costs of an effective surveillance, diagnostic and response system. Surveillance must achieve or approach real-time understanding of the disease situation at all stages and in all places and be accessible over the Internet by diverse government agencies and stakeholders in-country and abroad. Traditional responses must be abandoned because they encourage terrorism. Regulatory approval processes must be modernized because they cannot keep up with new technology.

Animal Diseases↗
PubMedDate not supplied

Pandemic influenza: are we ready?

An influenza pandemic is inevitable, and the H5N1 avian influenza outbreak in Southeast Asia has heightened concern that a disaster is imminent. Pandemic preparations are beginning around the world, and it is important for first responders, particularly disaster management personnel, to understand the difference between pandemic and epidemic influenza preparedness. This article will focus on distinguishing between an influenza epidemic and an influenza pandemic and, in light of these distinctions, how to manage the next pandemic with limited resources, particularly the absence of vaccine.

Adolescent↗
PubMed2004

HHS/CDC legal response to SARS outbreak.

Before the severe acute respiratory syndrome (SARS) outbreak, the Centers for Disease Control and Prevention's (CDC) legal authority to apprehend, detain, or conditionally release persons was limited to seven listed diseases, not including SARS, and could only be changed using a two-step process: 1) executive order of the President of the United States on recommendation by the Secretary, U.S. Department of Health and Human Services (HHS), and 2) amendment to CDC quarantine regulations (42 CFR Parts 70 and 71). In April 2003, in response to the SARS outbreak, the federal executive branch acted rapidly to add SARS to the list of quarantinable communicable diseases. At the same time, HHS amended the regulations to streamline the process of adding future emerging infectious diseases. Since the emergence of SARS, CDC has increased legal preparedness for future public health emergencies by establishing a multistate teleconference program for public health lawyers and a Web-based clearinghouse of legal documents.

Centers for Disease Control and Prevention, U.S.↗
PubMed2003

El Niño and health.

El Niño Southern Oscillation (ENSO) is a climate event that originates in the Pacific Ocean but has wide-ranging consequences for weather around the world, and is especially associated with droughts and floods. The irregular occurrence of El Niño and La Niña events has implications for public health. On a global scale, the human effect of natural disasters increases during El Niño. The effect of ENSO on cholera risk in Bangladesh, and malaria epidemics in parts of South Asia and South America has been well established. The strongest evidence for an association between ENSO and disease is provided by time-series analysis with data series that include more than one event. Evidence for ENSO's effect on other mosquito-borne and rodent-borne diseases is weaker than that for malaria and cholera. Health planners are used to dealing with spatial risk concepts but have little experience with temporal risk management. ENSO and seasonal climate forecasts might offer the opportunity to target scarce resources for epidemic control and disaster preparedness.

Climate↗
PubMed2002

Regional status and approaches to control and eradication of foot and mouth disease in the Middle East and North Africa.

The Middle East is regarded as the region of the world most heavily affected by foot and mouth disease (FMD). The situation in the Middle East and North Africa constitutes a threat to other regions of the world, especially Europe. Risk management differs between North Africa and the Middle East due to different epidemiological situations. In the Middle East, the national cattle population is the principal target of preventive vaccination. Vaccination is used as a tool for preventing economic losses due to the disease, rather than as a means to prevent the spread of the infection. In North Africa, as FMD occurs almost cyclically, management is more focused on emergency preparedness and limitation of the spread of the disease upon diagnosis, as well as on effective control measures based on quarantine and mass vaccination. To reduce future outbreaks of FMD in the countries of the two regions, a common strategic programme should be adopted, based on effective regional co-operation at many levels. This should be complemented by efforts to restructure and consolidate the national Veterinary Services.

Africa, Northern↗
PubMed1997

Meningococcal disease: public health burden and control.

Meningococcal disease which is increasing globally is still associated with a high mortality and persistent neurological defects, particularly among infants and young children. Sporadic meningococcal meningitis occurs throughout the world, with seasonal variations, and accounts for 10-40% of endemic bacterial meningitis. Epidemic meningitis occurs in any part of the world but the largest and most frequently recurring epidemics have been in the semi-arid area of sub-Saharan Africa where the current pandemic is associated with attack rates exceeding 500 per 100,000 population and thousands of deaths. In the Americas and Europe serogroup B is the predominant agent causing systemic disease, followed in frequency by serogroup C. Serogroup A meningococcus was historically the main cause of epidemic meningococcal disease globally and still predominates in Africa and Asia. A range of internal and external factors predispose for epidemics such as strain virulence, carriers, humoral immunity, co-infections, low humidity and drought, population movements and crowding. To respond to the current situation and the expected spread of the disease, WHO, in collaboration with its Member States and various governmental and non-governmental agencies, has developed a sustainable plan of action for preparedness and control of meningitis.

Adolescent↗
PubMed1999

Management of animal health emergencies in North America: prevention, preparedness, response and recovery.

Animal health emergency management (AHEM) is one of the most important issues confronting the world today and is the key to both food security (safety, quality, wholesomeness, affordability and abundance) and economic stability for many countries. Although the primary objective of emergency management in each of the countries of North America (Canada, Mexico and the United States of America [USA]) is implemented through individual AHEM systems, North America shares four common goals, as follows: preventing the introduction of foreign animal pathogens into North America being prepared to manage the outbreak of a foreign animal disease developing appropriate response strategies for control and eradication of disease taking active measures to recover from the animal health emergency in question. In the course of this paper, the authors provide an introduction to, and overview of, AHEM in North America. Furthermore, they outline the general infrastructure of prevention, preparedness, response and recovery strategies for Canada, Mexico and the USA. Finally, the authors discuss the future of AHEM in North America, concluding with a review of some of the joint activities currently being conducted with regard to AHEM.

Animal Diseases↗
PubMed2005

[Avian influenza H5NI in Europe: little risk as yet to health in the Netherlands].

Since 2004, outbreaks of fowl plague caused by a highly pathogenic avian influenza virus of the subtype A/H5NI have been reported from various countries in Southeast Asia. To date, 118 cases with 61 deaths have been documented in humans, due to close contact with infected poultry or raw poultry meat. Although efficient human-to-human transmission has not occurred, in a few cases transmission to blood relatives could not be ruled out. In October 2005, outbreaks of A/H5NI in poultry and wild fowl have been confirmed from Turkey, Romania and Russia, due probably to infection via migratory birds. The direct risk of infection in humans in Europe is very low and is associated with direct exposure to infected poultry. In order to address the long-term risk of a pandemic due to recombination of human and avian viruses or to mutations in the avian virus itself, guidelines for pandemic preparedness have been developed and implemented in the Netherlands.

Animals↗
PubMed2004

Health information privacy and syndromic surveillance systems.

The development of syndromic surveillance systems to detect potential terrorist-related outbreaks has the potential to be a useful public health surveillance activity. However, the perception of how the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule applies to the disclosure of certain public health information might affect the ability of state and local health departments to implement syndromic surveillance systems within their jurisdictions. To assess this effect, a multiple-question survey asked respondents to share their experiences regarding patient confidentiality and HIPAA Privacy Rule requirements when implementing syndromic surveillance systems. This assessment summarizes the results of a national survey of state terrorism-preparedness coordinators and state epidemiologists and reflects the authors' and others' experiences with implementation.

Bioterrorism↗