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PubMed2006

Disease prevention and preparedness for animal health emergencies in the Middle East.

The animal health situation in the Middle East is particularly unfavourable, as this area is exposed to many serious animal diseases. The Middle East is ill-prepared to institute disease prevention and control measures, due to deficiencies at both national and regional levels. Early detection, diagnosis and reporting of diseases must become a priority within these countries and effective communication should be maintained among them. Regional animal health programmes and the support of international institutions are essential to improve preparedness for natural or human-caused emergency situations, which can seriously affect animal health. Such emergencies can also have significant impacts on related public health issues.

Animal Diseases↗
PubMed2002

Confronting bioterrorism: physicians on the front line.

The events surrounding September 11, 2001, and its aftermath have compelled the public health and medical community to face the hitherto unfamiliar reality of bioterrorism. Physicians and public health personnel are frontline soldiers in this new form of warfare. This article provides a general overview of the pathophysiology, clinical presentation, diagnosis, and management of patients infected with the 6 highest priority agents that could potentially be used in bioterrorism. The diseases discussed include anthrax, smallpox, tularemia, plague, botulism, and viral hemorrhagic fevers. Despite the unpredictable nature of bioterrorism, disaster preparedness and knowledge of essential diagnostic and epidemiological principles can contribute substantially toward combating this new threat.

Anthrax↗
PubMed2002

Bioterrorism preparedness. III: State and federal programs and response.

Management of a bioterrorism event will begin with early detection and intervention at the local level. Any large-scale event will require rapid state and federal assistance. Federal initiatives targeting bioterrorism have increasingly become a complex web of executive and legislative actions, frequently initiated in reaction to specific events, and often unrelated to this threat. Multiple executive and legislative branch actions have resulted in a proliferation of federal programs, and coordination of these efforts remains a significant challenge. Still, great strides have been taken to improve our defensive posture against this emerging threat, and, at all levels, governmental authorities and agencies are much better prepared to respond to such events than they were a decade ago. The events of September 11, 2001 and subsequent events are clear indicators that the timeline for preparedness has been significantly compressed. Federal emergency operations, historically designed more for recovery than response, seemed up to the task in the wake of the World Trade Center and Pentagon attacks, although there was criticism of federal responsiveness to the subsequent anthrax incidents [71,72], and the timeliness of federal resources in the event of a large-scale outbreak resulting from a bioterrorism attack has yet to be truly tested. The recent establishment of the Office of Homeland Security and the Homeland Security Council holds promise that some of these inefficiencies may be rectified and overall coordination of programs will improve. Continued improvements in the effectiveness of the federal government in meeting the challenges of this and other emerging threats to homeland security will require: Establishment of consensus standards, metrics, and measures of effectiveness for all aspects of disaster, epidemic, and terrorism management at the local, regional, state, and federal levels Delineation of expected, quantifiable state and local capabilities to mitigate, prepare, respond, and recover from all disasters, including those caused by terrorist actions Development of predefined or clear and rapidly discernible criteria for deployment of state and federal emergency resources Full accountability of program costs and expenditures Continued consolidation or coordination of the many overlapping and at times redundant federal programs.

Bioterrorism↗
PubMedDate not supplied

Community preparedness for HIV vaccine trials in the Democratic Republic of Congo.

This paper reports on an assessment of community preparedness for HIV vaccine trials in the Democratic Republic of Congo. Formative research was conducted in the capital city of Kinshasa during the period October 2003 to March 2004 to answer questions pertinent to planning trials of a preventive HIV vaccine and to identify related issues. Twenty-seven in-depth interviews and two focus groups were held with potential trial participants and community leaders. Data was collected on the subjects of vaccines, HIV/AIDS and sexual behaviour, and an HIV vaccine. The study also sought to identify factors that motivate a person to volunteer for a vaccine trial or which are disincentives to participation, along with preparedness of the larger community for trials. Personal concerns for health and for the impact of the epidemic on families and country were common motivations for participation. The danger of an experimental vaccine and the stigma of a positive HIV antibody test as the result of vaccination are major concerns and disincentives. The health, educational, and local non-governmental sectors are identified as having important roles to play in assuring preparedness for trials, although significant challenges exist to achieving community preparedness.

AIDS Vaccines↗
PubMed2001

Psychological effects of biological warfare.

We compare and contrast psychological and behavioral reactions to bioterrorism with responses to the use of traditional and chemical weapons by terrorists. We discuss the characteristics of biological agents that make them potent agents of terror. We suggest strategies for preparation and response to bioterrorism. We reviewed the literature on psychological, behavioral, and social responses to terrorism, natural disasters, and infectious disease outbreaks. The first psychiatric intervention is to ensure good medical care for illness. Initial psychosocial interventions also include effective and accurate risk communication, management of misattribution of somatic symptoms, and the creation of a recovery environment that restores effective social roles and returns people to their usual sources of social support. Bioterrorism presents special challenges for our society. Domestic bioterrorism preparedness and response plans should reflect realistic consideration of psychological, behavioral, and societal reactions to this novel weapon.

Behavior↗
PubMed2002

Introduced ticks and tick-borne diseases: the threat and approaches to eradication.

Exotic tick species and tick-borne diseases are serious threats to live-stock, companion animals, and wildlife in the United States. Recurring introductions of exotic tick species into the United States are a significant indicator of the degree of risk. Successful tick-eradication campaigns, such as the national program that eradicated Boophilus annulatus and B. microplus from the United States, the Cattle Fever Tick Eradication Program of the US Department of Agriculture's Veterinary Services that protects against the re-entry and dissemination of Boophilus ticks from Mexico back into their former haunts in the southern states, and the eradication action that eliminated Rhipicephalus evertsi from a game park in Florida, are sources of useful information that aid in elucidating essential elements of successful eradication programs. Examples of failed eradication programs in places such as Puerto Rico and St. Croix also have heuristic value. Among the varieties of tick species and related infectious agents that threaten the United States, Boophilus ticks and bovine babesiosis, Amblyomma species (especially the tropical bont tick) and heartwater, and equine babesiosis, for which endemic vectors exist, are of special concern. Risk assessments to accumulate, evaluate, and synthesize information needed to appraise risks, consequences, and preparedness are necessary not just to inform federal, state, and local officials, as well as producers and stakeholders, but also to facilitate the creation of emergency response plans.

Animal Diseases↗
PubMed2005

Cross-sector leadership development for preparedness.

After fall 2001, scientists and professionals recognized the importance of integrating public health with traditional first-response professions in planning and training for disasters. However, operationalizing this approach among professionals in the field confronted barriers that were both inter-cultural and jurisdictional. The Pennsylvania Preparedness Leadership Institute (PPLI) is a collaboration of the Pennsylvania Department of Health and the University of Pittsburgh Center for Public Health Preparedness. Team members are recruited from public health, emergency medicine, emergency management, hospitals, and public safety agencies from each of nine multi-county regions in Pennsylvania. Each team takes on a year-long project that addresses a strategic problem as a focus for capacity-building within its region. Unexpectedly during PPLI's first year in operation, a hepatitis-A outbreak tested whether one regional team could successfully mount the necessary integrated response. This experience, as well as the planned evaluation for PPLI, demonstrated both the successful processes and the positive impact of this integrated leadership training initiative.

Curriculum↗
PubMed2006

Resurgence of wild poliovirus type 1 transmission and consequences of importation--21 countries, 2002-2005.

After the 1988 World Health Assembly resolution to eradicate poliomyelitis globally, the number of polio-endemic countries decreased from 125 in 1988 to six (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) in 2003. However, during 2002-2005, a total of 21 previously polio-free countries were affected by importations of wild poliovirus (WPV) type 1 from the six remaining countries (primarily Nigeria) where WPV was endemic; four countries (Indonesia, Somalia, Sudan, and Yemen) had outbreaks of >100 polio cases. By the end of 2005, WPV transmission in all 21 countries except Somalia had been interrupted or substantially curtailed. This report summarizes WPV importations into polio-free countries during 2002-2005 and the status of WPV transmission in these countries as of January 24, 2006, and describes actions that polio-free countries can take to improve importation preparedness.

Emigration and Immigration↗
PubMed2006

[Development of attenuated H5N1 avian influenza vaccines using reverse genetic technology].

Outbreaks caused by highly pathogenic H5N1 avian influenza viruses have spread worldwide and the containment is impossible no longer. During the outbreaks, over 200 human infection cases with 55% fatality are confirmed at the moment and some human-to -human transmission in family clusters have been observed in Vietnam, Thailand and Indonesia. The potency of pandemic caused by highly pathogenic H5N1 avian influenza is increasing gradually. Consequently, development of effective H5N1 vaccine and its licensing for vaccination to human are urgent countermeasures for pandemic preparedness. In the present article, the author reviews the development of H5N1 attenuated vaccine by reverse genetic technology and discuss the problems on the vaccine production to be dissolved before pandemic occur.

Animals↗
PubMedDate not supplied

Combining the benefits of decision science and financial analysis in public health management: a county-specific budgeting and planning model.

State public health agencies are charged with providing and overseeing the management of basic public health services on a population-wide basis. These activities have a re-emphasized focus as a result of the events of September 11, 2001, the subsequent anthrax events, and the continuing importance placed on bioterrorism preparedness, West Nile virus, and emerging infectious diseases (eg, monkeypox, SARS). This has added to the tension that exists in budgeting and planning, given the diverse constituencies that are served in each state. State health agencies must be prepared to allocate finite resources in a more formal manner to be able to provide basic public health services on a routine basis, as well as during outbreaks. This article describes the use of an analytical approach to assist financial analysis that is used for budgeting and planning in a state health agency. The combined benefits of decision science and financial analysis are needed to adequately and appropriately plan and budget to meet the diverse needs of the populations within a state. Health and financial indicators are incorporated into a decision model, based on multicriteria decision theory, that has been employed to acquire information about counties and public health programs areas within a county, that reflect the impact of planning and budgeting efforts. This information can be used to allocate resources, to distribute funds for health care services, and to guide public health finance policy formulation and implementation.

Budgets↗
PubMed2006

Influenza as an issue on the agenda of policy makers and government representatives. What can we do? What do we need?

Influenza vaccinations and antiviral drugs are the foundation of epidemic and pandemic preparedness, but only close collaboration between public health authorities and industry can achieve the necessary production levels and ensure the smooth distribution necessary to protect European citizens from this public health scourge. To focus the minds of all public health stakeholders, ESWI has translated these simple facts into clear achievable goals: it recommends that EU governments vaccinate one-third of their populations by 2010 and stockpile antiviral drugs for 20% of their citizens while promoting public-private partnerships. The scientific justification behind this objective is easily understood namely that while the annual flu shot protects against three viral strains,the pandemic vaccine will focus on only the one highly lethal virus. As a result if countries succeed in meeting the target to vaccine one-third of the EU-25 population with a trivalent vaccine, sufficient monovalent pandemic vaccine could be produced to vaccinate almost the entire EU-25 population at least once. Achieving these objectives would go far to containing the pandemic and ensuring necessary treatment to avoid needless deaths and social and economic disruption. It would also signal that influenza preparedness had become part of the European mindset. Relying on the technique of force-field analysis organised by professional facilitators the session asked government representatives and policy makers to identify existing factors that either provide support for the objectives or hinder progress.

Disease Outbreaks↗
PubMed2005

Coastal terrorism: using tabletop discussions to enhance coastal community infrastructure through relationship building.

The unique vulnerability of the nation's ports to terrorist attacks and other major disasters requires development of specialized training approaches that integrate and connect critical stakeholders. In 2003, the University of South Carolina Center for Public Health Preparedness developed and held its first Coastal Terrorism workshop in conjunction with the National Oceanic and Atmospheric Administration. Key federal, regional, state, and coastal agency leaders were invited to the 2-day event to explore, in a no-risk environment, the crucial role that public health agencies would play in a covert biological agent incident aboard a cruise ship. The incident began as a possible outbreak of a Norwalk-like viral agent; however, as the scenario unfolded, evidence of a terrorist plot emerged. This immediately shifted the scenario from a public health-dominated incident to one directed by law enforcement. Communication and coordination issues surfaced illustrating potential conflicts between disciplines and jurisdictions in terms of roles and responsibilities of responding agencies. The goals of the workshop were to facilitate communication and interagency networking among coastal stakeholders while assessing their training and research needs and increasing their familiarity with resources and protocols regarding a bioterrorist coastal event. Positive systems changes were observed.

Bioterrorism↗
PubMed2004

Modeling pandemic preparedness scenarios: health economic implications of enhanced pandemic vaccine supply.

Influenza pandemic planning is a complex, multifactorial process, which involves public health authorities, regulatory authorities, academia and industry. It is further complicated by the unpredictability of the time of emergence and severity of the next pandemic and the effectiveness of influenza epidemic interventions. The complexity and uncertainties surrounding pandemic preparedness have so far kept the various stakeholders from joining forces and tackling the problem from its roots. We developed a mathematical model, which shows the tangible consequences of conceptual plans by linking possible pandemic scenarios to health economic outcomes of possible intervention strategies. This model helps to structure the discussion on pandemic preparedness and facilitates the translation of pandemic planning concepts to concrete plans. The case study for which the model has been used shows the current level of global pandemic preparedness in an assumed pandemic scenario, the health economic implications of enhanced pandemic vaccine supply and the importance of cell culture-based influenza vaccine manufacturing technologies as a tool for pandemic control.

Disease Outbreaks↗
PubMed2006

How prepared is Europe for pandemic influenza? Analysis of national plans.

BACKGROUND: The threat of a human pandemic of influenza has prompted urgent development of national preparedness plans. We assessed these plans, to judge Europe's preparedness for pandemic influenza. METHODS: Published national pandemic influenza preparedness plans from the European Union countries, the two acceding countries (Bulgaria and Romania), Norway, and Switzerland, were evaluated against criteria taken from a WHO checklist. Plans were eligible for inclusion if formally published between Jan 1, 2002, and Nov 30, 2005. FINDINGS: 21 national plans were eligible for inclusion for analysis. Although preparation for surveillance, planning and coordination, and communication were good, maintenance of essential services, putting plans into action, and public-health interventions were probably inadequate. Few countries have addressed in their plans the need for collaboration with adjacent countries, despite this being an acknowledged imperative. Similarly, plans for the timely distribution of available medical supplies are notably absent. INTERPRETATION: Governmental commitment in most European countries is strong, and levels of preparedness are broadly good. However, gaps in preparedness planning remain, and substantial variations exist between countries, with important implications for the region and nation states. Improved cooperation between countries may be needed to share experience, and to ensure coherence of approaches.

Animals↗
PubMed2005

[Smallpox preparedness in Denmark].

Although the likelihood of a deliberate release is considered to be minor, smallpox virus poses a worldwide terrorism security risk because it (1) can easily be disseminated and transmitted from person to person; (2) results in high mortality rates and has the potential to create a major public health impact; (3) might cause public panic and social disruption; and (4) requires special action for public health preparedness. Consequently, Statens Serum Institute and the National Board of Health have developed a Danish smallpox preparedness plan. This article discusses critical aspects of the plan, including risk analysis and a multi-tiered action plan, vaccination, analysis of clinical specimens, the establishment of active surveillance teams and generic contingency elements.

Bioterrorism↗
PubMed2005

[Principles of epidemic emergency preparedness planning: the example of the German Influenza Pandemic Preparedness Plan].

Despite significant medical progress, recent events have shown that infectious diseases have not lost significance. Indeed, the threat of worldwide epidemics has increased. Due to their high infectious ness and rapid person-to-person transmissibility, the emergence of new influenza viruses with pandemic potential poses an especially alarming situation in this regard. The world population would be "immunologically naïve" to a new pandemic virus, permitting explosive spread of the disease. During the last century, three influenza pandemics have demonstrated that this is not merely a hypothetical risk. Currently it is feared that the possible human adaptation of avian influenza viruses that have recently become endemic in birds in Southeast Asia could result in a new pandemic strain. With the publication of the German Influenza Pandemic Preparedness Plan, preparation for this potential threat has reached an important stage in Germany. The implementation of the plan, which includes measures that go beyond the scope of public health, must now proceed swiftly. The long-term goal of pandemic preparedness planning is to be better equipped to deal with potential health threats in general, in particular those ensuing from the emergence of new infectious diseases under conditions of a growing global network.

Animals↗
PubMed2006

Preparing for the unthinkable: emergency preparedness for the hematopoietic cell transplant program.

Emergencies come at the most inopportune times. Some are totally unexpected, others come with short warnings. Although rare, an emergency comes with the potential to wreak disaster and pose serious risk to the services provided to hematopoietic cell transplant (HCT) patients. Yet, the consequences of an emergency can be mitigated by thinking the unthinkable and having a plan for emergency preparedness in place. Each HCT center should develop a plan containing steps of mitigation, preparedness, response and recovery. This report provides the framework for a HCT-specific emergency preparedness plan that can be used by individual centers to develop customized guidelines on preparing for, responding to, and recovering from an emergency.

Disaster Planning↗
PubMed2006

Public health preparedness in Alberta: a systems-level study.

BACKGROUND: Recent international and national events have brought critical attention to the Canadian public health system and how prepared the system is to respond to various types of contemporary public health threats. This article describes the study design and methods being used to conduct a systems-level analysis of public health preparedness in the province of Alberta, Canada. The project is being funded under the Health Research Fund, Alberta Heritage Foundation for Medical Research. METHODS/DESIGN: We use an embedded, multiple-case study design, integrating qualitative and quantitative methods to measure empirically the degree of inter-organizational coordination existing among public health agencies in Alberta, Canada. We situate our measures of inter-organizational network ties within a systems-level framework to assess the relative influence of inter-organizational ties, individual organizational attributes, and institutional environmental features on public health preparedness. The relative contribution of each component is examined for two potential public health threats: pandemic influenza and West Nile virus. DISCUSSION: The organizational dimensions of public health preparedness depend on a complex mix of individual organizational characteristics, inter-agency relationships, and institutional environmental factors. Our study is designed to discriminate among these different system components and assess the independent influence of each on the other, as well as the overall level of public health preparedness in Alberta. While all agree that competent organizations and functioning networks are important components of public health preparedness, this study is one of the first to use formal network analysis to study the role of inter-agency networks in the development of prepared public health systems.

Alberta↗