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PubMed2005

SARS and biothreat preparedness--a survey of ACT general practitioners.

In late 2003 and early 2004 the ACT Division of General Practice and ACT Health conducted two concurrent surveys designed to identify knowledge, attitudes and practices of Australian Capital Territory (ACT) general practitioners around severe acute respiratory syndrome (SARS) and biothreat preparedness. One survey asked individual general practitioners (GPs) about how they gathered information about SARS in 2003, how they preferred to receive information, current practices, and how they perceived the threat of SARS and other infectious agents. The second survey asked practice principals how they organised their practice to respond to the SARS threat in 2003, any difficulties they had with implementing this response, use of SARS infection control guidelines and current policies. The response rate for the individual GP survey was 48 per cent (184/381) and the response rate for the practice organisation survey was 54 per cent (74/136). GPS used many sources of information on SARS during the 2003 outbreak. Facsimiles from the ACT Division of General Practice were the primary source (17%) and facsimile was the preferred method of receiving information in future outbreaks. The majority of GP respondents felt adequately informed about SARS during the 2003 outbreak, but many general practices did not follow the national guidelines on telephone screening of patients, warning signs and having infection control kits available. The majority of practices reported that they had policies or procedures in place to isolate potentially infectious patients from others in the waiting room. GPs rated an influenza pandemic as a threat to themselves and their patients much more highly than SARS or bioterrorism. Suggestions and comments on how ACT GPs could be better prepared to respond to future outbreaks included the need for timeliness of information, information delivery mechanisms, communication issues, education, the availability of guidelines and protocols, planning, role delineation, the use of response teams, provision of equipment, and vaccination. Planning for future infectious disease outbreak events in the Australian Capital Territory should incorporate general practitioners so that the plans reflect what is a feasible response in the general practice setting.

Adult↗
PubMed2002

Conceptional considerations for a German influenza pandemic preparedness plan.

A pandemic appearance of influenza A virus must be expected at any time. The limitations of health preserving and life-saving resources, which will inevitably be reached in the event of a pandemic, will be accompanied by ethical and possibly social conflicts, which can be lessened or resolved only through precautionary planning, clearly specified competencies and transparent decisions within a social consensus. In case of a shortage of vaccines and virostatic agents, decisions will have to be made with regard to the segment of the population that absolutely must be vaccinated. It is currently estimated that a (monovalent) vaccine developed for a new pandemic strain would only suffice for the single vaccination of approximately half of the German population after a year; only 10-14 million vaccine dosages would be available to provide basic immunization and single boosters to personnel required to maintain basic medical care and essential infrastructure after half a year. In the event of local influenza outbreaks, antiviral chemotherapeutic agents could be used to close the gap until a vaccine can become effective. Even if suitable influenza vaccines and virostatic agents are not sufficiently available at the start of a pandemic, it is still possible to at least prevent an outbreak of two of the most feared secondary infections that accompany influenza: pneumococcal pneumonia or meningitis and illnesses resulting from Haemophilus influenzae. Agreement still needs to be reached with manufacturers for guaranteeing the necessary vaccine production or ensuring that they have a sufficient stock to meet the minimum demand for antiviral agents and agents for symptomatic treatment.

Antiviral Agents↗
PubMed2006

Coordinated response to SARS, Vancouver, Canada.

Two Canadian urban areas received travelers with severe acute respiratory syndrome (SARS) before the World Health Organization issued its alert. By July 2003, Vancouver had identified 5 cases (4 imported); Toronto reported 247 cases (3 imported) and 43 deaths. Baseline preparedness for pandemic threats may account for the absence of sustained transmission and fewer cases of SARS in Vancouver.

Adult↗
PubMedDate not supplied

The public health dashboard: a surveillance model for bioterrorism preparedness.

The City of Milwaukee Health Department piloted a short-term, near real-time syndromic surveillance and communication tool by using an existing secure regional Internet infrastructure. Voluntary, active syndromic case reporting by hospital Emergency Departments was combined with other data streams, including clinical laboratory reports of communicable disease, hospital emergency room diversions, ambulance runs, medical examiner reports of unusual or suspicious deaths, poison control and nursing hotline call volumes, and pharmacy over-the-counter sales. These data were aggregated into a "Surveillance Dashboard" format that was used to communicate community syndromic health trends to hospitals, Emergency Departments, and other providers using a secure Internet technology. Emergency Departments at 8 area hospitals reported a total of 314 cases meeting syndromic criteria from 26,888 patient encounters. Participants were satisfied with data entry and communications. All participating Emergency Departments received e-mail and text pager alerts sent by the Milwaukee Health Department. No unexplained findings or suggestions of an early outbreak were reported through syndrome surveillance for the 4-week duration of the project. Similar surveillance and communications systems could provide multiple benefits to Emergency Department workflow and management, as well as to public health and emergency response.

Bioterrorism↗
PubMed2027

Nanopore Sequencing for Chikungunya Virus: Principles and Application.

Nanopore sequencing is transforming viral genomics through real-time, portable, long-read analysis of RNA and DNA. Unlike traditional short-read platforms, it detects nucleotide sequences by measuring ionic current changes as nucleic acids pass through nanoscale pores, enabling direct single-molecule sequencing and base modification detection. Its simplicity, flexibility, and capacity for ultra-long reads make it ideal for resolving complex genomic regions, structural variants, and full viral genomes. These advantages have accelerated its use in pathogen surveillance and outbreak response, especially in resource-limited settings. For chikungunya virus (CHIKV), nanopore sequencing allows rapid, culture-independent recovery of complete genomes from clinical and vector samples, enabling real-time tracking of viral diversity, evolution, and spread. Experiences from Ebola, Zika, and COVID-19 have demonstrated the power of portable sequencing, now applied to CHIKV monitoring. Advances in tools such as Guppy, Dorado, Minimap2, and Medaka enhance read quality, consensus accuracy, and downstream analyses. Despite challenges in basecalling and error correction, robust quality control pipelines ensure reliable results. Ongoing improvements in chemistry, flow cell design, and machine learning will further enhance fidelity and throughput, establishing nanopore sequencing as a cornerstone of CHIKV genomic surveillance and epidemic preparedness.

Chikungunya virus↗
PubMed1992

Venezuelan equine encephalomyelitis and African horse sickness. Current status and review.

The arthropod-borne virus (arbovirus) diseases of livestock have worldwide impact. The prevention of an introduction of an exotic disease and the control of one subsequent to an introduction will require the attention, cooperation, and support of the livestock industry, regulatory agencies, and researchers. The most effective protection of our livestock industries is to prevent the introduction of an exotic disease agent. This implies complete restriction of animal imports and exports. However, "zero risk" is an unacceptable option in today's world of internationally integrated and interdependent agriculture. Scientifically sound and factually based regulatory decisions must be combined with continued vigilance and preparedness, as well as appropriately directed surveillance and research, to protect the world agricultural marketplace. Two exotic arbovirus diseases that are of current concern to the livestock industries and regulatory officials of the North American and Caribbean Basin countries are VEE and AHS. Devastating epizootics of VEE in equines have occurred frequently in the Western Hemisphere, but no recent epizootic activity has been documented. Naturally occurring foci of sylvatic, equine nonpathogenic VEE virus subtypes, however, do exist in the tropical countries of the hemisphere. The relationship of these sylvatic virus foci to the origin of equine virulent epizootic VEE virus subtypes is unknown. AHS epizootics had been confined to Africa, the Middle East, and the Indian subcontinent until recent outbreaks in 1966 and 1987-1990 in Spain. With the recurrence of AHS in Spain for the past four years, concern about the possible introduction into potential vector species and equines in the Western Hemisphere has increased. This review addresses the current VEE and AHS virus activity and the potential for outbreaks in the Western Hemisphere.

African Horse Sickness↗
PubMed2005

The application of the Haddon matrix to public health readiness and response planning.

State and local health departments continue to face unprecedented challenges in preparing for, recognizing, and responding to threats to the public's health. The attacks of 11 September 2001 and the ensuing anthrax mailings of 2001 highlighted the public health readiness and response hurdles posed by intentionally caused injury and illness. At the same time, recent natural disasters have highlighted the need for comparable public health readiness and response capabilities. Public health readiness and response activities can be conceptualized similarly for intentional attacks, natural disasters, and human-caused accidents. Consistent with this view, the federal government has adopted the all-hazards response model as its fundamental paradigm. Adoption of this paradigm provides powerful improvements in efficiency and efficacy, because it reduces the need to create a complex family of situation-specific preparedness and response activities. However, in practice, public health preparedness requires additional models and tools to provide a framework to better understand and prioritize emergency readiness and response needs, as well as to facilitate solutions; this is particularly true at the local health department level. Here, we propose to extend the use of the Haddon matrix--a conceptual model used for more than two decades in injury prevention and response strategies--for this purpose.

Disaster Planning↗
PubMed2005

[Modelling the impact of pandemic influenza].

The impact of the next influenza pandemic is difficult to predict. It is dependent on how virulent the virus is, how rapidly it spreads from population to population, and the effectiveness of prevention and response efforts. Despite the uncertainty about the magnitude of the next pandemic, estimates of the health and economic impact remain important to aid public health policy decisions and guide pandemic planning for health and emergency sectors. Planning ahead in preparation for an influenza pandemic, with its potentially very high morbidity and mortality rates, is essential for hospital administrators and public health officials. The estimation of pandemic impact is based on the previous pandemics--we had experienced at least 3 pandemics in 20th century. But the epidemiological characteristics--ie, start season, the impact of 1st wave, pathogenicity and virulence of the viruses and the primary victims of population were quite different from one another. I reviewed methodology for estimation and modelling of pandemic impact and described some nations's results using them in their national preparedness plans. And then I showed the estimates of pandemic influenza impact in Korea with FluSurge and FluAid. And, I described the results of pandemic modelling with parameters of 1918 pandemic for the sake of education and training of the first-line responder health officials to the epidemics. In preparing influenza pandemics, the simulation and modelling are the keys to reduce the uncertainty of the future and to make proper policies to manage and control the pandemics.

Computer Simulation↗
PubMed1999

Rinderpest: a case study of animal health emergency management.

The history of rinderpest and control of the disease in Africa and Asia is reviewed briefly. The present distribution of rinderpest virus in relation to its phylogenetic lineages is presented. Rinderpest-free countries bordering rinderpest-infected countries are considered to be under permanent threat of a transboundary rinderpest incursion and therefore face continuous and serious emergency situations. The nature of these emergencies in relation to the remaining foci of the three lineages is described. It is argued that the Global Rinderpest Eradication Programme (GREP) eradication strategies now need to focus on the use of epidemiological studies to define foci of infection and guide targeted, pulsed vaccination campaigns rather than broad, routine vaccination. The emergency posed by the re-emergence of African lineage 2 virus in East Africa and the challenge of mild rinderpest is explored in some detail as a phenomenon which may be more widespread than has been assumed. Points at which the future of GREP is threatened are illustrated and means of removing some of the dangers are suggested. The lessons which need to be learnt from the experience of the Indian National Project on Rinderpest Eradication and the Pan-African Rinderpest Campaign are discussed, including the value of strengthening surveillance systems in accordance with the Office International des Epizooties Pathway and how to cope with the problem associated with cryptic foci of rinderpest persistence--perhaps the greatest challenge facing GREP. The value of vaccine buffer zones is considered in detail and the authors conclude that unless those zones are of considerable depth and are well maintained, they are unlikely to prevent dissemination of the virus. The role of emergency preparedness planning in preventing the spread of rinderpest is discussed, with the understanding that effective surveillance, as a component of emergency preparedness planning, is safer than vaccination as a means of ensuring that the disease does not re-enter or penetrate a population. The swift initiation of a programme for the eradication of rinderpest from Pakistan is seen as the key issue in dealing with the Asian lineage rinderpest emergency. Development and implementation of strategies with the benefit of experience gained in Africa and India could provide a rapid resolution of the emergency.

Africa↗
PubMed2005

Federal role in early detection preparedness systems.

This report discusses CDC's role in the early detection of threats to public health, including linkage of detection to other preparedness functions, and provides an update on recent progress in improving these capabilities. CDC's role has been fivefold: 1) identifying and adopting information system standards; 2) providing funding; 3) defining critical surveillance functionalities; 4) accelerating Internet-based surveillance systems and electronic reporting of laboratory results; and 5) implementing BioSense, a secure, Internet-accessible, national early detection system that includes syndromic surveillance. Ongoing iterative efforts and consultation are needed to ensure future progress.

Centers for Disease Control and Prevention, U.S.↗
PubMed2006

Pandemic influenza: a note on international planning to reduce the risk from air transport.

The rapid and intercontinental spread of avian influenza in 2005 and the potential for human pandemic influenza caused preparedness plans for such an event to be highlighted. The World Health Organization (WHO) has developed a global influenza preparedness plan, but this document does not address in detail the contribution necessary by the aviation community. The International Civil Aviation Organization, with assistance from WHO, the Airports Council International, and the International Air Transport Association, and others, has developed preparedness guidelines that are in accord with those of WHO but which are focused on the aviation aspects. Effective communication between stakeholders is the single most important issue that is addressed in the preparedness guidelines. States are recommended to appoint a clear contact point at the national aviation level that has responsibility for ensuring that all stakeholders are adequately consulted in the development of an aviation preparedness plan and that the relevant communication links are established. It is also important that the aviation preparedness plan is incorporated into the State's general preparedness plan, which demands efficient collaboration between the departments of health and transport at the government level. Communication with passengers, and those considering traveling, is important so that individuals are made aware of the risks associated with travel to particular parts of the globe and of the risk-reduction measures they may experience, or can take themselves, at airports and on aircraft. The guidelines will be web-based and will evolve as more knowledge becomes available.

Aircraft↗
PubMed2006

Pandemic planning.

Recent trends of hospital ED overcrowding, ambulance diversion and the persistent "dire straits" of emergency medical systems can be expected to be exacerbated under the conditions a pandemic influenza will present. Partners of community healthcare systems must come together to solve these problems as they develop their pandemic influenza response plans. The solution must involve EMS, hospitals, public health and other healthcare partners, as well as local government. Limited surge capacity, overwhelming numbers of citizens requiring and demanding care, and the worried well will simply compound the challenges EMS responders will face. EMS must get proactive and tap the preparedness resources being marshaled at federal, state and local levels. These preparations will not be complete without an exercise that probes for weaknesses in the response plan. EMS agencies are encouraged to join up with other components of the healthcare system, such as hospitals, community health centers and public health, and conduct joint exercises. And we must not forget the coroners, whose plans must include a mass-fatality plan that details the management of what may become an overwhelming number of deceased.

Disaster Planning↗
PubMed2001

Agents of bioterrorism. Preparing for bioterrorism at the community health care level.

Bioterrorism preparedness is clearly a goal for the health care community, working in concert with city, county, state, and federal public health and emergency authorities and in collaboration with law enforcement at the local and federal levels. Opening the channels of communication between all groups involved, obtaining the necessary resources, and maintaining an understanding of the potential agents and the diseases they cause will foster a smooth transition to a rational program directed at patient, personnel, and community safety.

Anthrax↗
PubMed2002

Bioterrorism preparedness for local health departments.

Bioterrorism preparedness has not traditionally been an everyday concern of local public health departments. The likely first responders to a biological bioterrorism event will be local public health personnel. The events of September 11, 2001, and the anthrax crisis that followed tested the capabilities of the public health system and demonstrated its fragility. Little federal funding has trickled down to local health departments, and they have not been included in planning or training for bioterrorism preparedness. Now local health departments must develop detailed bioterrorism response plans. Effective plans will involve internal assessment of strengths and weaknesses and strategizing with other local community agencies. Our health department is a suburban county agency that serves a population of over 250,000. We have started this self-assessment and planning process. This bioterrorism guide has provided some structure for us and may be helpful for other local health departments as they begin this process.

Bioterrorism↗
PubMed2002

Legal preparedness for bioterrorism.

Responding to a terrorist biological weapon attack poses new challenges not only for the public health response community but also to the very construct of public health police powers as we know them today. States are debating the merits of revising and updating these powers in order to ensure an effective and legally appropriate response. This article covers three aspects of the policy debate: the experience in one state from a legislative perspective, a discussion from an academic viewpoint, and one example of the role of enhanced powers from the response perspective.

Biological Warfare↗
PubMed1999

Prevention and control of malaria epidemics.

Malaria epidemics have recently occurred in many areas of the world, particularly in the irregular fringe, along the limits of distribution of malaria endemicity, whether the limiting factors are temperature (latitude or altitude) or relative humidity (deserts), which were the scene of the major epidemics of the past. A review is made of the current approaches to epidemic prevention and control in line with the global malaria control strategy, of which it constitutes an essential element. The different components are discussed, including the identification and study of epidemic prone areas, the search for indicators of epidemic risk, their monitoring, and the early detection and control of actual epidemics. The potential implementation of preventive and control activities depends, nevertheless, on the degree of preparedness of the health services to detect alarm signals, the real time left for action and their capacity of implementation within that time. Recent developments in geographical information systems (GIS) and satellite derived meteorological information offer most useful tools for precise and timely epidemic forecasting, although it should be recognised that such information is only useful if based on a real understanding of their local significance. There remains an urgent need to develop and support local capabilities for the ground truthing of satellite information and for translating it into preventive and control actions.

Disease Outbreaks↗
PubMed1999

Emergency management of disasters involving livestock in developing countries.

Different disasters have similar consequence on the health and welfare of livestock. Numerous geophysical disasters can exacerbate epizootics, resulting in the deaths of many animals and the reduction of production efficiency. These disasters also present a considerable threat of spoilage of processed foods, endangering public health. Furthermore, large-scale disasters involving animals can modify the long-term stability of national economies, the environment and social structures. The authors discuss the vulnerability of the livestock industry to natural disasters and the impact of floods, droughts and transboundary diseases and pests on national economies. Examples are given on how some losses can be avoided, evaluated and compensated. The role of the veterinarian is presented in relation to work conducted by other relief organisations in cases of emergency. In developing countries, mitigation programmes should focus on strengthening global animal health services. Preparedness needs to be community based, with education provided in a timely manner. Effective recovery from disasters should be based on mitigation programmes, including international trade and mutual aid agreements between neighbouring countries to supply appropriate goods and environmentally and culturally appropriate breeds of livestock. Disaster relief for the care of livestock should be recognised as a form of humanitarian assistance, given the benefits to be derived for public health and the socio-economic implications of successful intervention.

Animal Diseases↗
PubMed2006

Vaccines and antiviral drugs in pandemic preparedness.

While measures such as closing schools and social distancing may slow the effects of pandemic influenza, only vaccines and antiviral drugs are clearly efficacious in preventing infection or treating illness. Unless the pandemic strain closely resembles one already recognized, vaccine will not be available early. However, studies can be conducted beforehand to address questions concerning vaccine dose, frequency of inoculation, and need for adjuvants. In contrast, antiviral drugs, particularly the neuraminidase inhibitors, will be effective for treatment and available if stockpiling takes place. Special questions need to be answered if a highly lethal virus, such as influenza A (H5N1), produces the pandemic. Both vaccines and antiviral drugs will be required for a coordinated strategy.

Antiviral Agents↗