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Health Security

Michael R Snyder, Sanjana J Ravi
2018 marks the centennial of the 1918 influenza pandemic, widely acknowledged as one of the deadliest infectious disease crises in human history. As public health and medical communities of practice reflect on the aftermath of the influenza pandemic and the ways in which it has altered the trajectory of history and informed current practices in health security, it is worth noting that the Spanish flu was preceded by a very different 100-year threat: the first Asiatic cholera pandemic of 1817 to 1824. In this commentary, we offer a historical analysis of the common socioeconomic, political, and environmental factors underlying both pandemics, consider the roles of cholera and Spanish flu in shaping global health norms and modern public health practices, and examine how strategic applications of soft power and broadening the focus of health security to include sustainable development could help the world prepare for pandemics of the future...
December 4, 2018: Health Security
Jacinta Smith, Denise Gangadharan, Mark Hemphill, Samuel Edwin
The Centers for Disease Control and Prevention's Division of Select Agents and Toxins (DSAT) regulates the possession, use, and transfer of select agents and toxins throughout the United States as part of the Federal Select Agent Program. The Department of Health and Human Services (HHS) select agent regulations also include criteria for the exclusion of select agents and toxins from the requirements of the regulations (42 CFR § 73.3 and 73.4). An entity may request the exclusion of an attenuated strain of a select agent or a select toxin modified to be less potent or toxic...
December 4, 2018: Health Security
David Manheim
The central argument in this article is that the probability of very large natural pandemics is more uncertain than either previous analyses or the historical record suggest. In public health and health security analyses, global catastrophic biological risks (GCBRs) have the potential to cause "sudden, extraordinary, widespread disaster," with "tens to hundreds of millions of fatalities." Recent analyses focusing on extreme events presume that the most extreme natural events are less likely than artificial sources of GCBRs and should receive proportionately less attention...
November 29, 2018: Health Security
Lacey MenkinSmith, Kathy Lehman-Huskamp, John Schaefer, Myrtede Alfred, Ken Catchpole, Brandy Pockrus, Dulaney A Wilson, J G Reves
This article describes a pilot trial of an internet-distributable online software package that provides course materials and built-in evaluation tools to train healthcare workers in high-risk infectious disease response. It includes (1) an online self-study component, (2) a "hands-on" simulation workshop, and (3) a data-driven performance assessment toolset to support debriefing and course reporting. This study describes a pilot trial of the software package using a course designed to provide education in Ebola response to prepare healthcare workers to safely function as a measurable, high-reliability team in an Ebola simulated environment...
November 29, 2018: Health Security
Tamer Hadi, Christopher Paquet, Naeem Ullah, Beth Maldin Morgenthau
From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations...
November 29, 2018: Health Security
Mitch Stripling, Colin Stimmler, Marisa Raphael, Oxiris Barbot
In late 2017 and early 2018, the New York City Department of Health and Mental Hygiene deployed multiple teams to Puerto Rico and the US Virgin Islands to support public health in those territories. This article is a description of how those teams were conceived, deployed, supported, and reintegrated into the agency. This was an unprecedented mission for our agency, and what follows is a reflection on what worked and what didn't work for us. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and that collectively we can continue to advance the field of public health preparedness and response...
October 6, 2018: Health Security
Bishwa B Adhikari, Lisa M Koonin, Melissa L Mugambi, Kellye D Sliger, Michael L Washington, Emily B Kahn, Martin I Meltzer
Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call® , a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call® during an influenza pandemic. The tool incorporates 2 influenza clinical attack rates (20% and 30%), 4 different levels of pandemic severity, and different initial "seed numbers" of cases (10 or 100), and it allows variation in which week the nurse triage line opens...
September 2018: Health Security
Jeffrey S Quinn
No abstract text is available yet for this article.
September 2018: Health Security
Sarah R Carter, Christopher M Warner
Recent developments in synthetic biology tools and techniques are driving commercialization of a wide range of products for human health, agriculture, environmental stewardship, and other purposes. This article reviews some of the trends in synthetic biology applications as well as some of the tools enabling these and future advances. These tools and capabilities are being developed in the context of a rapidly changing industry, which may have an impact on the rate and direction of progress. Final products are subject to a regulatory framework that is being challenged by the pace, scale, and novelty of this new era of biotechnology...
September 2018: Health Security
Crystal Watson, Matthew Watson, Daniel Gastfriend, Tara Kirk Sell
This article is the latest in an annual series analyzing federal funding for health security programs. We examine proposed funding in the President's Budget Request for FY2019, provide updated amounts for FY2018, and update actual funding amounts for FY2010 through FY2017. Building health security for the nation is the responsibility of multiple agencies in the US federal government, as well as that of state, tribal, territorial, and local governments and the private sector. This series of articles focuses on the federal government's role in health security by identifying health security-related programs in public health, health care, national security, and defense and reporting funding levels for that ongoing work...
September 2018: Health Security
Nathan Myers, Karl Schmitt
This commentary discusses the prospect and value of using the preparedness rule developed and implemented by the Centers for Medicare and Medicaid Services as a focal point for better integrating health system preparedness into broader community resilience efforts, whether at the local or international level. Much attention has been given to the idea that community resilience requires extensive collaboration and coordination between actors across sectors, elements that are vital to effective emergency preparedness in health care as well...
September 2018: Health Security
Holly A Taylor, Lainie Rutkow, Daniel J Barnett
As ecologic, social, and economic conditions continue to facilitate the emergence and transmission of infectious diseases, local health department workers' willingness to respond will remain vital to the United States' ability to recognize and respond to new and emerging disease threats. As demonstrated by heavy occupational morbidity and mortality associated with the 2014 Ebola outbreak, infectious disease response can pose serious risks to the health workforce and presents many ethical and logistical challenges...
September 2018: Health Security
Feng-Jen Tsai, Rebecca Katz
In 2016, the World Health Organization moved from using only a self-assessment to monitor national implementation of the International Health Regulations (IHR) to introducing an external evaluation process. In this article, we use preliminary findings from the published Joint External Evaluations to identify if and how the external evaluations differ from IHR self-assessments conducted in the same year. We found that of the 32 countries for which data were available, external assessment scores are consistently 1 to 1...
September 2018: Health Security
Leslie Z Sokolow, Anita Patel, Lisa M Koonin, Samuel B Graitcer
In 2015, the Centers for Disease Control and Prevention (CDC) collaborated with the National Association of County and City Health Officials (NACCHO) to develop and conduct the Scripted Surge Pharmacy Pandemic Exercise to assess the capacity of pharmacies to administer vaccines and dispense medications during a severe influenza pandemic and to evaluate their various approaches to this activity. A mass merchant pharmacy and a supermarket pharmacy were recruited in 2 different states. At each pharmacy, 2 consecutive 90-minute exercise runs were completed in which actors, simulating patients, presented themselves to the pharmacy counter and requested a vaccine and/or prescription(s)...
July 2018: Health Security
Mark Misener, David T Starr, Allison J Scaccia, Vibhuti Arya
Individuals exposed to spores of B. anthracis must take a course of antibiotics as postexposure prophylaxis (PEP) to prevent inhalation anthrax. During an anthrax event, public health authorities are responsible for conducting dispensing operations to offer PEP to exposed individuals. Jurisdictions have developed antibiotic PEP screening algorithms to determine which antibiotic is appropriate for each individual. Variability exists with regard to screening questions and dispensing decisions based on responses to those questions...
July 2018: Health Security
Celia Quinn, Eugenie Poirot, Afua Sanders Kim, Aishwarya L Viswanath, Sneha N Patel, David M Abramson, Rachael Piltch-Loeb
The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) used multiple methods to provide guidance to healthcare providers on the management and prevention of Zika virus disease during 2016. To better understand providers' use of information sources related to emerging disease threats, this article describes reported use of information sources by NYC providers to stay informed about Zika, and patterns observed by provider type and practice setting. We sent an electronic survey to all email addresses in the Provider Data Warehouse, a system used to maintain information from state and local health department sources on all prescribing healthcare providers in NYC...
July 2018: Health Security
Lindsay R Gabbert, Justin D Smith, John G Neilan, Geoffrey S Ferman, Max V Rasmussen
Validated procedures for decontamination of laboratory surfaces and equipment are essential to biosafety and biorisk programs at high-containment laboratories. Each high-containment laboratory contains a unique combination of surfaces, procedures, and biological agents that require decontamination methods tailored to specific facility practices. The Plum Island Animal Disease Center (PIADC) is a high-containment laboratory operating multiple biosafety level (BSL)-3, ABSL-3, and BSL-3 Ag spaces. The PIADC facility requires the use of federally issued smart cards, called personal identity verification (PIV) cards, to access information technology (IT) networks both outside and within the high-containment laboratory...
July 2018: Health Security
Elizabeth A Armstrong-Mensah, Serigne M Ndiaye
In today's interconnected world, infectious diseases can spread rapidly within and between countries. The 2014-2016 Ebola epidemic in Guinea, Liberia, and Sierra Leone underscored the inability of countries with limited capacities and weak public health systems to respond effectively to outbreaks. To mitigate future health threats, nations and international organizations launched the Global Health Security Agenda (GHSA) to accelerate compliance with the WHO's International Health Regulations, so as to enhance global protection from infectious disease threats...
July 2018: Health Security
Elena H Kwon, Ronald B Reisler, Anthony P Cardile, Theodore J Cieslak, Michael J D'Onofrio, Angela L Hewlett, Karen A Martins, Chi Ritchie, Mark G Kortepeter
Differentiating between illness caused by community-acquired respiratory pathogens versus infection by biothreat agents is a challenge. This review highlights respiratory and clinical features of category A and B potential biothreat agents that have respiratory features as their primary presenting signs and symptoms. Recent world events make such a reminder that the possibility of rare diseases and unlikely events can occur timely for clinicians, policymakers, and public health authorities. Despite some distinguishing features, nothing can replace good clinical acumen and a strong index of suspicion in the diagnosis of uncommon infectious diseases...
July 2018: Health Security
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