Publications

Tuberculosis (TB) remains a global public health problem with significant morbidity and mortality. In 2011, there were an estimated 8.7 million new cases of TB, and 1.4 million people died from TB. Individuals with latent TB infection (LTBI) represent an important source of new cases of active TB. Approximately 5%–10% of those infected will develop active disease, and most will be capable of infecting others. Accurate diagnosis and effective treatment of LTBI represent an important opportunity to prevent the morbidity and mortality associated with TB.

The UPMC Center for Health Security and the National Association of County and City Health Officials (NACCHO) produced this report to catalyze improvements in local health departments' ability to use social media and mobile technologies to improve preparedness efforts. We conducted 65 interviews with LHD staff across the country and analyzed existing data and studies on the use of social media and mobile technologies for disaster management. This report outlines organizational factors that enable or impede LHDs' ability to use social media and mobile health platforms, as identified through interviews with LHD staff, and puts forth a series of recommendations for local health practitioners and state and federal policymakers to support use of these platforms at the local level.

Over the past decade, community engagement has become a central tenet of US federal doctrine on public health emergency preparedness. Little is known, however, about how the vision of a ready, aware, and involved populace has translated into local practice, or which conditions thus far have advanced community involvement in what is typically considered the province of government authorities and emergency professionals. In 2011-12, to help close that knowledge gap, investigators carried out semistructured qualitative interviews with practitioners (N = 25) from 7 local health departments about which conditions have advanced or inhibited community engagement in public health emergency preparedness. Among the organizational factors identified as enabling local health departments’ involvement of community residents and groups in emergency preparedness were a supportive agency leadership and culture, sufficient staffing and programmatic funding, interested and willing partners, and external triggers such as federal grants and disaster experiences that spotlighted the importance of community relationships to effective response. Facing budget and staff cuts, local health departments feel increasingly constrained in efforts to build trusted and lasting preparedness ties with community partners. At the same time, some progress in preparedness partnerships may be possible in the context of agency leadership, culture, and climate that affirms the value of collaboration with the community.

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series have analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through proposed funding for FY2013. This article updates those figures with budgeted amounts for FY2014, specifically analyzing the budgets and allocations for biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, Commerce, Veterans Affairs, and State; the Environmental Protection Agency; and the National Science Foundation. This article also includes an updated assessment of the proportion of biodefense funding provided for programs that address multiple scientific, public health, healthcare, national security, and international security issues in addition to biodefense. The FY2014 federal budget for civilian biodefense totals $6.69 billion. Of that total, $5.86 billion (88%) is budgeted for programs that have both biodefense and nonbiodefense goals and applications, and $835 million (12%) is budgeted for programs that have objectives solely related to biodefense.

It's that time of year to think about New Year's resolutions--the kind that could increase our chances that the coming year will be better than 2013 and years prior. In that spirit, we suggest some resolutions for 2014 to better protect people from the consequences of (increasingly common) disasters, epidemics, and other threats to health security.

During past influenza seasons, the principal quandary individuals faced was whether or not to get a flu vaccination. However, this flu season we have the additional decision of choosing among several different vaccine options. The fact that these options exist is a testament to the investments made to improve flu vaccine in the face of looming pandemics.

To better respond to influenza pandemics, vaccines have been sought that offer broader protection, can be delivered in novel ways, have greater immunogenicity, are antigen sparing (that is, contain less of the active ingredient), do not require eggs for manufacture, and harness recombinant technology. This year, for the first time, each of these advances is represented in one or more of the vaccine options.

The Rad Resilient City Checklist is a local planning tool that can help save tens of thousands of lives following a nuclear detonation. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the most lives following a nuclear detonation. Yet, most Americans are not familiar with correct safety measures against fallout, and many believe that nothing can be done to reduce the suffering and death inflicted by a nuclear attack. Moreover, cities have no checklist on how to prepare the emergency management infrastructure and the larger population for this hazard, despite hundreds of pages of useful guidance from the federal government and radiation professional organizations. The Rad Resilient City Checklist reverses this situation by converting the latest federal guidance and technical reports into clear, actionable steps for communities to take to protect their residents from exposure to radioactive fallout. The checklist reflects the shared judgment of the Nuclear Resilience Expert Advisory Group, a national panel led by the Center for Biosecurity and comprised of government decision makers, scientific experts, emergency responders, and leaders from business, volunteer, and community sectors.

Abstract: Hurricane Katrina demonstrated that a catastrophic event in the continental United States (US) can overwhelm domestic medical response capabilities. The recent focus on response planning for a catastrophic earthquake in the New Madrid Seismic Zone and the detonation of an improvised nuclear device also underscore the need for improved plans. The purpose of this analysis is to identify the potential role of foreign medical teams (FMTs) in providing medical response to a catastrophic event in the US. We reviewed existing policies and frameworks that address medical response to catastrophic events and humanitarian emergencies and assess current response capabilities by a variety of FMTs. While several policies and plans outline the role of the US in providing medical assistance during foreign disasters, further planning is necessary to identify how the US will integrate foreign medical assistance during a domestic catastrophic event. We provide an overview of considerations related to federal roles and responsibilities for managing and integrating FMTs into the overarching domestic medical response to a catastrophic disaster occurring in the continental US.

The UPMC Center for Health Security and the Rad Resilient City Initiative commend the public health leaders of Ventura County, CA, and their partners  on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

Ventura County, CA, Launches Nuclear Response Public Information Campaign

September 18, 2013—The UPMC Center for Health Security commend the public health leaders of Ventura County, CA, and their partners today on the launch of the jurisdiction’s pre-nuclear explosion public information campaign and on the thoughtful groundwork that went into it.

These authorities have rightly trusted in the maturity of county residents to handle the issue of nuclear incident preparedness. In a potential or actual public health crisis, the dangers of alarming people unnecessarily or having them not grasp the complexity of the matter are far less than most leaders imagine. A nuclear terrorist attack, while low in probability, is still possible given present day politics and technology, and people deserve to know the correct protective actions to take.

In the interest of public health, Ventura County is taking reasonable steps by providing its citizens with life-saving information. If prevention of nuclear terrorism fails, then reducing exposure to radioactive fallout is the intervention that can save the greatest number of lives following a nuclear detonation. In the aftermath of a nuclear explosion, promptly finding and staying in a robust shelter will reduce exposure and save lives. Acting on the instinct to flee the affected area will result in lives lost.

Through this campaign, and the opportunity for dialogue it provides, county residents will be empowered with the information to save their own lives. Pre-incident public education is a top priority because people cannot wait to be told what to do. Fallout is the most dangerous in the first few hours after detonation, and degraded communication will keep officials from warning people in the areas that most need the information.

We encourage the citizens of Ventura County, CA, to ask questions at the planned town hall meetings and become more informed. We also invite other jurisdictions interested in learning more about nuclear preparedness to visit the . There they will find 7 clear, actionable steps for communities to protect inhabitants from radioactive fallout, thus saving many tens of thousands of lives following a nuclear blast.

In 2009 the state of Florida confirmed that native transmission of dengue fever was occurring—something that had not happened for decades. An astute clinician in New York made the diagnosis in a patient who had just returned from Key West. In the years prior to that outbreak, local transmission of dengue fever had occurred in both Texas and Hawaii.

That such a scenario occurred in 21st-century America, where other mosquito scourges such as yellow fever and malaria are historical curiosities, reinforces the fact that so long as mosquitoes capable of spreading disease inhabit a country, that country will harbor some risk of an outbreak of a mosquito-borne disease occurring.

Not only do dengue outbreaks have the potential to cause significant morbidity in the populace, but the identification of the presence of dengue in a region can also have a negative impact on the local economy in decreased tourism and added expenses for augmented vector control activities.

This commentary on the scope, content, translation, and policy utility of research is shaped by the authors’ perspectives from federal, state, and local levels and national policy making. The reflections presented here were offered in response to presentations at the Dynamics of Preparedness Conference in Pittsburgh, October 22-24, 2012, many of which are included in this journal supplement issue.

We sought to determine the proportion of refugee patients at the Baltimore City Health Department Tuberculosis program (BCHD-TB) successfully completing latent tuberculosis infection (LTBI) treatment, as compared to other referral groups, and to identify factors associated with treatment completion. We completed a retrospective cohort analysis of individuals referred to BCHD-TB program for LTBI care between February 1, 2009 and March 31, 2011. Among 841 patients evaluated by BCHD-TB and diagnosed with LTBI, 81 % of refugees, 50 % of non-refugee foreign-born, and 35 % of US-born patients completed LTBI treatment. In multivariate analysis, refugees had greater odds of LTBI treatment completion (Adjusted Odds Ratio 7.2; 95 % CI 4.2–12.4, p < 0.001) compared to US-born individuals adjusting for age, gender, and treatment regimen. Overall, LTBI treatment completion remains suboptimal. At BCHD-TB, LTBI treatment completion was significantly higher among refugees than other referral groups. Additional efforts are needed to optimize LTBI care, and future efforts may need to be tailored for different risk groups.

In April 2009, following an experimental protocol, staff members at a Navy lab in San Diego tested specimens from two patients using a new diagnostic device. Both tested positive for influenza, but, oddly, neither specimen matched the influenza A subtypes that are known to infect humans. This finding raised suspicions, and so the samples were sent to the US Centers for Disease Control and Prevention (CDC). Further tests would reveal that these two patients were the first reported cases of a novel H1N1 influenza virus that would cause a global pandemic in 2009.

Approximately 6 years ago, then-President George W. Bush first signed the Pandemic and All-Hazards Preparedness Act (PAHPA) into law, reforming the nation's public health preparedness landscape. On March 14, 2013, President Barack Obama reauthorized the legislation, incorporating important lessons learned and setting the path for the next 5 years. When the law was originally passed by the 109th Congress, policymakers were acting in response to Hurricane Katrina and the threat of a possible influenza pandemic. Members of the 113th Congress have reauthorized PAHPA, seeking to enhance existing programs and authorities in light of recent public health emergencies. This article examines PAHPA, considers its impact on preparedness over the past 5 years, and describes the recently signed reauthorization legislation.

In this CFR working paper, author Gigi Kwik Gronvall examines the controversy surrounding the publication of two H5N1 flu–transmission and clarifies the arguments that arose for and against publication; offers lessons learned for future dual-use research to scientists, research directors, publishers, and policymakers; and promotes a reasonable consideration of the risks and benefits of dual-use research.
 

We celebrate the 35th year without smallpox, once the most serious pestilence known to mankind. The achievement was the product of a global eradication program that was launched in 1967 with a 10-year time target. The last case occurred in October 1977. The total cost of the program was estimated to be about $300 million, one-third of which constituted international contributions. The achievement has been lauded as one of the most important of the 20th century. However, the decision by the 1966 World Health Assembly to undertake this campaign had been controversial. At the time, a global malaria eradication program, then in its 12th year, was failing. Many argued that it was technically impossible to eradicate any disease and questioned the judgment of WHO and professional public health. The decision to proceed was decided by a margin of only two votes.

When letters containing anthrax spores were mailed to several US senators and media offices in September 2001, just one week after the 9/11 attacks, bioterrorism catapulted to the national stage. Political leaders and public health officials, desperate for guidance on this once-theoretical scenario, turned to experts including Tom Inglesby, then deputy director of the Johns Hopkins Center for Civilian Biodefense Strategies, a bioterrorism research and analysis think tank in Baltimore. In the years that followed, Inglesby and his colleagues ran exercises to simulate bioterror incidents, established a peer-reviewed journal on biodefense and advised government agencies on how to reduce the public health impact of biological threats.

Diagnostic tests are critical for diagnosing diseases in US troops, for domestic and in­ternational early disease detection and bio­surveillance, and for improving global health.¹ Advances in diagnostics could improve clinical management of a range of diseases in the US healthcare system. The ability to rapidly di­agnose infectious disease has been identified as a strategic priority by the White House,^2,3 the US Department of Health and Human Ser­vices (HHS),⁴ the National Institutes of Health (NIH),⁵ the US Centers for Disease Control and Prevention (CDC),⁶ and the US Department of Defense (DoD).⁷

Pulmonary agents (also known as “choking” agents) compose a class of chemical compounds that disrupt normal breathing.

It has been suggested that the true case fatality rate of human H5N1 influenza infection is appreciably less than the figure of approximately 60% that is based on official WHO confirmed case reports because asymptomatic cases may have been missed. A number of sero-epidemiological studies have been conducted in an attempt to identify such missed cases.