Office of Public Health Preparedness and Response

Atlanta, GA, United States

Office of Public Health Preparedness and Response

Atlanta, GA, United States
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Fleischauer A.T.,Office of Public Health Preparedness and Response | Ruhl L.,University of North Carolina at Chapel Hill | Barnes E.,Wake forest University
Morbidity and Mortality Weekly Report | Year: 2017

What is already known about this topic? Injection drug use and opioid dependence have increased to epidemic levels in the United States, and evidence suggests that bacterial complications of injection drug use, such as endocarditis, are increasing. What is added by this report? In North Carolina, analysis of hospital discharge data identified an approximately twelvefold increase in hospitalizations for endocarditis combined with drug dependence during 2010-2015. Consistent with overall trends in the U.S. opioid epidemic, the majority of patients were non-Hispanic, white, aged <40 years, and from rural areas; in addition, approximately one third were infected with hepatitis C virus. On average, the cost for each hospitalization for endocarditis exceeded $50,000, and 42% of hospitalizations were among persons on Medicaid or without insurance. The total hospital costs of hospitalizations for drug dependence-associated endocarditis increased eighteenfold during 2010-2015. What are the implications for public health practice? As the U.S. opioid epidemic continues to grow, hospitalizations for infectious complications associated with injection drug use are likely to increase. Effective and cost-saving public health interventions, such as syringe service programs and harm reduction strategies, are needed to reduce disease burden and save health care costs. Collaboration between public health, health care systems, and policy makers is important to reduce the risks associated with injection drug use. © 2017, Department of Health and Human Services. All rights reserved.

Law R.K.,Agency for Toxic Substances and Disease Registry | Schier J.G.,Agency for Toxic Substances and Disease Registry | Martin C.A.,Agency for Toxic Substances and Disease Registry | Olivares D.E.,Office of Public Health Preparedness and Response | And 3 more authors.
Clinical Toxicology | Year: 2013

Background. In March of 2011, an earthquake struck Japan causing a tsunami that resulted in a radiological release from the damaged Fukushima Daiichi nuclear power plant. Surveillance for potential radiological and any iodine/iodide product exposures was initiated on the National Poison Data System (NPDS) to target public health messaging needs within the United States (US). Our objectives are to describe self-reported exposures to radiation, potassium iodide (KI) and other iodine/iodide products which occurred during the US federal response and discuss its public health impact. Methods. All calls to poison centers associated with the Japan incident were identified from March 11, 2011 to April 18, 2011 in NPDS. Exposure, demographic and health outcome information were collected. Calls about reported radiation exposures and KI or other iodine/iodide product ingestions were then categorized with regard to exposure likelihood based on follow-up information obtained from the PC where each call originated. Reported exposures were subsequently classified as probable exposures (high likelihood of exposure), probable non-exposures (low likelihood of exposure), and suspect exposure (unknown likelihood of exposure). Results. We identified 400 calls to PCs associated with the incident, with 340 information requests (no exposure reported) and 60 reported exposures. The majority (n = 194; 57%) of the information requests mentioned one or more substances. Radiation was inquired about most frequently (n = 88; 45%), followed by KI (n = 86; 44%) and other iodine/iodide products (n = 47; 24%). Of the 60 reported exposures, KI was reported most frequently (n = 25; 42%), followed by radiation (n = 22; 37%) and other iodine/iodide products (n = 13; 22%). Among reported KI exposures, most were classified as probable exposures (n = 24; 96%); one was a probable non-exposure. Among reported other iodine/iodide product exposures, most were probable exposures (n = 10, 77%) and the rest were suspect exposures (n = 3; 23%). The reported radiation exposures were classified as suspect exposures (n = 16, 73%) or probable non-exposures (n = 6; 27%). No radiation exposures were classified as probable exposures. A small number of the probable exposures to KI and other iodide/iodine products reported adverse signs or symptoms (n = 9; 26%). The majority of probable exposures had no adverse outcomes (n = 28; 82%). These data identified a potential public health information gap regarding KI and other iodine/iodide products which was then addressed through public health messaging activities. Conclusion. During the Japan incident response, surveillance activities using NPDS identified KI and other iodine/iodide products as potential public health concerns within the US, which guided CDC's public health messaging and communication activities. Regional PCs can provide timely and additional information during a public health emergency to enhance data collected from surveillance activities, which in turn can be used to inform public health decision-making. Copyright © 2013 Informa Healthcare USA, Inc.

Petersen B.W.,National Center for Emerging and Zoonotic Infectious Diseases | Damon I.K.,National Center for Emerging and Zoonotic Infectious Diseases | Pertowski C.A.,Office of Public Health Preparedness and Response | Meaney-Delman D.,National Center for Emerging and Zoonotic Infectious Diseases | And 6 more authors.
MMWR Recommendations and Reports | Year: 2015

This report outlines recommendations for the clinical use of the three smallpox vaccines stored in the U.S. Strategic National Stockpile for persons who are exposed to smallpox virus or at high risk for smallpox infection during a postevent vaccination program following an intentional or accidental release of the virus. No absolute contraindications exist for smallpox vaccination in a postevent setting. However, several relative contraindications exist among persons with certain medical conditions. CDC recommendations for smallpox vaccine use were developed in consideration of the risk for smallpox infection, risk for an adverse event following vaccination, and benefit from vaccination. Smallpox vaccines are made from live vaccinia viruses that protect against smallpox disease. They do not contain variola virus, the causative agent of smallpox. The three smallpox vaccines stockpiled are ACAM2000, Aventis Pasteur Smallpox Vaccine (APSV), and Imvamune. Surveillance and containment activities including vaccination with replication-competent smallpox vaccine (i.e., vaccine viruses capable of replicating in mammalian cells such as ACAM2000 and APSV) will be the primary response strategy for achieving epidemic control. Persons exposed to smallpox virus are at high risk for developing and transmitting smallpox and should be vaccinated with a replication-competent smallpox vaccine unless severely immunodeficient. Because of a high likelihood of a poor immune response and an increased risk for adverse events, smallpox vaccination should be avoided in persons with severe immunodeficiency who are not expected to benefit from vaccine, including bone marrow transplant recipients within 4 months of transplantation, persons infected with HIV with CD4 cell counts <50 cells/mm3, and persons with severe combined immunodeficiency, complete DiGeorge syndrome, and other severely immunocompromised states requiring isolation. If antivirals are not immediately available, it is reasonable to consider the use of Imvamune in the setting of a smallpox virus exposure in persons with severe immunodeficiency. Persons without a known smallpox virus exposure might still be at high risk for developing smallpox infection depending on the magnitude of the outbreak and the effectiveness of the public health response. Such persons will be defined by public health authorities and should be screened for relative contraindications to smallpox vaccination. Relative contraindications include atopic dermatitis (eczema), HIV infection (CD4 cell counts of 50-199 cells/mm3), other immunocompromised states, and vaccine or vaccine-component allergies. Persons with relative contraindications should be vaccinated with Imvamune when available and authorized for use by the Food and Drug Administration. These recommendations will be updated as new data on smallpox vaccines become available and further clinical guidance for other medical countermeasures including antivirals is developed.

Chitnis A.S.,Centers for Disease Control and Prevention | Caruthers P.S.,Kindred Hospital Bay Area St Petersburg | Rao A.K.,Centers for Disease Control and Prevention | Lurvey R.,Centers for Disease Control and Prevention | And 7 more authors.
Infection Control and Hospital Epidemiology | Year: 2012

objective. To describe a Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission. design, setting, and patients. Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH). methods. Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009-July 2011. Biweekly CRE prevalence surveys were conducted during July 2010-July 2011, and interventions to prevent transmission were implemented, including education and auditing of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the blaKPC gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates. results. Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received b-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related. conclusion. CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach. © 2012 by The Society for Healthcare Epidemiology of America.

PubMed | Centers for Disease Control and Prevention and Office of Public Health Preparedness and Response
Type: Journal Article | Journal: Disaster medicine and public health preparedness | Year: 2016

For the past decade, emergency preparedness campaigns have encouraged households to meet preparedness metrics, such as having a household evacuation plan and emergency supplies of food, water, and medication. To estimate current household preparedness levels and to enhance disaster response planning, the Virginia Department of Health with remote technical assistance from the Centers for Disease Control and Prevention conducted a community health assessment in 2013 in Portsmouth, Virginia.Using the Community Assessment for Public Health Emergency Response (CASPER) methodology with 2-stage cluster sampling, we randomly selected 210 households for in-person interviews. Households were questioned about emergency planning and supplies, information sources during emergencies, and chronic health conditions.Interview teams completed 180 interviews (86%). Interviews revealed that 70% of households had an emergency evacuation plan, 67% had a 3-day supply of water for each member, and 77% had a first aid kit. Most households (65%) reported that the television was the primary source of information during an emergency. Heart disease (54%) and obesity (40%) were the most frequently reported chronic conditions.The Virginia Department of Health identified important gaps in local household preparedness. Data from the assessment have been used to inform community health partners, enhance disaster response planning, set community health priorities, and influence Portsmouths Community Health Improvement Plan.

Martin J.L.,Office of Public Health Preparedness and Response | Wen L.S.,Office of Public Health Preparedness and Response
Health security | Year: 2015

The death of an African-American man, injured while in police custody, led to protests and several days of civil unrest in Baltimore City beginning on April 27, 2015. This article discusses the role of the Baltimore City Health Department, during and after the initial protests and civil unrest, as the lead agency for ESF-8 response. We review and share initial response actions, short-term recovery operations, long-term recovery efforts, and lessons learned.

Gangadharan D.,Office of Public Health Preparedness and Response | Smith J.,Office of Public Health Preparedness and Response | Weyant R.,Office of Public Health Preparedness and Response
MMWR Recommendations and Reports | Year: 2013

The CDC and National Institutes of Health (NIH) Biosafety in Microbiological and Biomedical Laboratories (BMBL) manual describes biosafety recommendations for work involving highly pathogenic avian influenza (HPAI) (US Department of Health and Human Services [HHS], CDC. Biosafety in microbiological and biomedical laboratories, 5th ed. Atlanta, GA: CDC; 2009. HHS publication no. [CDC] 21-1112. Available at The U.S. Department of Agriculture Guidelines for Avian Influenza Viruses builds on the BMBL manual and provides additional biosafety and biocontainment guidelines for laboratories working with HPAI (US Department of Agriculture, Animal and Plant Health Inspection Service, Agricultural Select Agent Program. Guidelines for avian influenza viruses. Washington, DC: US Department of Agriculture; 2011. Available at The recommendations in this report, which are intended for laboratories in the United States, outline the essential baseline biosafety measures for working with the subset of influenza viruses that contain a hemagglutinin (HA) from the HPAI influenza A/goose/Guangdong/1/96 lineage, including reassortant influenza viruses created in a laboratory setting. All H5N1 influenza virus clades known to infect humans to date have been derived from this lineage (WHO/OIE/FAO H5N1 Evolution Working Group. Continued evolution of highly pathogenic avian influenza A [H5N1]: updated nomenclature. Influenza Other Respir Viruses 2012;6:1-5). In 2009, the NIH Guidelines for Research Involving Recombinant or Synthetic Nucleic Acid Molecules were amended to include specific biosafety and biocontainment recommendations for laboratories working with Recombinant Risk Group 3 influenza viruses, including HPAI H5N1 influenza viruses within the Goose/Guangdong/1/96-like H5 lineage. In February 2013, the NIH guidelines were further revised to provide additional biosafety containment enhancements and practices for research with HPAI H5N1 viruses that are transmissible among mammals by respiratory droplets (i.e., mammalian-transmissible HPAI H5N1) (National Institutes of Health, Office of Biotechnology Activities. NIH guidelines for research involving recombinant or synthetic nucleic acid molecules. Appendix G-II-C-5: biosafety level 3 enhanced for research involving risk group 3 influenza viruses. Bethesda, MD: National Institutes of Health; 2013. Available at The recent revisions to the NIH guidelines focus on a smaller subset of viruses but are applicable and consistent with the recommendations in this report. The biosafety recommendations in this report were developed by CDC with advice from the Intragovernmental Select Agents and Toxins Technical Advisory Committee, which is a panel composed of federal government subject-matter experts, and from public input received in response to the request for information that was published in the Federal Register on October 17, 2012 (US Department of Health and Human Services, CDC. Influenza viruses containing the hemagglutinin from the Goose/ Guangdong/1/96 lineage; proposed rule; request for information and comment. 42 CFR, Part 73. Federal Register 2012;77:63783-5). Work with HPAI H5N1 virus should be conducted, at a minimum, at biosafety level 3 (BSL-3), with specific enhancements to protect workers, the public, animal health, and animal products. Original clinical specimens suspected of containing viruses of this lineage can only be handled at BSL-2 if the procedures do not involve the propagation of the virus. An appropriate biosafety level should be determined in accordance with a biosafety risk assessment. Additional information on performing biosafety risk assessments and establishing effective biosafety containment is available in the BMBL manual.

Martin J.L.,Office of Public Health Preparedness and Response
Health Security | Year: 2016

Heat response plans are becoming increasingly more common as US cities prepare for heat waves and other effects of climate change. Standard elements of heat response plans exist, but plans vary depending on geographic location and distribution of vulnerable populations. Because heat events vary over time and affect populations differently based on vulnerability, it is difficult to compare heat response plans and evaluate responses to heat events. This article provides an overview of the Baltimore City heat response plan, the Code Red program, and discusses the city's response to the 2012 Ohio Valley/Mid Atlantic Derecho, a complex heat event. Challenges with and strategies for evaluating the program are reviewed and shared. © Mary Ann Liebert, Inc. 2016.

Testa M.A.,Harvard University | Pettigrew M.L.,Office of Public Health Preparedness and Response | Savoia E.,Harvard University
Journal of Public Health Management and Practice | Year: 2014

Context: County and state health departments are increasingly conducting hazard vulnerability and jurisdictional risk (HVJR) assessments for public health emergency preparedness and mitigation planning and evaluation to improve the public health disaster response; however, integration and adoption of these assessments into practice are still relatively rare. While the quantitative methods associated with complex analytic and measurement methods, causal inference, and decision theory are common in public health research, they have not been widely used in public health preparedness and mitigation planning. Objective: To address this gap, the Harvard School of Public Health PERLC's goal was to develop measurement, geospatial, and mechanistic models to aid public health practitioners in understanding the complexity of HVJR assessment and to determine the feasibility of using these methods for dynamic and predictive HVJR analyses. Methods: We used systematic reviews, causal inference theory, structural equation modeling (SEM), and multivariate statistical methods to develop the conceptual and mechanistic HVJR models. Geospatial mapping was used to inform the hypothetical mechanistic model by visually examining the variability and patterns associated with county-level demographic, social, economic, hazards, and resource data. A simulation algorithm was developed for testing the feasibility of using SEM estimation. Results: The conceptual model identified the predictive latent variables used in public health HVJR tools (hazard, vulnerability, and resilience), the outcomes (human, physical, and economic losses), and the corresponding measurement subcomponents. This model was translated into a hypothetical mechanistic model to explore and evaluate causal and measurement pathways. To test the feasibility of SEM estimation, the mechanistic model path diagram was translated into linear equations and solved simultaneously using simulated data representing 192 counties. Conclusions: Measurement, geospatial, and mechanistic models can be used to confirm and validate existing and proposed HVJR models and potentially increase the predictive validity of these models for optimizing and improving public health preparedness planning. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

PubMed | Office of Public Health Preparedness and Response
Type: Journal Article | Journal: MMWR. Morbidity and mortality weekly report | Year: 2016

During November 3, 2014-December 27, 2015, CDC implemented guidance on movement and monitoring of persons in the United States with potential exposure to Ebola virus (Ebola) (1). Monitoring was concluded in December 2015. After CDC modified the guidance for monitoring travelers from Guinea (the last country for which monitoring of travelers was recommended) in late December 2015, jurisdictional reports were no longer collected by CDC. This report documents the number of persons monitored as part of the effort to isolate, test, and, if necessary, treat symptomatic travelers and other persons in the United States who had risk for exposure to Ebola during the period the guidance was in effect. Sixty jurisdictions, including all 50 states, two local jurisdictions, and eight territories and freely associated states, reported a total of 29,789 persons monitored, with >99% completing 21-day monitoring with no loss to follow-up exceeding 48 hours. No confirmed cases of imported Ebola were reported once monitoring was initiated. This landmark public health response demonstrates the robust infrastructure and sustained monitoring capacity of local, state, and territorial health authorities in the United States as a part of a response to an international public health emergency.

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