Public health emergencies and responses: what are they, how long do they last, and how many staff does your agency need?

Responding to outbreaks is one of the most routine yet most important functions of a public health agency. However, some outbreaks are bigger, more visible, or more complex than others, prompting discussion about when an "outbreak" becomes a "public health emergency." When a public health emergency is identified, resources (eg, funding, staff, space) may need to be redirected from core public health programs to contribute to the public health emergency response. The need to sustain critical public health functions while preparing for public health emergency responses raises a series of operational and resource management questions, including when a public health emergency begins and ends, why additional resources are needed, how long an organization should expect staff to be redirected, and how many staff (or what proportion of the agency's staff ) an organization should anticipate will be needed to conduct a public health emergency response. This article addresses these questions from a national perspective by reviewing events for which the Centers for Disease Control and Prevention redirected staff from core public health functions to respond to a series of public health emergencies. We defined "public health emergency" in both operational and public health terms and found that on average each emergency response lasted approximately 4 months and used approximately 9.5% of our workforce. We also provide reasons why public health agencies should consider the impact of redirecting resources when preparing for public health emergencies.

SARS: mobilizing and maintaining a public health emergency response.

During the spring and summer of 2003, the Centers for Disease Control and Prevention (CDC) mobilized the resources of the entire agency in a concerted effort to meet the challenges posed by the outbreak of Severe Acute Respiratory Syndrome (SARS). Over the 133 days that comprised the emergency response phase of the SARS outbreak, CDC utilized the skills of more than 850 people. These staff were deployed from every Center, Institute, and Office within CDC and the Agency for Toxic Substances and Disease Registry. They provided technical assistance to countries reporting large numbers of cases and requesting assistance, met passengers and crew from these locations upon arrival in the United States, and assured that the syndrome was reported and thoroughly investigated within the United States. This paper describes the operational requirements that were established and the resources that were used to conduct this investigation.

First case of bioterrorism-related inhalational anthrax in the United States, Palm Beach County, Florida, 2001.

On October 4, 2001, we confirmed the first bioterrorism-related anthrax case identified in the United States in a resident of Palm Beach County, Florida. Epidemiologic investigation indicated that exposure occurred at the workplace through intentionally contaminated mail. One additional case of inhalational anthrax was identified from the index patient's workplace. Among 1,076 nasal cultures performed to assess exposure, Bacillus anthracis was isolated from a co-worker later confirmed as being infected, as well as from an asymptomatic mail-handler in the same workplace. Environmental cultures for B. anthracis showed contamination at the workplace and six county postal facilities. Environmental and nasal swab cultures were useful epidemiologic tools that helped direct the investigation towards the infection source and transmission vehicle. We identified 1,114 persons at risk and offered antimicrobial prophylaxis.