US disaster planners' attitudes regarding preevent vaccine for first responders and point-of-dispensing workers.

Disaster planners' attitudes toward pre-event anthrax and smallpox vaccine for first responders and point-of-dispensing (POD) workers have not been examined. An online questionnaire was sent to US Cities Readiness Initiative (CRI) and non-CRI public health disaster planners in 2013. Multivariate logistic regressions were used to assess determinants of belief that first responders and POD workers should be offered the anthrax and/or smallpox vaccine before an event. A total of 301 disaster planners participated. Only half (50.6%, n=126) were aware of the ACIP recommendation that first responders could be offered pre-event anthrax vaccine. Many (66.0%, n=164) believed that pre-event anthrax vaccine should be offered to first responders. The oldest respondents were least likely to believe anthrax vaccine should be given (OR: 0.27, 0.12, 0.63, p<.001). Fewer disaster planners believed that pre-event anthrax vaccine should be offered to POD workers compared to first responders (55.0% vs 66.0%, X(2)=151, p<.001). Almost 20% (18.3%, n=47) reported having already received pre-event smallpox vaccine. Among the unvaccinated (n=210), half (52.0%, n=105) were willing to receive pre-event smallpox vaccine if it was offered free of charge. Half (53.4%, n=133) believed that POD workers should be offered smallpox vaccine before an event. Many disaster planners support pre-event anthrax vaccination for first responders and POD workers, and about half support pre-event smallpox vaccine for POD workers. Jurisdictions should consider partnering with first responder agencies to implement a pre-event anthrax vaccination program.

Are US jurisdictions prepared to dispense medical countermeasures through open points of dispensing? Findings from a national study.

Communities will rely on open points of dispensing (PODs) for mass dispensing of medical countermeasures following a bioterrorism attack or a pandemic. US Cities Readiness Initiative (CRI) open POD preparedness is assessed using the Technical Assistance Review (TAR) but focuses on oral prophylaxis dispensing; mass vaccination readiness is not well measured. Non-CRI preparedness had not been studied. In 2013 an online questionnaire was sent to all 456 CRIs and a random sample of 500 non-CRIs to measure open POD preparedness and exercise participation. Hierarchical linear regression was used to describe factors associated with higher POD preparedness and exercise participation scores. In total, 257 subjects participated, for a 41% response rate. Almost all open PODs have existing written plans and/or a layout for each site (93.4%, n=240, and 87.0%, n=220). Only half (46.7%, n=120) have an alternative dispensing modality in place, and even fewer (42.6%, n=104) report having adequate staffing. Determinants of open POD preparedness were perceived preparedness, participation in more POD exercises, and more closed POD coverage. Most jurisdictions conducted a full-scale exercise and a staff notification drill (83.7%, n=215 for both). Fewer than half (40.5%, n=104) have conducted a vaccination clinic exercise. Determinants of increased POD exercises were perceived preparedness, years of work experience, community type (nontribal), and larger population. Because successful open POD deployment is critical, jurisdictions need to plan for mass vaccination, use of alternative dispensing modalities, and recruitment strategies to increase POD staffing.

Infection prevention and mass vaccination training for U.S. point of dispensing staff and volunteers: a national study.

BACKGROUND: Points of dispensing (PODs) are deployed for medical countermeasure mass dispensing. However, infection prevention and vaccine administration pre-event training offered and just-in-time (JIT) education planned for POD workers have not been assessed. METHODS: Disaster planners were sent an online questionnaire in 2013. McNemar tests compared training offered to staff versus volunteers and pre-event training versus JIT training. RESULTS: In total, 301 disaster planners participated. The most frequent pre-event training included hand hygiene (59.1% and 28.0%) and personal protective equipment (PPE) selection (52.1% and 24.1%) for staff and volunteers, respectively. Few provided pre-event training on the cold chain technique (14.8% and 5.1%) or smallpox vaccine administration (4.7% and 2.3%) for staff or volunteers. For all topics except smallpox vaccine administration, more staff than volunteers received pre-event training (P < .01). The most frequent planned JIT training includes hand hygiene (79.8% and 73.5%) and PPE selection (79.4% and 70.0%) to staff and volunteers. For all topics, more JIT education is planned for staff than volunteers (P < .001). More JIT training is planned than has been given pre-event for all topics (P < .001). CONCLUSION: More pre-event training is needed on infection prevention and vaccine administration to ensure safe and successful POD deployment.

A national study examining closed points of dispensing (PODs): existence, preparedness, exercise participation, and training provided.

The Centers for Disease Control and Prevention recommends using open points of dispensing (PODs) and alternative modalities, such as closed PODs, for mass dispensing of medical countermeasures. However, closed POD existence has not been assessed. In 2013 we sent an online questionnaire to US Cities Readiness Initiative (CRI) and non-CRI public health disaster planners. Chi-square tests were used to determine differences between CRIs and non-CRIs when comparing having at least 1 closed POD, and to compare having a closed POD and perceived mass dispensing preparedness. A total of 301 disaster planners participated. Almost all (89.3%, n=218) jurisdictions have considered establishing a closed POD, and three-quarters (74.2%, n=181) currently have at least one. CRIs were more likely than non-CRIs to have a closed POD (85.0% vs 58.5%, X(2)=21.3, p<.001). Those with 1 or more closed PODs were more likely to believe their jurisdiction could distribute medical countermeasures within 48 hours compared to those without a closed POD (78.5% vs 21.5%; X(2)=10.8, p=.001). Half had a written plan and/or written standing orders (59.1% and 52.5%, respectively). Almost half (42%, n=72) have done no preevent training for POD staff in the past 2 years; almost 20% (18%, n=32) do not plan to offer any just-in-time training. Nearly 40% (n=70) have conducted no exercises in the past year. Closed PODs contribute to community preparedness; their establishment should be followed by development of written plans, worker training, and exercises.

US school morbidity and mortality, mandatory vaccination, institution closure, and interventions implemented during the 2009 influenza A H1N1 pandemic.

The 2009 H1N1 pandemic disproportionately affected school-aged children, but only school-based outbreak case studies have been conducted. The purposes of this study were to evaluate US academic institutions' experiences during the 2009 H1N1 pandemic in terms of infection prevention interventions implemented and to examine factors associated with school closure during the pandemic. An online survey was sent to school nurses in May through July 2011. Hierarchical logistic regressions were used to determine predictive models for having a mandatory H1N1 vaccination policy for school nurses and school closure. In all, 1,997 nurses from 26 states participated. Very few nurses (3.3%, n=65) reported having a mandatory H1N1 influenza vaccination policy; nurses were more likely than all other school employees (p<.001) to be mandated to receive vaccine. Determinants of having a mandatory H1N1 vaccination policy were being employed by a hospital or public health agency, and the school being located in a western or northeastern state. Factors related to school closure included being in a western or northeastern state, having higher H1N1-related morbidity/mortality, being a school nurse employed by a public health agency or hospital, and being a private school. The most commonly implemented interventions included encouraging staff and students to exercise hand hygiene and increasing classroom cleaning; least commonly implemented interventions included discouraging face-to-face meetings, training staff on H1N1 influenza and/or respiratory hygiene, and discouraging handshaking. Schools should develop and continue to improve their pandemic plans, including collaborating with community response agencies.

Health care versus non-health care businesses' experiences during the 2009 H1N1 pandemic: financial impact, vaccination policies, and control measures implemented.

BACKGROUND: Only limited data are available on businesses' experiences related to the 2009 H1N1 pandemic in terms of interventions implemented, staffing shortages, employees working while ill, and H1N1 vaccination policy. METHODS: A questionnaire was administered to human resource professionals during May-July 2011 to assess US businesses' experiences related to the 2009 pandemic. Logistic regressions were used to describe factors associated with providing H1N1 and respiratory hygiene training and offering H1N1 vaccine to staff. Linear regression was used to describe factors associated with higher infection prevention intervention scores (ie, number of interventions implemented). RESULTS: In all, 471 human resource professionals participated. Most (85.1%, n = 401) did not work while ill. Twelve percent (n = 57) reported staffing shortages, 2.1% (n = 10) needed to hire temporary staff, and fewer than 1% (0.8%, n = 4) reduced workload or closed during the pandemic. From logistic and linear regressions, determinants of providing employees H1N1 influenza training, respiratory hygiene education, offering H1N1 vaccine to employees, and higher infection prevention intervention scores were size of the business (with larger businesses implementing more interventions, such as providing education and vaccine, than smaller businesses) and being a health care agency. CONCLUSION: Businesses should continue to improve business continuity and pandemic plans to prepare for the next biologic event (ie, pandemic, bioterrorism attack, or emerging infectious disease outbreak).

Business continuity and pandemic preparedness: US health care versus non-health care agencies.

BACKGROUND: Only limited data are available on US business continuity activities related to biologic events. METHODS: A questionnaire was administered to human resource professionals during May-July 2011 to assess business continuity related to biologic events, incentives businesses are providing to maximize worker surge capacity, and seasonal influenza vaccination policy. Linear regressions were used to describe factors associated with higher business continuity and pandemic preparedness scores. The χ(2) and Fisher exact tests compared health care versus non-health care businesses on preparedness indicators. RESULTS: Possible business continuity and pandemic preparedness scores ranged from 0.5 to 27 and 0 to 15, with average resulting scores among participants at 13.2 and 7.3, respectively. Determinants of business continuity and pandemic preparedness were (1) business size (larger businesses were more prepared), (2) type of business (health care more prepared), (3) having human resource professional as company disaster planning committee member, and (4) risk perception of a pandemic in the next year. Most businesses (63.3%, n = 298) encourage staff influenza vaccination; 2.1% (n = 10) mandate it. Only 10% of businesses (11.0%, n = 52) provide employee incentives, and fewer than half (41.0%, n = 193) stockpile personal protective equipment. CONCLUSION: Despite the recent H1N1 pandemic, many US businesses lack adequate pandemic plans. It is critical that businesses of all sizes and types become better prepared for a biologic event.

US school/academic institution disaster and pandemic preparedness and seasonal influenza vaccination among school nurses.

BACKGROUND: School pandemic preparedness is essential, but has not been evaluated. METHODS: An online survey was sent to school nurses (from state school nurse associations and/or state departments of education) between May and July 2011. Overall school pandemic preparedness scores were calculated by assigning 1 point for each item in the school's pandemic plan; the maximum score was 11. Linear regression was used to describe factors associated with higher school pandemic preparedness scores. Nurse influenza vaccine uptake was assessed as well. RESULTS: A total of 1,997 nurses from 26 states completed the survey. Almost three-quarters (73.7%; n = 1,472) reported receiving the seasonal influenza vaccine during the 2010-11 season. Very few (2.2%; n = 43) reported that their school/district had a mandatory influenza vaccination policy. Pandemic preparedness scores ranged from 0 to 10 points, with an average score of 4.3. Determinants of school pandemic preparedness were as follows: planning to be a point of dispensing during a future pandemic (P < .001), having experienced multiple student or employee hospitalizations and/or deaths related to H1N1 during the pandemic (P = .01 or <.05, respectively), having a lead nurse complete the survey (P < .001), and having the school nurse study participant be a member of the school disaster planning committee (P < .001). CONCLUSIONS: US schools must continue to address gaps in pandemic planning.