Update: COVID-19 Among Workers in Meat and Poultry Processing Facilities - United States, April-May 2020.

Meat and poultry processing facilities face distinctive challenges in the control of infectious diseases, including coronavirus disease 2019 (COVID-19) (1). COVID-19 outbreaks among meat and poultry processing facility workers can rapidly affect large numbers of persons. Assessment of COVID-19 cases among workers in 115 meat and poultry processing facilities through April 27, 2020, documented 4,913 cases and 20 deaths reported by 19 states (1). This report provides updated aggregate data from states regarding the number of meat and poultry processing facilities affected by COVID-19, the number and demographic characteristics of affected workers, and the number of COVID-19-associated deaths among workers, as well as descriptions of interventions and prevention efforts at these facilities. Aggregate data on confirmed COVID-19 cases and deaths among workers identified and reported through May 31, 2020, were obtained from 239 affected facilities (those with a laboratory-confirmed COVID-19 case in one or more workers) in 23 states.* COVID-19 was confirmed in 16,233 workers, including 86 COVID-19-related deaths. Among 14 states reporting the total number of workers in affected meat and poultry processing facilities (112,616), COVID-19 was diagnosed in 9.1% of workers. Among 9,919 (61%) cases in 21 states with reported race/ethnicity, 87% occurred among racial and ethnic minority workers. Commonly reported interventions and prevention efforts at facilities included implementing worker temperature or symptom screening and COVID-19 education, mandating face coverings, adding hand hygiene stations, and adding physical barriers between workers. Targeted workplace interventions and prevention efforts that are appropriately tailored to the groups most affected by COVID-19 are critical to reducing both COVID-19-associated occupational risk and health disparities among vulnerable populations. Implementation of these interventions and prevention efforts† across meat and poultry processing facilities nationally could help protect workers in this critical infrastructure industry.

Serial Hurricanes The 2017 Hurricane Public Health Responses: Case Studies Illustrating the Role of Centers for Disease Control and Prevention's Public Health Emergency Preparedness Program.

The Centers for Disease Control and Prevention (CDC), Division of State and Local Readiness (DSLR), Public Health Emergency Preparedness(PHEP) program funds 62 recipients to strengthen capability standards to prepare for and respond to public health emergencies. Recipients use these PHEP resources in addition to CDC's administrative and scientific guidance to support preparedness and response program planning and requirements. It is expected that public health agencies develop and maintain comprehensive emergency preparedness and response plans in preparation for disasters such as hurricanes. The 2017 historic hurricane season highlighted how emergency planning and collaborative operational execution is important for public health agencies to effectively prepare for and respond to both the immediate and long-term population health consequences of these disasters. In 2017, the southeastern United States (US) and US Caribbean territories experienced 3 Category 4 or higher Atlantic hurricanes (Harvey, Irma, and Maria) within a 5-week period. This paper highlights selected case studies that illustrate the contributions and impact of jurisdictional emergency management planning and operational capacity supported by capability standards during the 2017 hurricane season. Although the magnitude of the 2017 hurricanes required public health officials to seek additional assistance, the following case studies describe the use of public health preparedness systems and recovery resources supported by the PHEP program.

Passenger behaviors during norovirus outbreaks on cruise ships.

BACKGROUND: Norovirus causes a majority of outbreaks of gastrointestinal (GI) illness on cruise ships calling on the United States. Control measures include patient isolation, hand washing, and facility closure. Little is known about the behaviors and practices of people who have become ill with norovirus GI illness compared to those who remained well during an outbreak. METHODS: Passenger surveys were distributed during three cruise ship outbreaks caused by norovirus. Surveys inquired about illness symptoms, ill contacts, illness reporting status, hand sanitation beliefs and practices, and availability of public hand sanitizer. A case was a passenger reporting three or more episodes of loose stool in a 24-hour period, three or more episodes of vomiting in a 24-hour period, or one or more episodes each of loose stool and vomiting in a 24-hour period. Controls reported that they were not ill during the cruise. RESULTS: In total, 1,323 responses were compared. All ships had passengers who were ill prior to embarkation. Most cases delayed or did not report their illness to the ship's infirmary because they did not believe it was serious (43%-70% of responses). Cases were less likely to believe that isolation was effective in preventing disease spread [Mann-Whitney-Wilcoxon (MWW) p value <0.0001]. Cases were less likely to believe that hand washing or hand sanitizer are effective means of preventing disease spread (MWW p values 0.002 and 0.04, respectively), wash their hands after restroom use (MWW p value 0.02), or believe that hand sanitizer was available for public use prior to/after knowing about an outbreak (MWW p values 0.002 and 0.03, respectively). CONCLUSIONS: Prevention and control of norovirus GI illness may be improved by routine screening of embarking passengers, education about GI illness and its impact on public health, a focus on improving hand-washing practices, and identification of public hand sanitizer dispensing locations.

Beyond compliance: environmental health problem solving, interagency collaboration, and risk assessment to prevent waterborne disease outbreaks.

A systems approach to environmental health problem solving was used to investigate two waterborne norovirus outbreaks in Wyoming and can serve in the development of improved prevention strategies. An interagency collaboration to prevent waterborne disease involving local, state, and federal partners was designed to coordinate response to outbreak investigations. Improved risk assessment and reporting procedures were also integrated to ensure better availability of necessary data. Public health entities should implement sustainable intersectoral interventions to prevent waterborne disease that not only improve regulatory compliance but also have a positive impact on community health outcomes. Collaborative preventive health and water system protection activities should receive priority attention for implementation in state and local jurisdictions.

Impact of 2003 power outages on public health and emergency response.

INTRODUCTION: In 2003, a major power outage occurred in the midwest and northeast United States affecting some 50 million people. The power outages affected multiple systems in state and local municipalities and, in turn, affected public health. METHODS: Semi-structured interviews were conducted using open-ended questionnaires, with a convenience sample of state- and locally selected subject matter experts from Ohio, Michigan, and New York. Respondents were interviewed in groups representing one of five areas of interest, including: (1) emergency preparedness; (2) hospital and emergency medical services; (3) municipal environmental systems; (4) public health surveillance and epidemiology; and (5) psychosocial and behavioral issues. The reported positive and negative impacts of the power outage on public health, medical services, and emergency preparedness and response were documented. Responses were categorized into common themes and recommendations were formulated. RESULTS: The amount of time that the respondents' locations were without power ranged from <1 hour to 52 hours. Many common themes emerged from the different locations, including communications failures, alternate power source problems, manpower and training issues, and psychosocial concerns. There was minimal morbidity and mortality reported that could be attributed to the event. CONCLUSION: Power outages negatively impacted multiple municipal infra-structures, and affected medical services, emergency response, and public health efforts. Previous federal funding positively impacted public health and emergency response capabilities. Recommendations were made based upon the common themes identified by the respondents. Recommendations may assist state and local health departments, medical service providers, and emergency responders in planning for future power outage problems.

A waterborne outbreak of Norwalk-like virus among snowmobilers-Wyoming, 2001.

In February 2001, episodes of acute gastroenteritis were reported to the Wyoming Department of Health from persons who had recently vacationed at a snowmobile lodge in Wyoming. A retrospective cohort study found a significant association between water consumption and illness, and testing identified Norwalk-like virus (NLV) in 8 of 13 stool samples and 1 well. Nucleotide sequences from the positive well-water specimen and 6 of the positive stool samples were identical. This multistrain NLV outbreak investigation illustrates the importance of NLV as a cause of waterborne illness and should encourage monitoring for NLVs in drinking water.

Understanding physician agreement with varicella immunization guidelines.

BACKGROUND: Although varicella vaccine was licensed in 1995, immunization rates are only moderate. This study identifies factors associated with physician self-reported likelihood of recommending varicella vaccination to patients. METHODS: Two hundred eighty-one Minnesota and Pennsylvania primary care physicians who participated in surveys on barriers to vaccination in 1990-1991 and 1993 were surveyed in 1999, assessing physicians' beliefs about varicella disease and vaccine and their self-reported likelihood of recommending varicella vaccine to three age groups of children. RESULTS: Most (79, 80, and 83%) were likely to recommend varicella vaccine for 12- to 18-month old, 4- to 6-year-old, and 11- to 12-year old children, respectively, and most (78%) agreed with national recommendations to vaccinate. If physicians believed that the vaccine would fail, they were less likely to recommend varicella vaccination for 12- to 18-month-old (70% vs 85%, P = 0.001) and 4- to 6-year-old (83% vs 85%, P = 0.001) children, than if they believed in its efficacy. Pediatricians were more likely to recommend varicella vaccine than were family physicians and general practitioners (P < 0.01). CONCLUSIONS: Physicians, especially pediatricians, report that they recommend varicella vaccination when they agree with national recommendations, believe in the efficacy of the vaccine, and perceive that parents want the vaccine for their children.