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1.
Health Secur ; 18(2): 69-74, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32196387

RESUMEN

During a severe pandemic, especially one causing respiratory illness, many people may require mechanical ventilation. Depending on the extent of the outbreak, there may be insufficient capacity to provide ventilator support to all of those in need. As part of a larger conceptual framework for determining need for and allocation of ventilators during a public health emergency, this article focuses on the strategies to assist state and local planners to allocate stockpiled ventilators to healthcare facilities during a pandemic, accounting for critical factors in facilities' ability to make use of additional ventilators. These strategies include actions both in the pre-pandemic and intra-pandemic stages. As a part of pandemic preparedness, public health officials should identify and query healthcare facilities in their jurisdiction that currently care for critically ill patients on mechanical ventilation to determine existing inventory of these devices and facilities' ability to absorb additional ventilators. Facilities must have sufficient staff, space, equipment, and supplies to utilize allocated ventilators adequately. At the time of an event, jurisdictions will need to verify and update information on facilities' capacity prior to making allocation decisions. Allocation of scarce life-saving resources during a pandemic should consider ethical principles to inform state and local plans for allocation of ventilators. In addition to ethical principles, decisions should be informed by assessment of need, determination of facilities' ability to use additional ventilators, and facilities' capacity to ensure access to ventilators for vulnerable populations (eg, rural, inner city, and uninsured and underinsured individuals) or high-risk populations that may be more susceptible to illness.


Asunto(s)
Planificación en Desastres , Urgencias Médicas , Pandemias , Asignación de Recursos , Ventiladores Mecánicos/provisión & distribución , Toma de Decisiones , Brotes de Enfermedades , Instituciones de Salud , Humanos , Salud Pública
2.
Vaccine ; 38(17): 3351-3357, 2020 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-32169391

RESUMEN

BACKGROUND: Japanese encephalitis (JE) virus is the leading vaccine-preventable cause of encephalitis in Asia. For most travelers, JE risk is very low but varies based on several factors, including travel duration, location, and activities. To aid public health officials, health care providers, and travelers evaluate the worth of administering/ receiving pre-travel JE vaccinations, we estimated the numbers-needed-to-treat to prevent a case and the cost-effectiveness ratios of JE vaccination for U.S. travelers in different risk categories. METHODS: We used a decision tree model to estimate cost per case averted from a societal and traveler perspective for hypothetical cohorts of vaccinated and unvaccinated travelers. Risk Category I included travelers planning to spend ≥1 month in JE-endemic areas, Risk Category II were shorter-term (<1 month) travelers spending ≥20% of their time doing outdoor activities in rural areas, and Risk Category III were all remaining travelers. We performed sensitivity analyses including examining changes in cost-effectiveness with 10- and 100-fold increases in incidence and medical treatment costs. RESULTS: The numbers-needed-to-treat to prevent a case and cost per case averted were approximately 0.7 million and $0.6 billion for Risk Category I, 1.6 million and $1.2 billion for Risk Category II, and 9.8 million and $7.6 billion for Risk Category III. Increases of 10-fold and 100-fold in disease incidence proportionately decreased cost-effectiveness ratios. Similar levels of increases in medical treatment costs resulted in negligible changes in cost-effectiveness ratios. CONCLUSION: Numbers-needed-to-treat and cost-effectiveness ratios associated with preventing JE cases in U.S. travelers by vaccination varied greatly by risk category and disease incidence. While cost effectiveness ratios are not the sole rationale for decision-making regarding JE vaccination, the results presented here can aid in making such decisions under very different risk and cost scenarios.

3.
PLoS Negl Trop Dis ; 13(12): e0007869, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31790398

RESUMEN

BACKGROUND: Once a canine rabies-free status has been achieved, there is little guidance available on vaccination standards to maintain that status. In areas with risk of reintroduction, it may be practical to continue vaccinating portions of susceptible dogs to prevent re-establishment of canine rabies. METHODS: We used a modified version of RabiesEcon, a deterministic mathematical model, to evaluate the potential impacts and cost-effectiveness of preventing the reintroduction of canine rabies through proactive dog vaccination. We analyzed four scenarios to simulate varying risk levels involving the reintroduction of canine rabies into an area where it is no longer present. In a sensitivity analysis, we examined the influences of reintroduction frequency and intensity, the density of susceptible dog population, dog birth rate, dog life expectancy, vaccine efficacy, rate of loss of vaccine immunity, and the basic reproduction number (R0). RESULTS: To prevent the re-establishment of canine rabies, it is necessary to vaccinate 38% to 56% of free-roaming dogs that have no immunity to rabies. These coverage levels were most sensitive to adjustments in R0 followed by the vaccine efficacy and the rate of loss of vaccine immunity. Among the various preventive vaccination strategies, it was most cost-effective to continue dog vaccination at the minimum coverage required, with the average cost per human death averted ranging from $257 to $398 USD. CONCLUSIONS: Without strong surveillance systems, rabies-free countries are vulnerable to becoming endemic when incursions happen. To prevent this, it may be necessary to vaccinate at least 38% to 56% of the susceptible dog population depending on the risk of reintroduction and transmission dynamics.


Asunto(s)
Erradicación de la Enfermedad , Transmisión de Enfermedad Infecciosa/prevención & control , Enfermedades de los Perros/prevención & control , Utilización de Medicamentos/estadística & datos numéricos , Vacunas Antirrábicas/administración & dosificación , Rabia/veterinaria , Animales , Perros , Modelos Teóricos , Rabia/prevención & control
4.
Epidemiol Rev ; 2019 Nov 29.
Artículo en Inglés | MEDLINE | ID: mdl-31781750

RESUMEN

In 2014/15 an Ebola outbreak of unprecedented dimensions afflicted the West African countries of Liberia, Guinea, and Sierra Leone. We performed a systematic review of manuscripts that forecasted the outbreak while it was occurring, and derive implications on the ways results could be interpreted by policy-makers. We reviewed 26 manuscripts, published between 2014 and April 2015, that presented forecasts of the West African Ebola outbreak. Forecasted case counts varied widely. An important determinant of forecast accuracy for case counts was how far into the future predictions were made. Generally, those that made forecasts less than 2 months into the future tended to be more accurate than those that made forecasts more than 10 weeks into the future. The exceptions were parsimonious statistical models in which the decay of the rate of spread of the pathogen among susceptible individuals was dealt with explicitly. Regarding future outbreaks, the most important lessons for policy makers when using similar modeling results are: i) uncertainty of forecasts will be higher in the beginning of the outbreak, ii) when data are limited, forecasts produced by models designed to inform specific decisions should be used in complimentary fashion for robust decision making - for this outbreak, two statistical models produced the most reliable case counts forecasts, but did not allow to understand the impact of interventions, while several compartmental models could estimate the impact of interventions but required data that was not available; iii) timely collection of essential data is necessary for optimal model use.

5.
Am J Public Health ; 109(S4): S322-S324, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31505153

RESUMEN

Objectives. To show how the Centers for Disease Control and Prevention's Pandemic Vaccine Campaign Planning Tool (PanVax Tool) can help state and local public health emergency planners demonstrate and quantify how partnerships with community vaccine providers can improve their overall pandemic vaccination program readiness.Methods. The PanVax Tool helps planners compare different strategies to vaccinate their jurisdiction's population in a severe pandemic by allowing users to customize the underlying model inputs in real time, including their jurisdiction's size, community vaccine provider types, and how they allocate vaccine to these providers. In this report, we used a case study with hypothetical data to illustrate how jurisdictions can utilize the PanVax Tool for preparedness planning.Results. By using the tool, planners are able to understand the impact of engaging with different vaccine providers in a vaccination campaign.Conclusions. The PanVax Tool is a useful tool to help demonstrate the impact of community vaccine provider partnerships on pandemic vaccination readiness and identify areas for improved partnerships for pandemic response.

6.
BMC Infect Dis ; 19(1): 172, 2019 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-30782131

RESUMEN

BACKGROUND: In the event of a shigellosis outbreak in a childcare setting, exclusion policies are typically applied to afflicted children to limit shigellosis transmission. However, there is scarce evidence of their impact. METHODS: We evaluated five exclusion policies: Children return to childcare after: i) two consecutive laboratory tests (either PCR or culture) do not detect Shigella, ii) a single negative laboratory test (PCR or culture) does not detect Shigella, iii) seven days after beginning antimicrobial treatment, iv) after being symptom-free for 24 h, or v) 14 days after symptom onset. We also included four treatments to assess the policy options: i) immediate, effective treatment; ii) effective treatment after laboratory diagnosis; iii) no treatment; iv) ineffective treatment. Relying on published data, we calculated the likelihood that a child reentering childcare would be infectious, and the number of childcare-days lost per policy. RESULTS: Requiring two consecutive negative PCR tests yielded a probability of onward transmission of < 1%, with up to 17 childcare-days lost for children receiving effective treatment, and 53 days lost for those receiving ineffective treatment. CONCLUSIONS: Of the policies analyzed, requiring negative PCR testing before returning to childcare was the most effective to reduce the risk of shigellosis transmission, with one PCR test being the most effective for the least childcare-days lost.


Asunto(s)
Jardines Infantiles , Disentería Bacilar/epidemiología , Disentería Bacilar/transmisión , Antibacterianos/uso terapéutico , Jardines Infantiles/estadística & datos numéricos , Preescolar , Brotes de Enfermedades , Disentería Bacilar/tratamiento farmacológico , Heces/microbiología , Femenino , Humanos , Lactante , Masculino , Reacción en Cadena de la Polimerasa , Shigella/genética , Shigella/patogenicidad , Factores de Tiempo , Esparcimiento de Virus
7.
Health Secur ; 16(5): 334-340, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30339099

RESUMEN

Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call®, a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call® during an influenza pandemic. The tool incorporates 2 influenza clinical attack rates (20% and 30%), 4 different levels of pandemic severity, and different initial "seed numbers" of cases (10 or 100), and it allows variation in which week the nurse triage line opens. The tool calculates call volume by using call-to-hospitalization ratios based on pandemic severity. We derived data on nurse triage line calls and call-to-hospitalization ratios from experience with the 2009 Minnesota FluLine nurse triage line. Assuming a 20% clinical attack rate and a case hospitalization rate of 0.8% to 1.5% (1968-like pandemic severity), we estimated the nationwide number of calls during the peak week of the pandemic to range from 1,551,882 to 3,523,902. Assuming a more severe 1957-like pandemic (case hospitalization rate = 1.5% to 3.0%), the national number of calls during the peak week of the pandemic ranged from 2,909,778 to 7,047,804. These results will aid in planning and developing nurse triage lines at both the national and state levels for use during a future influenza pandemic.


Asunto(s)
Gripe Humana/epidemiología , Rol de la Enfermera , Pandemias , Teléfono/estadística & datos numéricos , Triaje/métodos , Humanos , Modelos Estadísticos , Triaje/estadística & datos numéricos
8.
PLoS Negl Trop Dis ; 12(5): e0006490, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29791440

RESUMEN

BACKGROUND: Dog rabies annually causes 24,000-70,000 deaths globally. We built a spreadsheet tool, RabiesEcon, to aid public health officials to estimate the cost-effectiveness of dog rabies vaccination programs in East Africa. METHODS: RabiesEcon uses a mathematical model of dog-dog and dog-human rabies transmission to estimate dog rabies cases averted, the cost per human rabies death averted and cost per year of life gained (YLG) due to dog vaccination programs (US 2015 dollars). We used an East African human population of 1 million (approximately 2/3 living in urban setting, 1/3 rural). We considered, using data from the literature, three vaccination options; no vaccination, annual vaccination of 50% of dogs and 20% of dogs vaccinated semi-annually. We assessed 2 transmission scenarios: low (1.2 dogs infected per infectious dog) and high (1.7 dogs infected). We also examined the impact of annually vaccinating 70% of all dogs (World Health Organization recommendation for dog rabies elimination). RESULTS: Without dog vaccination, over 10 years there would a total of be approximately 44,000-65,000 rabid dogs and 2,100-2,900 human deaths. Annually vaccinating 50% of dogs results in 10-year reductions of 97% and 75% in rabid dogs (low and high transmissions scenarios, respectively), approximately 2,000-1,600 human deaths averted, and an undiscounted cost-effectiveness of $451-$385 per life saved. Semi-annual vaccination of 20% of dogs results in in 10-year reductions of 94% and 78% in rabid dogs, and approximately 2,000-1,900 human deaths averted, and cost $404-$305 per life saved. In the low transmission scenario, vaccinating either 50% or 70% of dogs eliminated dog rabies. Results were most sensitive to dog birth rate and the initial rate of dog-to-dog transmission (Ro). CONCLUSIONS: Dog rabies vaccination programs can control, and potentially eliminate, dog rabies. The frequency and coverage of vaccination programs, along with the level of dog rabies transmission, can affect the cost-effectiveness of such programs. RabiesEcon can aid both the planning and assessment of dog rabies vaccination programs.


Asunto(s)
Enfermedades de los Perros/economía , Enfermedades de los Perros/prevención & control , Programas de Inmunización/economía , Vacunas Antirrábicas/economía , Rabia/prevención & control , Vacunación/economía , África Oriental , Animales , Análisis Costo-Beneficio , Enfermedades de los Perros/mortalidad , Enfermedades de los Perros/transmisión , Perros , Femenino , Humanos , Programas de Inmunización/métodos , Masculino , Modelos Teóricos , Rabia/economía , Rabia/mortalidad , Rabia/transmisión , Vacunas Antirrábicas/administración & dosificación
9.
Infect Dis Poverty ; 6(1): 159, 2017 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-29191243

RESUMEN

BACKGROUND: The 2014-2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the possibility of broad-scale transmission of Ebola. MAIN TEXT: Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak, we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission (based on late 2014 air travel patterns). We estimated Ebola cases in three scenarios: a delayed response, a Liberia-like response, and a fast response scenario. Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci, we emphasize the need for improved levels of preparedness and response to public health threats, which is the goal of the Global Health Security Agenda. Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci, had local and international health workers and organizations not committed to a major response effort. Our results underscore the importance of rapid detection and initiation of an effective, organized response, and the challenges faced by countries with limited public health systems. Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel, bolstering primary and critical healthcare facilities, developing public health infrastructure (e.g. laboratory capacity), and improving disease surveillance. With stronger local public health systems infectious disease outbreaks would still occur, but their rapid escalation would be considerably less likely, minimizing the impact of public health threats such as Ebola. CONCLUSIONS: The Ebola outbreak could have potentially spread to other countries, where limited public health surveillance and response capabilities may have resulted in additional foci. Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak.


Asunto(s)
Países en Desarrollo , Brotes de Enfermedades , Ebolavirus/fisiología , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Salud Pública , África Occidental/epidemiología , Ciudades/epidemiología , Salud Global , Humanos , Modelos Teóricos
10.
Disaster Med Public Health Prep ; 11(5): 552-561, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28330513

RESUMEN

OBJECTIVE: This study describes findings from an assessment conducted to identify perceived knowledge gaps, information needs, and research priorities among state, territorial, and local public health preparedness directors and coordinators related to public health emergency preparedness and response (PHPR). The goal of the study was to gather information that would be useful for ensuring that future funding for research and evaluation targets areas most critical for advancing public health practice. METHODS: We implemented a mixed-methods approach to identify and prioritize PHPR research questions. A web survey was sent to all state, city, and territorial health agencies funded through the Public Health Emergency Preparedness (PHEP) Cooperative Agreement program and a sample of local health departments (LHDs). Three focus groups of state and local practitioners and subject matter experts from the Centers for Disease Control and Prevention (CDC) were subsequently conducted, followed by 3 meetings of an expert panel of PHPR practitioners and CDC experts to prioritize and refine the research questions. RESULTS: We identified a final list of 44 research questions that were deemed by study participants as priority topics where future research can inform PHPR programs and practice. We identified differences in perceived research priorities between PHEP awardees and LHD survey respondents; the number of research questions rated as important was greater among LHDs than among PHEP awardees (75%, n=33, compared to 24%, n=15). CONCLUSIONS: The research questions identified provide insight into public health practitioners' perceived knowledge gaps and the types of information that would be most useful for informing and advancing PHPR practice. The study also points to a higher level of information need among LHDs than among PHEP awardees. These findings are important for CDC and the PHPR research community to ensure that future research studies are responsive to practitioners' needs and provide the information required to enhance their capacity to meet the needs of the communities and jurisdictions they serve. (Disaster Med Public Health Preparedness. 2017;11:552-561).


Asunto(s)
Defensa Civil/métodos , Socorristas/clasificación , Salud Pública/métodos , Investigación/clasificación , /organización & administración , Defensa Civil/clasificación , Humanos , Gobierno Local , Evaluación de Necesidades/estadística & datos numéricos , Encuestas y Cuestionarios , Estados Unidos
11.
MMWR Suppl ; 65(3): 85-9, 2016 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-27387097

RESUMEN

To aid decision-making during CDC's response to the 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa, CDC activated a Modeling Task Force to generate estimates on various topics related to the response in West Africa and the risk for importation of cases into the United States. Analysis of eight Ebola response modeling projects conducted during August 2014-July 2015 provided insight into the types of questions addressed by modeling, the impact of the estimates generated, and the difficulties encountered during the modeling. This time frame was selected to cover the three phases of the West African epidemic curve. Questions posed to the Modeling Task Force changed as the epidemic progressed. Initially, the task force was asked to estimate the number of cases that might occur if no interventions were implemented compared with cases that might occur if interventions were implemented; however, at the peak of the epidemic, the focus shifted to estimating resource needs for Ebola treatment units. Then, as the epidemic decelerated, requests for modeling changed to generating estimates of the potential number of sexually transmitted Ebola cases. Modeling to provide information for decision-making during the CDC Ebola response involved limited data, a short turnaround time, and difficulty communicating the modeling process, including assumptions and interpretation of results. Despite these challenges, modeling yielded estimates and projections that public health officials used to make key decisions regarding response strategy and resources required. The impact of modeling during the Ebola response demonstrates the usefulness of modeling in future responses, particularly in the early stages and when data are scarce. Future modeling can be enhanced by planning ahead for data needs and data sharing, and by open communication among modelers, scientists, and others to ensure that modeling and its limitations are more clearly understood. The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).


Asunto(s)
/organización & administración , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/prevención & control , Modelos Teóricos , África Occidental/epidemiología , Predicción , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Cooperación Internacional , Rol Profesional , Estados Unidos
12.
Health Secur ; 13(5): 317-26, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26348094

RESUMEN

Our objective was to inform state and community interventions focused on increasing household preparedness by examining the association between self-reported possession of household disaster preparedness items (ie, a 3-day supply of food and water, a written evacuation plan, and a working radio and flashlight) and perceptions of household preparedness on a 3-point scale from "well prepared" to "not at all prepared." Data were analyzed from 14 states participating in a large state-based telephone survey: the 2006-2010 Behavioral Risk Factor Surveillance System (BRFSS) (n = 104,654). Only 25.3% of the population felt they were well prepared, and only 12.3% had all 5 of the recommended items. Fewer than half the households surveyed had 4 or more of the recommended preparedness items (34.1%). Respondents were more likely to report their households were well prepared as the number of preparedness items possessed by their household increased. Risk factors for having no preparedness items were: younger age, being female, lower levels of education, and requesting the survey to be conducted in Spanish. To increase household disaster preparedness, more community-based preparedness education campaigns targeting vulnerable populations, such as those with limited English abilities and lower reading levels, are needed.


Asunto(s)
Planificación en Desastres/estadística & datos numéricos , Urgencias Médicas , Salud Pública/educación , Adolescente , Adulto , Sistema de Vigilancia de Factor de Riesgo Conductual , Suministros de Energía Eléctrica , Composición Familiar , Femenino , Alimentos , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Práctica de Salud Pública , Clase Social , Estados Unidos , Agua , Adulto Joven
13.
Influenza Other Respir Viruses ; 9(3): 131-42, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25688806

RESUMEN

BACKGROUND: As public health leaders prepare for possible future influenza pandemics, the rapid spread of 2009 H1N1 influenza highlights the need to focus on measures the public can adopt to help slow disease transmission. Such measures may relate to hygiene (e.g., hand washing), social distancing (e.g., avoiding places where many people gather), and pharmaceutical interventions (e.g., vaccination). Given the disproportionate impact of public health emergencies on minority communities in the United States, it is important to understand whether there are differences in acceptance across racial/ethnic groups that could lead to targeted and more effective policies and communications. OBJECTIVES: This study explores racial/ethnic differences in the adoption of preventive behaviors during the 2009 H1N1 influenza pandemic. PATIENTS/METHODS: Data are from a national telephone poll conducted March 17 to April 11, 2010, among a representative sample of 1123 white, 330 African American, 317 Hispanic, 268 Asian, and 262 American Indian/Alaska Native adults in the USA. RESULTS: People in at least one racial/ethnic minority group were more likely than whites to adopt several behaviors related to hygiene, social distancing, and healthcare access, including increased hand washing and talking with a healthcare provider (P-values <0.05). Exceptions included avoiding others with influenza-like illnesses and receiving 2009 H1N1 and seasonal influenza vaccinations. After we controlled the data for socioeconomic status, demographic factors, healthcare access, and illness- and vaccine-related attitudes, nearly all racial/ethnic differences in behaviors persisted. CONCLUSIONS: Minority groups appear to be receptive to several preventive behaviors, but barriers to vaccination are more pervasive.


Asunto(s)
Grupos Étnicos , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/prevención & control , Adolescente , Adulto , Anciano , Grupos Étnicos/psicología , Femenino , Desinfección de las Manos/tendencias , Conocimientos, Actitudes y Práctica en Salud/etnología , Humanos , Vacunas contra la Influenza , Gripe Humana/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Vacunación/estadística & datos numéricos , Vacunación/tendencias , Adulto Joven
14.
J Public Health Manag Pract ; 20(2): 197-204, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-23838895

RESUMEN

OBJECTIVE: To identify the extent to which the Homeland Security Exercise and Evaluation Program's (HSEEP) After Action Report/Improvement Plan (AAR/IP) template was followed by public health entities and facilitated the identification of detailed corrective actions and continuous improvement. DESIGN: Data were drawn from the US H1N1 Public Health Emergency Response (PHER) federal grant awardees (n = 62). After action report/improvement plan text was examined to identify the presence of AAR/IP HSEEP elements and characterized as "minimally complete," "partially complete," or "complete." Corrective actions (CA) and recommendations within the IP focusing on performance deficits were coded as specific, measurable, and time-bound, and whether they were associated with a problem that met root cause criteria and whether the CA/recommendation was intended to address or fix the root cause. MAIN OUTCOME MEASURES: A total of 2619 CA/recommendations were identified. More than half (n = 1480, 57%) addressed root causes. Corrective actions/recommendations associated with complete AARs more frequently addressed root cause (58% vs 51%, χ = 9.1, P < 0.003) and were more specific (34% vs 23%, χ = 32.3, P < 0.0001), measurable (30% vs 18%, χ = 37.9, P < 0.0001), and time-bound (38% vs 15%, χ = 115.5, P < 0.0001) than partially complete AARs. The same pattern was not observed with completeness of IPs. Corrective actions and recommendations were similarly specific and measurable. Recommendations significantly addressed root cause more than CAs. CONCLUSIONS: Our analysis indicates a possible lack of awardee distinction between CA and recommendations in AARs. As HSEEP adapts to align with the 2011 National Preparedness Goal and National Preparedness System, future HSEEP documents should emphasize the importance of root cause analysis as a required element within AAR documents and templates in the exercise and real incident environment, as well as the need for specific and measurable CAs.


Asunto(s)
Planificación en Desastres/normas , Brotes de Enfermedades/prevención & control , Gripe Humana/epidemiología , Planificación en Desastres/métodos , Estudios de Evaluación como Asunto , Humanos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/prevención & control , Gripe Humana/virología , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normas , Análisis de Causa Raíz
15.
J Public Health Manag Pract ; 19(1): 70-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23169406

RESUMEN

OBJECTIVES: We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response. DESIGN: Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made. SETTING: Local health departments during the fall 2009 H1N1 pandemic response. PARTICIPANTS: Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network. MAIN OUTCOME MEASURES: Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity. RESULTS: One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity. CONCLUSIONS: Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity.


Asunto(s)
Defensa Civil/organización & administración , Defensa Civil/estadística & datos numéricos , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/epidemiología , Gobierno Local , Pandemias/estadística & datos numéricos , Salud Pública , Absentismo , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Higiene de las Manos/estadística & datos numéricos , Humanos , Máscaras/estadística & datos numéricos , Cuarentena/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos
16.
Lancet Infect Dis ; 12(11): 845-50, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23041199

RESUMEN

BACKGROUND: Many important strategies to reduce the spread of pandemic influenza need public participation. To assess public receptivity to such strategies, we compared adoption of preventive behaviours in response to the 2009 H1N1 influenza pandemic among the public in five countries and examined whether certain non-pharmaceutical behaviours (such as handwashing) were deterrents to vaccination. We also assessed public support for related public health recommendations. METHODS: We used data from simultaneous telephone polls (mobile telephone and landline) in Argentina, Japan, Mexico, the UK, and the USA. In each country, interviews were done in a nationally representative sample of adults, who were selected by the use of random digit dial techniques. The questionnaire asked people whether or not they had adopted each of various preventive behaviours (non-pharmaceutical--such as personal protective and social distancing behaviour--or vaccinations) to protect themselves or their family from H1N1 at any point during the pandemic. Two-tailed t tests were used for statistical analysis. FINDINGS: 900 people were surveyed in each country except the USA where 911 people were contacted. There were wide differences in the adoption of preventive behaviours between countries, although certain personal protective behaviours (eg, handwashing) were more commonly adopted than social distancing behaviours (eg, avoiding places where many people gather) across countries (53-89%vs 11-69%). These non-pharmaceutical behaviours did not reduce the likelihood of getting vaccinated in any country. There was also support across all countries for government recommendations related to school closure, avoiding places where many people gather, and wearing masks in public. INTERPRETATION: There is a need for country-specific approaches in pandemic policy planning that use both non-pharmaceutical approaches and vaccination. FUNDING: US Centers for Disease Control and Prevention and the National Public Health Information Coalition.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Subtipo H1N1 del Virus de la Influenza A/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Argentina , Femenino , Humanos , Gripe Humana/virología , Entrevistas como Asunto , Japón , Masculino , México , Persona de Mediana Edad , Encuestas y Cuestionarios , Reino Unido , Estados Unidos , Adulto Joven
17.
Am J Obstet Gynecol ; 207(4): 294.e1-7, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22921096

RESUMEN

OBJECTIVE: We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. STUDY DESIGN: From February to May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. RESULTS: Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. CONCLUSION: Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic.


Asunto(s)
Gripe Humana/prevención & control , Pautas de la Práctica en Medicina/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/prevención & control , Adulto , Actitud del Personal de Salud , Femenino , Ginecología , Encuestas de Atención de la Salud , Humanos , Obstetricia , Embarazo , Salud Pública
18.
Pediatrics ; 129 Suppl 2: S68-74, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22383484

RESUMEN

OBJECTIVES: We determined program effectiveness, feasibility, and acceptance of school-located vaccination (SLV) clinics for seasonal influenza that took place before the 2008 universal influenza vaccination recommendations. METHODS: We surveyed program directors of 23 programs in the United States who conducted SLV clinics during the 2005 to 2006 and 2006 to 2007 influenza seasons. RESULTS: Of 391,423 children enrolled in schools with SLV clinics, 61,463 (15.7%) were vaccinated at 499 sites (schools) in 23 programs. Of these, 22 were small- and medium-sized programs that vaccinated 32,875 (24.1%) of the 136,151 children enrolled there, averaging 31.9% of students per site. One populous county vaccinated an additional 28,588 (11.2%) of its 255,272 enrolled children, averaging 13.9% per school. Children in grades K to 6 had consistently higher mean vaccination rates (21.5%) compared with middle school children (10.3%) or high school youth (5.8%). Program acceptability was high, and no program had to forego any key public health activities; 5 hired temporary help or paid overtime. The outlook for continuing such clinics was good in 7 programs, but depended on help with vaccine purchasing (9), funding (8), or additional personnel (4), with multiple responses allowed. CONCLUSIONS: These vaccination coverage rates provide a baseline for future performance of school-located mass vaccination clinics. Although the existence and conduct of these programs in our study was considered acceptable by leaders of public health departments and anecdotally by parents and school administrators, sustainability may require additional means to pay for vaccines or personnel beyond the usual available health department resources.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Vacunas contra la Influenza/administración & dosificación , Vacunación Masiva/organización & administración , Vacunación Masiva/estadística & datos numéricos , Servicios de Salud Escolar/organización & administración , Niño , Preescolar , Humanos , Gripe Humana/inmunología , Gripe Humana/prevención & control , Evaluación de Programas y Proyectos de Salud , Estaciones del Año , Estados Unidos
19.
Obstet Gynecol ; 118(5): 1074-80, 2011 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-22015875

RESUMEN

OBJECTIVE: To assess knowledge, attitudes, and practices of obstetrician-gynecologists (ob-gyns) regarding vaccination of pregnant women during the 2009 H1N1 pandemic. METHODS: From February to July 2010, a self-administered mail survey was conducted among a random sample of American College of Obstetricians and Gynecologists (the College) members involved in obstetric care. To assess predictors of routinely offering influenza vaccination, adjusted prevalence ratios and 95% confidence intervals (CIs) were calculated from survey data. RESULTS: Among 3,096 survey recipients, 1,310 (42.3%) responded to the survey, of whom 873 were eligible for participation. The majority of ob-gyns reported routinely offering both seasonal and 2009 H1N1 influenza vaccination to their pregnant patients (77.6% and 85.6%, respectively) during the 2009-2010 season; 21.1% and 13.3% referred patients to other specialists. Reported reasons for not offering vaccination included inadequate reimbursement, storage limitations, or belief that vaccine should be administered by another provider. Seasonal and 2009 H1N1 influenza vaccination during the first trimester was not recommended by 10.6% and 9.6% of ob-gyns, respectively. Predictors of routinely offering 2009 H1N1 influenza vaccine included: considering primary care and preventive medicine a very important part of practice (adjusted prevalence ratio 1.2, CI 1.01-1.4); observing serious conditions attributed to influenza-like illness (adjusted prevalence ratio 1.1, CI 1.02-1.1); personally receiving 2009 H1N1 influenza vaccination (adjusted prevalence ratio 1.2, CI 1.1-1.4); and practicing in multispecialty group (adjusted prevalence ratio 1.1, CI 1.1-1.2). Physicians in solo practice were less likely to routinely offer influenza vaccine (adjusted prevalence ratio 0.8, CI 0.7-0.9). CONCLUSION: Although most ob-gyns routinely offered influenza vaccination to pregnant patients, vaccination coverage rates may be improved by addressing logistic and financial challenges of vaccine providers.


Asunto(s)
Actitud del Personal de Salud , Vacunas contra la Influenza , Obstetricia/estadística & datos numéricos , Pautas de la Práctica en Medicina , Femenino , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Gripe Humana/prevención & control , Masculino , Persona de Mediana Edad , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control
20.
Obstet Gynecol ; 113(1): 33-40, 2009 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-19104357

RESUMEN

OBJECTIVE: To examine the effect of data source (birth certificate compared with hospital discharge records) and the definition of risk on the prevalence of cesarean deliveries thought to have "no indicated risk"; eg, the fetus is full-term, singleton, and in the vertex position, and the mother has no reported medical risk factors or complications of labor and/or delivery identified on the birth certificate. METHODS: The study is based on data from 565,767 women who delivered singleton, vertex neonates with gestational ages of 37-41 weeks in Georgia hospitals between 1999 and 2004 and for whom data from birth certificates and hospital discharge records could be linked. The percentages of women with primary cesarean deliveries who did not have risk indicated on the birth certificate and on the hospital discharge record were compared. We also calculated the agreement between data sources overall and for each risk indicator. RESULTS: Among 40,932 women with primary cesarean deliveries and no risk indicated on the birth certificate, 35,761 (87.4%) had a risk identified in the hospital discharge data. The overall agreement between data sources on the presence of any risk indicator was low (kappa=0.18). Among primary cesarean deliveries, the percentage without indicated risk was 58.3% when using birth certificate data alone and 3.9% when using hospital discharge data in combination with the birth certificate. CONCLUSION: Using birth certificate information alone overestimated the proportion of women who had no-indicated-risk cesarean deliveries in Georgia. Evidence of many indications for cesarean delivery can be found only in the hospital discharge data. The construct of no indicated risk as determined from birth certificates should be interpreted with caution, and the use of linked data should be considered whenever possible. LEVEL OF EVIDENCE: III.


Asunto(s)
Certificado de Nacimiento , Cesárea/estadística & datos numéricos , Registros de Hospitales , Recolección de Datos , Femenino , Humanos , Recién Nacido , Embarazo , Complicaciones del Embarazo , Factores de Riesgo
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