Experiences of HIV/STD Providers in New York State During Hurricane Sandy: Strengths, Challenges, and Recommendations.

OBJECTIVES: The aim of this study was to assess strengths and challenges experienced by HIV/STD providers in providing care during the response to Hurricane Sandy (Sandy) in New York State, and their recommendations for future preparedness. METHODS: A mixed methods approach, including a focus group (n = 3), interviews (n = 3), and survey (n = 31) of HIV/STD providers, was used. Key words identified by means of open coding methodology from collected data were organized into strengths, challenges, and recommendations and then grouped into federal and study-associated preparedness capabilities. RESULTS: Key words were organized into 81 strengths (38.8%), 73 challenges (34.9%), and 55 recommendations (26.3%). Services most interrupted during Sandy were related to HIV/STD outreach and education. While providers reported challenges with external agency communication, the ability to still connect clients to needed resources was reported as a strength. Strengthening partnerships with federal, state, and local agencies was among the major recommendations made by these providers. CONCLUSIONS: This study presents unique information about challenges experienced by HIV/STD providers in providing services during a natural disaster and the use of national public health emergency preparedness capabilities to address and overcome those challenges. Lessons learned and recommendations regarding inter-agency communications emerged as an important priority during a natural disaster to minimize or reduce service interruption.

Salmonella and the changing environment: systematic review using New York State as a model.

Salmonella is a public health concern, for which a complex interplay between host, agent, and environment exists. An improved understanding of causal processes can be used to better gauge the causes and trajectory of Salmonella in a changing environment. This would be useful in determining the impact of climate change on the New York State (NYS) environment, the effect of climate change on Salmonella in NYS, factors contributing to Salmonella vulnerability in humans, and aspects of climate change and Salmonella which necessitate further research. A systematic review was conducted to study associations between Salmonella and the environment. Using the search criteria, a total of 91 relevant articles were identified from four electronic databases. Key information was abstracted, organized, and synthesized to identify causal processes and linkages between climate change, the environment of NYS, and Salmonella-related outcomes, as well as risk factors to characterize Salmonella vulnerabilities. Three inter-related domains were identified for consideration and application to epidemiological research to confirm and extrapolate disease patterns using climate change scenarios: improved quantification of causal relationships, inclusion of factors linked to sectors not immediately associated with the exposure and outcome, and increased capacity to validate models in diverse settings.

Superstorm Sandy's impact on the provision of WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) services in New York State.

OBJECTIVE: Services provided by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were interrupted in 2012 when Superstorm Sandy struck New York State (NYS). The present study evaluates the impact on WIC providers. DESIGN: A focus group, telephone interviews and anonymous online survey were conducted. Qualitative data were analysed by coding transcribed text into key words and identifying major and minor themes for strengths, challenges and recommendations using national public health preparedness capabilities. Survey responses were analysed quantitatively; reported challenges were classified by preparedness capability. SETTING: The focus group was held at a 2014 regional WIC meeting. Interviews and a survey were conducted via telephone in 2014 and online in 2015, respectively. SUBJECTS: WIC staff representing New York City and three NYS counties. RESULTS: In the focus group (n 12) and interviews (n 6), 'emergency operations coordination' was the most cited capability as a strength, 'environmental health protection' (against environmental hazards) as a challenge and 'flexibility' (on rules and procedures) as a recommendation. In the survey (n 24), the capability 'information sharing' was most often cited as a challenge. Most staff (66·6 %) reported their programmes were at least somewhat prepared for future weather-related disasters. Only 16·7 % indicated having practiced a work-related emergency response plan since Sandy. Staff who practiced an emergency response plan were more likely to indicate they were prepared (P < 0·05). CONCLUSIONS: The study identified WIC programme areas requiring preparedness improvements. The research methodology can be utilized to assess the continuity of other public health services during disasters.

Superstorm Sandy: Emergency management staff perceptions of impact and recommendations for future preparedness, New York State.

OBJECTIVE: This study collected and summarized feedback from staff at the New York State (NYS) Office of Emergency Management (OEM) and three county OEMs within NYS to understand lessons learned from the 2012 Superstorm Sandy. DESIGN: Cross-sectional qualitative and quantitative analysis. SUBJECTS, PARTICIPANTS: One staff person from each identified critical role from the state and county OEMs who were still employed in the roles identified. INTERVENTIONS: In-person interviews in 2014 followed by an anonymous survey in 2015 examined the response strengths, challenges, and recommendations using federally and study-defined Public Health Preparedness Capabilities. Quantitative analysis of staff survey ratings was used to summarize perceptions of interagency collaboration, communication effectiveness, and differences by staff position. RESULTS: Response rates were 78 percent for interviews (n = 7) and 45 percent for surveys (n = 36). In interviews, "emergency operations coordination" was cited most frequently (48 percent), specifically for successful interagency coordination. "Emergency operations coordination" was also cited most among challenges (45 percent), with emphasis on problems with uniformity of software systems across agencies. Survey responses indicated that "volunteer management" (50 percent) and the "safety and health of responders" (40 percent) were frequently reported as challenges. Additionally, 38 percent of OEM staff reported that situation reports submitted by health departments need improvement. Recommendations from OEM staff included "emergency operations coordination" (36 percent) such as sharing of resources and "training" (16 percent) including hospital evacuation training. CONCLUSIONS: Analysis of OEM staff feedback identified specific challenges, and concrete recommendations were made to improve response going forward.

New York State Public Health System Response to Hurricane Sandy: Lessons From the Field.

OBJECTIVE: The aim of this study was to conduct interviews with public health staff who responded to Hurricane Sandy and to analyze their feedback to assess response strengths and challenges and recommend improvements for future disaster preparedness and response. METHODS: Qualitative analysis was conducted of information from individual confidential interviews with 35 staff from 3 local health departments in New York State (NYS) impacted by Hurricane Sandy and the NYS Department of Health. Staff were asked about their experiences during Hurricane Sandy and their recommendations for improvements. Open coding was used to analyze interview transcripts for reoccurring themes, which were labeled as strengths, challenges, or recommendations and then categorized into public health preparedness capabilities. RESULTS: The most commonly cited strengths, challenges, and recommendations related to the Hurricane Sandy public health response in NYS were within the emergency operations coordination preparedness capability, which includes the abilities of health department staff to partner among government agencies, coordinate with emergency operation centers, conduct routine conference calls with partners, and manage resources. CONCLUSIONS: Health departments should ensure that emergency planning includes protocols to coordinate backup staffing, delineation of services that can be halted during disasters, clear guidelines to coordinate resources across agencies, and training for transitioning into unfamiliar disaster response roles. (Disaster Med Public Health Preparedness. 2016;10:443-453).

New York State Public Health System Response to Hurricane Sandy: An Analysis of Survey Feedback.

OBJECTIVE: The objective was to provide a broad spectrum of New York State and local public health staff the opportunity to contribute anonymous feedback on their own and their agencies' preparedness and response to Hurricane Sandy, perceived challenges, and recommendations for preparedness improvement. METHODS: In 2015, 2 years after Hurricane Sandy, public health staff who worked on Hurricane Sandy response were identified and were provided a link to the anonymous survey. Quantitative analyses were used for survey ratings and qualitative content analyses were used for open-ended questions. RESULTS: Surveys were completed by 129 local health department (LHD) staff in 3 counties heavily impacted by Sandy (Nassau, Suffolk, and Westchester) and 69 staff in the New York State Department of Health who supported the LHDs. Staff agreed that their Hurricane Sandy responsibilities were clearly defined and that they had access to adequate information to perform their jobs. Challenges were reported in the operational, communication, service interruptions, and staff categories, with LHD staff also reporting challenges with shelters. CONCLUSIONS: New York local and state public health staff indicated that they were prepared for Hurricane Sandy. However, their feedback identified specific challenges and recommendations that can be addressed to implement improved preparedness and response strategies. (Disaster Med Public Health Preparedness. 2016;10:454-462).

New York State Public Health System Response to Hurricane Sandy: An Analysis of Emergency Reports.

OBJECTIVE: Analyzing Hurricane Sandy emergency reports to assess the New York State (NYS) public health system response will help inform and improve future disaster preparedness and response. METHODS: Qualitative analysis of NYS Department of Health (NYSDOH) and Nassau and Suffolk County local health department (LHD) emergency reports was conducted. Three after-action reports and 48 situation reports were reviewed, grouped by key words and sorted into 16 Public Health Preparedness Capabilities. Within each capability, key words were labeled as strengths, challenges, or recommendations. RESULTS: The NYSDOH capability most cited as a strength was successful emergency operations coordination, eg, interagency conference calls (27.4% of 1681 strengths). The most cited challenge was environmental health protection, eg, mold and oil spills (28% of 706 challenges). The LHD capability most cited both as a strength (46.7% of 30 strengths) and as a challenge (32.5% of 123 challenges) was emergency operations coordination. Strengths were exemplified by sharing local resources and challenges by insufficient memorandums of understanding for coordination. CONCLUSIONS: Post-disaster emergency reports should be systematically reviewed to highlight both successes and areas for improvement. Future studies should prioritize collecting feedback from a wider spectrum of public health and service provider staff for planning of preparedness and response activities. (Disaster Med Public Health Preparedness. 2015;10:308-313).

Public Health Climate Change Adaptation Planning Using Stakeholder Feedback.

CONTEXT: Public health climate change adaptation planning is an urgent priority requiring stakeholder feedback. The 10 Essential Public Health Services can be applied to adaptation activities. OBJECTIVE: To develop a state health department climate and health adaptation plan as informed by stakeholder feedback. DESIGN: With Centers for Disease Control and Prevention (CDC) funding, the New York State Department of Health (NYSDOH) implemented a 2010-2013 climate and health planning process, including 7 surveys on perceptions and adaptation priorities. PARTICIPANTS: New York State Department of Health program managers participated in initial (n = 41, denominator unknown) and follow-up (72.2%) needs assessments. Surveillance system information was collected from 98.1% of surveillance system managers. For adaptation prioritization surveys, participants included 75.4% of NYSDOH leaders; 60.3% of local health departments (LHDs); and 53.7% of other stakeholders representing environmental, governmental, health, community, policy, academic, and business organizations. Interviews were also completed with 38.9% of other stakeholders. RESULTS: In 2011 surveys, 34.1% of state health program directors believed that climate change would impact their program priorities. However, 84.6% of state health surveillance system managers provided ideas for using databases for climate and health monitoring/surveillance. In 2012 surveys, 46.5% of state health leaders agreed they had sufficient information about climate and health compared to 17.1% of LHDs (P = .0046) and 40.9% of other stakeholders (nonsignificant difference). Significantly fewer (P < .0001) LHDs (22.9%) were incorporating or considering incorporating climate and health into planning compared to state health leaders (55.8%) and other stakeholders (68.2%). Stakeholder groups agreed on the 4 highest priority adaptation categories including core public health activities such as surveillance, coordination/collaboration, education, and policy development. CONCLUSIONS: Feedback from diverse stakeholders was utilized by NYSDOH to develop its Climate and Health Strategic Map in 2013. The CDC Building Resilience Against Climate Effects (BRACE) framework and funding provides a collaborative model for state climate and health adaptation planning.

An evidence-based public health approach to climate change adaptation.

BACKGROUND: Public health is committed to evidence-based practice, yet there has been minimal discussion of how to apply an evidence-based practice framework to climate change adaptation. OBJECTIVES: Our goal was to review the literature on evidence-based public health (EBPH), to determine whether it can be applied to climate change adaptation, and to consider how emphasizing evidence-based practice may influence research and practice decisions related to public health adaptation to climate change. METHODS: We conducted a substantive review of EBPH, identified a consensus EBPH framework, and modified it to support an EBPH approach to climate change adaptation. We applied the framework to an example and considered implications for stakeholders. DISCUSSION: A modified EBPH framework can accommodate the wide range of exposures, outcomes, and modes of inquiry associated with climate change adaptation and the variety of settings in which adaptation activities will be pursued. Several factors currently limit application of the framework, including a lack of higher-level evidence of intervention efficacy and a lack of guidelines for reporting climate change health impact projections. To enhance the evidence base, there must be increased attention to designing, evaluating, and reporting adaptation interventions; standardized health impact projection reporting; and increased attention to knowledge translation. This approach has implications for funders, researchers, journal editors, practitioners, and policy makers. CONCLUSIONS: The current approach to EBPH can, with modifications, support climate change adaptation activities, but there is little evidence regarding interventions and knowledge translation, and guidelines for projecting health impacts are lacking. Realizing the goal of an evidence-based approach will require systematic, coordinated efforts among various stakeholders.

Integrating public health education in a public health practice setting: the experience of the School of Public Health, University at Albany and the New York State Department of Health.

The New York State Department of Health (DOH) has a long history of biomedical research, public health policy and program development, peer-reviewed scholarship, and teaching. Its evolution as an academic health department advanced significantly when the University at Albany and DOH formed the School of Public Health Sciences in 1985 to further develop these functions while formally training the next generation of public health workers. The School, renamed in 1990 as the School of Public Health (SPH), was initially located within the DOH with its staff as the founding faculty. The curriculum was heavily influenced by public health practice imperatives. The SPH has evolved to have an independent campus and full-time academic faculty, but the DOH remains closely linked. The relationship is governed by a memorandum of understanding that commits both partners to provide substantial and continuing resources to the SPH. The SPH brings value to the DOH's mission to improve the health of the state's citizens by providing an academic focus to problems faced in health department practice settings. The opportunity to teach and be involved in an academic environment increases the DOH's ability to recruit, retain, and improve the skill level of its professional and scientific staff and thereby improve its ability to assess health problems and to design and evaluate public health programs. The SPH also provides training and support to county health departments and nongovernment organizations, which further the DOH's mission, through continuing education programs and an online MPH degree program. International exchanges including those with China, Vietnam, and the Republic of Georgia have enriched the academic environment. Challenges include maintaining sufficient full-time faculty members, the need for the SPH to take on broader public health issues than those applicable to New York, and the shrinkage of the DOH's workforce and departure of many senior scientists who served as faculty.

Guillain-Barré syndrome surveillance during National Influenza Vaccination Campaign, New York, U.S.A., 2009.

The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009-May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture-recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.

State requirements for rabies-related animal control.

OBJECTIVE: Rabies postexposure prophylaxis is an important secondary prevention step but is unnecessary if the exposing animal is not rabid. Effective rabies-related animal control (RRAC) requirements enforced by animal control officers (ACO) are an alternative step to reduce the number of rabies exposures and postexposure prophylaxes. The purpose of this study was to describe the variability of requirements for RRAC by statutes and regulations across the United States. METHODS: Current state laws and regulations pertaining to rabies and animal control were reviewed and assessed for 3 primary RRAC activities related to obtaining animals that have potentially exposed humans to rabies, that have been potentially exposed to rabies, or that show signs of rabies. Animal control infrastructure was assessed on the basis of the requirement for, and authority granted to, ACOs for conducting these RRAC activities. State Public Health Veterinarians, State Veterinarians with the Departments of Agriculture, and/or State Epidemiologists were contacted for verification and assistance with interpretation of laws and regulations. RESULTS: Twenty-three states and the District of Columbia authorize specific actions related to all 3 RRAC activities. Twenty-four states have laws and regulations that do not clearly address at least 1 of the RRAC activities or limit the authority to domestic animals. Three states have laws or regulations that address RRAC nonspecifically or leave the requirements to localities. Eleven states mandate the placement of ACOs with authority over domestic and wild animals, 7 states require ACOs for control of domestic animals only, and 32 states and the District of Columbia have no statewide requirements for ACOs. DISCUSSION: Only 9 states have legal requirements for ACOs with authority over wild and domestic animals and RRAC that addresses all 3 primary RRAC activities. Consequently, RRAC requirements may represent an incompletely tapped rabies prevention mechanism.

Rabid foxes, rabid raccoons, and the odds of a human bite exposure, New York State, 1999-2007.

Anecdotal evidence suggests that rabid foxes are more likely to attack humans than are other rabid terrestrial animals. To examine this issue, we analyzed rabies surveillance data (1999-2007) maintained by the New York State Department of Health. Compared to rabid raccoons (Procyon lotor), foxes infected with raccoon variant rabies were more likely to bite during a human exposure incident (P<0.01). Additionally, rabid gray foxes (Urocyon cinereoargenteus) were significantly more likely to bite a human than were rabid red foxes (Vulpes vulpes; P<0.01). Animal control personnel and others who handle wildlife should be educated about the increased risk of bite exposure when dealing with potentially rabid foxes.

Survey of New York veterinarians to assess needs for public health preparedness training.

OBJECTIVE: Because most bioterrorist disease agents are zoonotic, veterinarians are important partners in preparedness. New York State is a prime port of entry and has a network of health and emergency management agencies for response. However, knowledge and participation by veterinarians has not yet been assessed. METHODS: A 25-question survey was mailed out to approximately half (1832) of the veterinarians licensed in New York State. Participants were asked about past emergency preparedness training, likelihood of participating in future training, preferred training topics, and their relationship with their local health department (LHD). RESULTS: Completed questionnaires were received from 529 veterinarians (29%). Most (83%) reported that they were likely to participate in emergency preparedness training, but in the past 2 years, only 14% received training in zoonotic disease outbreaks and 12% in emergency preparedness. Only 21% reported having a relationship with their LHD, but 48% were interested in having one. Lack of time was the biggest obstacle to involvement with the LHD (40%). Most (69%) of those responding to the survey said they would participate in training once per year or more often. CONCLUSIONS: Inducements, such as earning continuing education credits, or the development of active networks of preparedness organizations, state and local health departments, and veterinary schools are needed to deliver emergency preparedness training and information efficiently to veterinarians.

Terrestrial rabies and human postexposure prophylaxis, New York, USA.

During 1993-2002, cats accounted for 2.7% of rabid terrestrial animals in New York but for one third of human exposure incidents and treatments. Nonbite exposures and animals of undetermined rabies status accounted for 54% and 56%, respectively, of persons receiving rabies treatments.

Assessment of methods for prediction of human West Nile virus (WNV) disease from WNV-infected dead birds.

BACKGROUND: West Nile virus (WNV) is currently the leading cause of arboviral-associated encephalitis in the U.S., and can lead to long-term neurologic sequelae. Improvements in dead bird specimen processing time, including the availability of rapid field laboratory tests, allows reassessment of the effectiveness of using WNV-positive birds in forecasting human WNV disease. METHODS: Using New York State integrated WNV surveillance data from transmissions seasons in 2001-2003, this study determined which factors associated with WNV-positive dead birds are most closely associated with human disease. The study also addressed the 'delay' period between the distribution of the dead bird variable and the distribution of the human cases. In the last step, the study assessed the relative risk of contracting WNV disease for people who lived in counties with a 'signal' value of the predictor variable versus people who lived in counties with no 'signal' value of the predictor variable. RESULTS: The variable based on WNV-positive dead birds [(Positive/Tested)*(Population/Area)] was identified as the optimum variable for predicting WNV human disease at a county level. The delay period between distribution of the variable and human cases was determined to be approximately two weeks. For all 3 years combined, the risk of becoming a WNV case for people who lived in 'exposed' counties (those with levels of the positive dead bird variable above the signal value) was about 2 times higher than the risk for people who lived in 'unexposed' counties, but risk varied by year. CONCLUSION: This analysis develops a new variable based on WNV-positive dead birds, [(Positive/Tested)*(Population/Area)] to be assessed in future real-time studies for forecasting the number of human cases in a county. A delay period of approximately two weeks between increases in this variable and the human case onset was identified. Several threshold 'signal' values were assessed and found effective at indicating human case risk, although specific thresholds are likely to vary by region and surveillance system differences.

Factors associated with endemic raccoon (Procyon lotor) rabies in terrestrial mammals in New York State, USA.

This study evaluated characteristics associated with raccoon (Procyon lotor) rabies in New York State (NYS), USA, where this disease has been endemic for the last 15 years. The study included 4448 cases of raccoon rabies in terrestrial mammals reported across 1639 census tracts of NYS during 1997-2003. A Poisson-regression model with census tract-year as the unit of analysis revealed a higher number of raccoon-variant rabies cases per square kilometer in census tracts with each percent increase in the proportion of low-intensity residential areas (those with a lower concentration of housing units) (RR=7.68) and a lack of rivers/lakes (RR=1.20) and major roads (RR=1.10), while the number of cases decreased with each 1-m increase in land elevation (RR=0.998), and each percent increase in the proportion of wetlands (RR=0.01). The model was adjusted for county, ecoregion, and latitude to help control for unknown spatially dependent covariates. The model may be used in prioritizing areas for rabies control based on differential risk, including use of costly intervention methods such as oral rabies vaccine.