Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research.

In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.

Defining and applying a method for improving the sensitivity and specificity of an emergency department early event detection system.

The sensitivity and specificity of syndrome definitions used in early event detection (EED) systems affect the usefulness of the system for end-users. The ability to calculate these values aids system designers in the refinement of syndrome definitions to better meet public health needs. Utilizing a stratified sampling method and expert review to create a gold standard dataset for the calculation of sensitivity and specificity, we describe how varying syndrome structure impacts these statistical parameters and discuss the relevance of this to outbreak detection and investigation.

Pre-event willingness to receive smallpox vaccine among physicians and public safety personnel.

BACKGROUND: Planning for voluntary smallpox vaccination of health and safety officials began in December 2002. MATERIALS AND METHODS: Surveys were conducted among physicians and fire and police department personnel in Atlanta, Georgia. Information on demographics, willingness to receive smallpox vaccine, self-reported knowledge level, and potential vaccine contraindications was analyzed. RESULTS: Forty-one percent of physicians (n = 199) were undecided on vaccination (32% would receive vaccine and 27% would not). Forty-eight percent of firefighters (n = 343) and 41% of police (n = 466) were undecided; 23% and 41% would receive vaccine, whereas 28% and 18% would not (fire and police, respectively). Absence of contraindications was associated with physicians' willingness to be vaccinated (P = 0.006). Many physicians (66%) and most public safety personnel (88%) considered themselves inadequately informed on smallpox vaccine. In a multivariate analysis, inadequately informed respondents were more likely to be undecided (OR = 2.23, CI = 1.39 to 3.56). CONCLUSIONS: Before implementation of the smallpox vaccination program, self-assessed knowledge about smallpox disease and vaccine were poor.

Development of an interactive bioterrorism and emerging infections curriculum for medical students and internal medicine residents.

While awareness of bioterrorism threats and emerging infectious diseases has resulted in an increased sense of urgency to improve the knowledge base and response capability of physicians, few medical schools and residency programs have curricula in place to teach these concepts. Public health agencies are an essential component of a response to these types of emergencies. Public health education during medical school is usually limited to the non-clinical years. With collaboration from our local public health agency, the Emory University School of Medicine developed a curriculum in bioterrorism and emerging infections. By implementing this curriculum in the clinical years of medical school and residency programs, we seek to foster improved interactions between clinicians and their local public health agencies.

The recording of demographic information on death certificates: a national survey of funeral directors.

OBJECTIVE: The authors sought to ascertain the methods used by funeral directors to determine the demographic information recorded on death certificates. METHODS: Standardized questionnaires were administered to funeral directors in five urban locations in the U.S. In addition, personnel on four Indian reservations were interviewed. Study sites were selected for diverse racial/ethnic populations and variability in recording practices; funeral homes were selected by stratified random sampling. RESULTS: Fifty-two percent of responding funeral directors reported receiving no formal training in death certification. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation. Only three respondents reported that occupation was a problematic item. CONCLUSIONS: The authors recommend that the importance of demographic data and the instructions for data collection be clarified for funeral directors, that standard data collection worksheets be developed, and that training videos be developed.

Vigilancia y epidemiología / Vigilance and Epidemiology

Se hace una relación entre la vigilancia en salud pública (VSP) y la epidemiología. La vigilancia en salud pública es vista como herramienta para identificar los problemas en un área determinada, establecer las prioridades para quienes toman decisiones y evaluar la efectividad de las actividades realizadas. Se encuentran definiciones de la VSP y su uso en la planeación, implementación y evaluación de los programas de salud pública. Incluye información sobre el ciclo de la vigilancia en salud pública, las características de los métodos de recolección de datos en escenarios de desastre y los pasos en la planificación del sistema de vigilancia. Se refiere también a los problemas metodológicos como la evaluación y la vigilancia post-desastre e incluye ejemplos seleccionados de estrategias y métodos que incluyen la planificación, la evaluación epidemiológica rápida, vigilancia activa que usa servicios médicos existentes y temporales, vigilancia centinela, investigación de rumores, investigaciones por conglomerados para estimar las necesidades de los servicios de salud. Finalmente incluye recomendaciones para mejorar la eficiencia de la VSP en todas las fases del desastre

Vigilancia y epidemiología / Vigilance and Epidemiology

Se hace una relación entre la vigilancia en salud pública (VSP) y la epidemiología. La vigilancia en salud pública es vista como herramienta para identificar los problemas en un área determinada, establecer las prioridades para quienes toman decisiones y evaluar la efectividad de las actividades realizadas. Se encuentran definiciones de la VSP y su uso en la planeación, implementación y evaluación de los programas de salud pública. Incluye información sobre el ciclo de la vigilancia en salud pública, las características de los métodos de recolección de datos en escenarios de desastre y los pasos en la planificación del sistema de vigilancia. Se refiere también a los problemas metodológicos como la evaluación y la vigilancia post-desastre e incluye ejemplos seleccionados de estrategias y métodos que incluyen la planificación, la evaluación epidemiológica rápida, vigilancia activa que usa servicios médicos existentes y temporales, vigilancia centinela, investigación de rumores, investigaciones por conglomerados para estimar las necesidades de los servicios de salud. Finalmente incluye recomendaciones para mejorar la eficiencia de la VSP en todas las fases del desastre