Successful Distribution of Tecovirimat During the Peak of the Mpox Outbreak - Los Angeles County, June 2022-January 2023.

Tecovirimat is the first-line antiviral treatment recommended for severe mpox or for persons with mpox who are at risk for severe disease; tecovirimat is available in the United States under an expanded access investigational new drug (IND) protocol. During the 2022-2023 mpox outbreak, local U.S. health jurisdictions facilitated access to tecovirimat. In June 2022, Los Angeles County (LAC) rapidly developed strategies for tecovirimat distribution using existing medical countermeasure distribution networks established by the Public Health Emergency Preparedness Program and the Hospital Preparedness Program, creating a hub and spoke distribution network consisting of 44 hub facilities serving 456 satellite sites across LAC. IND patient intake forms were analyzed to describe mpox patients treated with tecovirimat. Tecovirimat treatment data were matched with case surveillance data to calculate time from specimen collection to patients receiving tecovirimat. Among 2,281 patients with mpox in LAC, 735 (32%) received tecovirimat during June 2022-January 2023. Among treated patients, approximately two thirds (508; 69%) received treatment through community clinics and pharmacies. The median interval from specimen collection to treatment was 2 days (IQR = 0-5 days). Local data collection and analysis helped to minimize gaps in treatment access and facilitated network performance monitoring. During public health emergencies, medical countermeasures can be rapidly deployed across a large jurisdiction using existing distribution networks, including clinics and pharmacies.

Los Angeles County Department of Public Health's Health Hazard Assessment: putting the "health" into hazard assessment.

A ll communities, explicitly or implicitly, assess and prepare for the natural and manmade hazards that they know could impact their community. The commonality of hazard-based threats in most all communities does not usually result in standard or evidence-based preparedness practice and outcomes across those communities. Without specific efforts to build a shared perspective and prioritization, "all-hazards" preparedness can result in a random hodgepodge of priorities and preparedness strategies, resulting in diminished emergency response capabilities. Traditional risk assessments, with a focus on physical infrastructure, do not present the potential health and medical impacts of specific hazards and threats. With the implementation of Centers for Disease Control and Prevention's capability-based planning, there is broad recognition that a health-focused hazard assessment process--that engages the "Whole of Community"--is needed. Los Angeles County's Health Hazard Assessment and Prioritization tool provides a practical and innovative approach to enhance existing planning capacities. Successful utilization of this tool can provide a way for local and state health agencies and officials to more effectively identify the health consequences related to hazard-specific threats and risk, determine priorities, and develop improved and better coordinated agency planning, including community engagement in prioritization.

Planning for the control of pandemic influenza A (H1N1) in Los Angeles County and the United States.

Mathematical and computer models can provide guidance to public health officials by projecting the course of an epidemic and evaluating control measures. The authors built upon an existing collaboration between an academic research group and the Los Angeles County, California, Department of Public Health to plan for and respond to the first and subsequent years of pandemic influenza A (H1N1) circulation. The use of models allowed the authors to 1) project the timing and magnitude of the epidemic in Los Angeles County and the continental United States; 2) predict the effect of the influenza mass vaccination campaign that began in October 2009 on the spread of pandemic H1N1 in Los Angeles County and the continental United States; and 3) predict that a third wave of pandemic influenza in the winter or spring of 2010 was unlikely to occur. The close collaboration between modelers and public health officials during pandemic H1N1 spread in the fall of 2009 helped Los Angeles County officials develop a measured and appropriate response to the unfolding pandemic and establish reasonable goals for mitigation of pandemic H1N1.