The volume herein provides a glimpse of public health preparedness requirements to ensure that MCMs are available for immediate deployment when the public requires protection.1,2 Included here are 14 ...articles in the form of briefs, commentaries, a public health practice summary, analytic essay, and a series of content focused editorials to highlight past, present, and future considerations for MCM preparedness programs, response, and evaluation. Lehnert et al. (p. S194) describe four critical mass vaccination components the CDC recommend jurisdictions exercise and test in preparation for a severe influenza pandemic, requiring 2 doses of influenza vaccine with or without a separate adjuvant within a specific time interval. Correspondenceshouldbe sentto Tanya TelfairLeBlanc, PhD, MS, Office ofPublic Health Preparedness and Response/Division of State and Local Readiness/Applied Science and Evaluation Branch/Science Integration, Applied Research and Translation Team, Centers for Disease Control and Prevention, 1600 Clifton Road Mail Stop D-18, Atlanta, GA 30329 (e-mail: tqs3@cdc.gov).
Forging common ground among the disparate entities involved in protecting the public's health is confounded by contemporary trends in the quantity and quality of available information and public ...confidence in information. We are only 23years into the 21 st century, but life for ordinary people, especially those in the United States, has changed significantly during the period. The "information age," which employs computers, the Internet, smartphones, tablets, and other electronic devices, eases access to countless content products and applications-in seconds rather than hours. The rapidity of information dissemination has many advantages. Results of medical tests can be interpreted rapidly to aid in speedier diagnosis and treatment of illnesses. College students and professionals are able to conduct literature searches online in minutes, rather than days. Many people born in the 2000s and later have likely never heard of a library card catalog or read a hard copy newspaper.
The negative impact of lead exposure on young children and those who become pregnant is well documented but is not well known by those at highest risk from this hazard. Scientific evidence suggests ...that there is no known safe blood lead level (BLL), because even small amounts of lead can be harmful to a child's developing brain (1). In 2012, CDC introduced the population-based blood lead reference value (BLRV) to identify children exposed to more lead than most other children in the United States. The BLRV should be used as a guide to 1) help determine whether medical or environmental follow-up actions should be initiated for an individual child and 2) prioritize communities with the most need for primary prevention of exposure and evaluate the effectiveness of prevention efforts. The BLRV is based on the 97.5th percentile of the blood lead distribution in U.S. children aged 1-5 years from National Health and Nutrition Examination Survey (NHANES) data. NHANES is a complex, multistage survey designed to provide a nationally representative assessment of health and nutritional status of the noninstitutionalized civilian adult and child populations in the United States (2). The initial BLRV of 5 μg/dL, established in 2012, was based on data from the 2007-2008 and 2009-2010 NHANES cycles. Consistent with recommendations from a former advisory committee, this report updates CDC's BLRV in children to 3.5 μg/dL using NHANES data derived from the 2015-2016 and 2017-2018 cycles and provides helpful information to support adoption by state and local health departments, health care providers (HCPs), clinical laboratories, and others and serves as an opportunity to advance health equity and environmental justice related to preventable lead exposure. CDC recommends that public health and clinical professionals focus screening efforts on populations at high risk based on age of housing and sociodemographic risk factors. Public health and clinical professionals should collaborate to develop screening plans responsive to local conditions using local data. In the absence of such plans, universal BLL testing is recommended. In addition, jurisdictions should follow the Centers for Medicare & Medicaid Services requirement that all Medicaid-enrolled children be tested at ages 12 and 24 months or at age 24-72 months if they have not previously been screened (3).
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Collaboration Is Key to Community Preparedness Telfair LeBlanc, Tanya; Kosmos, Christine; Avchen, Rachel Nonkin
American journal of public health,
09/2019, Letnik:
109, Številka:
S4
Journal Article
Recenzirano
Odprti dostop
Community preparedness is complex and involves multiple stakeholders and crosscutting sectors such as state and local governments; public health departments and agencies; law enforcement, fire, and ...rescue organizations; social service and faith-based organizations; and ordinary citizens from varied communities. In 2002, the Centers for Disease Control and Prevention (CDC) initiated a federal program to strengthen 62 US jurisdictions to plan and prepare for public health emergencies, providing resources, guidance, technical assistance, and evaluation support (http://bit.ly/2KesXqs). CDC issued 15 public health emergency response capability standards in 2011, updated in 2018, to assist health department planning efforts organized around six overarching domains ofpreparedness: community resilience, incident management, information management, countermeasures and mitigation, surge management, and biosurveillance.
This special section of AJPH represents a collection of COVID-19 treatises that highlight some of the deep flaws in the American social and economic, health care, and disaster response ...systems-present before the onset of the current pandemic-that contribute to national mitigation challenges. Rao et al. (p. 849) provide an important comparison between Hurricane Katrina and COVID-19, two major public health disasters that devastated the United States. They demonstrate how both situations have revealed the concentrated impact on vulnerable populations who live in social, historical, and political environments in which health disparities and barriers to care exist under routine circumstances. The authors suggest using science to inform methods of addressing social determinants of health and public health policy, with the goals of increasing access to care and reducing health care costs. Self et al. (p. 854) examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection point prevalence during universal testing at homeless shelters. They conclude that sleeping arrangements and staffing policies, such as excluding symptomatic staff and having medical services on site, are modifiable factors that may be associated with transmission of SARS-CoV-2. They also emphasize the requirement of continuing services for people experiencing homelessness.
When 2017 Hurricane Harvey struck the coastline of Texas on August 25, 2017, it resulted in 88 fatalities and more than US $125 billion in damage to infrastructure. The floods associated with the ...storm created a toxic mix of chemicals, sewage and other biohazards, and over 6 million cubic meters of garbage in Houston alone. The level of biohazard exposure and injuries from trauma among persons residing in affected areas was widespread and likely contributed to increases in emergency department (ED) visits in Houston and cities receiving hurricane evacuees. We investigated medical surge resulting from these evacuations in Dallas-Fort Worth (DFW) metroplex EDs.
We used data sourced from the North Texas Syndromic Surveillance Region 2/3 in ESSENCE to investigate ED visit surge following the storm in DFW hospitals because this area received evacuees from the 60 counties with disaster declarations due to the storm. We used the interrupted time series (ITS) analysis to estimate the magnitude and duration of the ED surge. ITS was applied to all ED visits in DFW and visits made by patients residing in any of the 60 counties with disaster declarations due to the storm. The DFW metropolitan statistical area included 55 hospitals. Time series analyses examined data from March 1, 2017-January 6, 2018 with focus on the storm impact period, August 14-September 15, 2017. Data from before, during, and after the storm were visualized spatially and temporally to characterize magnitude, duration, and spatial variation of medical surge attributable to Hurricane Harvey.
During the study period overall, ED visits in the DFW area rose immediately by about 11% (95% CI: 9%, 13%), amounting to ~16 500 excess total visits before returning to the baseline on September 21, 2017. Visits by patients identified as residing in disaster declaration counties to DFW hospitals rose immediately by 127% (95% CI: 125%, 129%), amounting to 654 excess visits by September 29, 2017, when visits returned to the baseline. A spatial analysis revealed that evacuated patients were strongly clustered (Moran's I = 0.35, P < 0.0001) among 5 of the counties with disaster declarations in the 11-day window during the storm surge.
The observed increase in ED visits in DFW due to Hurricane Harvey and ensuing evacuation was significant. Anticipating medical surge following large-scale hurricanes is critical for community preparedness planning. Coordinated planning across stakeholders is necessary to safeguard the population and for a skillful response to medical surge needs. Plans that address hurricane response, in particular, should have contingencies for support beyond the expected disaster areas.
Recently, I became aware of a social media post regarding a 2018 incident during a Fourth of July parade in Geauga County, Ohio. Julianne Speyer, a 12year-old Girl Scout marching with her troop ...behind Boy Scouts, was offended with the remarks of commentators during the event who referred to the boys as "future leaders of America" and suggested that the girls were "just having fun." Disappointed, she wrote to the editor of the local newspaper, disparaging the remarks as sexist, patronizing, and offensive.The post spread like wildfire on social media and aired on television news channels. In due course, it got the attention of former secretary of state Hillary Clinton, who sent Miss Speyer a note applauding her courage for speaking out against injustice.1As a former Girl Scout and leader, I fully understand that scouting is much more than a social activity. The program builds responsibility, civic awareness, confidence, and leadership skills and emphasizes the importance of education and living healthy lives. The Girl Scout Leadership Institute is committed to helping girls develop 21st-century skills for success such as innovation, resilience, collaboration, and critical thinking through relevant, girl-led projects designed to make the world a better place. The Girl Scouts of America has pledged to add 2.5 million girls to the STEM (science, technology, engineering, and mathematics) career pipeline by 2025, with programs engaging scouts five to 17 years old in STEM projects.
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