The unanticipated global outbreak of Zika virus infection is the most current but certainly not the last emerging infectious disease challenge to confront the US public heath system. Despite a number of such threats in recent years, significant gaps remain in core areas of public health system readiness. Stable, sustained investments are required to establish a solid foundation for achieving necessary national public health emergency preparedness and response capacity. (Disaster Med Public Health Preparedness. 2016;10:298–299)

People wounded during bombings or other events resulting in mass casualties or in conjunction with the resulting emergency response may be exposed to blood, body fluids, or tissue from other injured people and thus be at risk for bloodborne infections such as hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or tetanus. This report adapts existing general recommendations on the use of immunization and postexposure prophylaxis for tetanus and for occupational and nonoccupational exposures to bloodborne pathogens to the specific situation of a mass casualty event. Decisions regarding the implementation of prophylaxis are complex, and drawing parallels from existing guidelines is difficult. For any prophylactic intervention to be implemented effectively, guidance must be simple, straightforward, and logistically undemanding. Critical review during development of this guidance was provided by representatives of the National Association of County and City Health Officials, the Council of State and Territorial Epidemiologists, and representatives of the acute injury care, trauma, and emergency response medical communities participating in the Centers for Disease Control and Prevention’s Terrorism Injuries: Information, Dissemination and Exchange project. The recommendations contained in this report represent the consensus of US federal public health officials and reflect the experience and input of public health officials at all levels of government and the acute injury response community. (Disaster Med Public Health Preparedness. 2008;2:150–165)

In response to the 2009 H1N1 influenza pandemic, public health authorities launched an ambitious vaccination program to protect tens of millions of Americans from the virus. In April and May 2010, the Institute of Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events hosted a series of 3 regional workshops to examine the 2009 H1N1 vaccination campaign. The workshops brought together stakeholders involved in distributing and dispensing H1N1 vaccine to discuss successes and challenges and to identify strategies to improve future vaccination programs and other medical countermeasure dispensing campaigns. On the basis of the presentations and the discussions that followed, several themes and opportunities for future efforts were identified in the following areas: vaccine supply and demand; state and local implementation of Centers for Disease Control and Prevention/Advisory Committee on Immunization Practices recommendations, including prioritization for vaccination; vaccine formulations and priority groups; opportunities for developing partnerships; opportunities to increase seasonal vaccination rates among pregnant women and health care workers and to increase acceptance of live attenuated nasal spray vaccine; standardization and improvement of immunization information management systems; opportunities to simplify, systematize, and automate processes and practices; and research needs and opportunities.

(Disaster Med Public Health Preparedness. 2011;5:81-86)

Background: In April 2009, King County, Washington, experienced a sustained outbreak of 2009 H1N1 influenza A. This report describes the epidemiology of that outbreak in King County, home to a diverse population of 1.9 million people.

Methods: The 2 primary sources of data are case investigations of reported laboratory-confirmed 2009 H1N1 influenza A and a population-based syndromic surveillance system that captures data from emergency departments (EDs). A syndromic category for influenza-like illness was defined based on chief complaint and diagnosis.

Results: ED visits for influenza-like illness peaked quickly in the first week of the outbreak and remained high for approximately 6 weeks, with school-age children accounting for the greater number of ED visits, followed by young adults. Children ages 0 to 4 years had the highest rate of hospitalization. Among reported cases, blacks, Asians, and Hispanics were more likely to be hospitalized. Predisposing factors associated with admission were immune compromise, chronic lung disease, chronic heart disease, pregnancy, diabetes, and asthma. Of people receiving antiviral treatment, 34% started their medication more than 2 calendar days after the onset of illness. Mean days between illness onset and antiviral treatment were greater for blacks, Hispanics, and foreign language speakers.

Conclusions: The spring 2009 influenza A H1N1 outbreak disproportionately affected children, young adults, and racial and ethnic minorities. Opportunities exist to improve the timeliness of antiviral treatment. Potential barriers to care for racial and ethnic minorities should be proactively addressed to ensure prompt evaluation and treatment. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S109–S116)

Objective: We evaluated emergency department (ED) data, emergency medical services (EMS) data, and public utilities data for describing an outbreak of carbon monoxide (CO) poisoning following a windstorm.

Methods: Syndromic ED data were matched against previously collected chart abstraction data. We ran detection algorithms on selected time series derived from all 3 data sources to identify health events associated with the CO poisoning outbreak. We used spatial and spatiotemporal scan statistics to identify geographic areas that were most heavily affected by the CO poisoning event.

Results: Of the 241 CO cases confirmed by chart review, 190 (78.8%) were identified in the syndromic surveillance data as exact matches. Records from the ED and EMS data detected an increase in CO-consistent syndromes after the storm. The ED data identified significant clusters of CO-consistent syndromes, including zip codes that had widespread power outages. Weak temporal gastrointestinal (GI) signals, possibly resulting from ingestion of food spoiled by lack of refrigeration, were detected in the ED data but not in the EMS data. Spatial clustering of GI-based groupings in the ED data was not detected.

Conclusions: Data from this evaluation support the value of ED data for surveillance after natural disasters. Enhanced EMS data may be useful for monitoring a CO poisoning event, if these data are available to the health department promptly.

(Disaster Med Public Health Preparedness. 2011;5:37-45)