Crystal Franco

Lessons learned during dengue outbreaks in the United States, 2001-2011.

Public health authorities should involve the clinical and laboratory community and engage the local community in vector control and case reporting.

Billions for Biodefense: Federal Agency Biodefense Funding, FY2009-FY2010

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. Earlier articles in this series analyzed civilian biodefense funding by the federal government for fiscal years (FY) 2001 through 2009. This article updates those figures with budgeted amounts for FY2010, specifically analyzing the budgets and allocations for biodefense at the Departments of Health and Human Services, Defense, Homeland Security, Agriculture, and State; the Environmental Protection Agency; and the National Science Foundation. This years article also provides an assessment of the proportion of the biodefense budget that serves multiple programmatic goals and benefits, including research into infectious disease pathogenesis and immunology, public health planning and preparedness, and disaster response efforts. The FY2010 federal budget for civilian biodefense totals

Return of Epidemic Dengue in the United States: Implications for the Public Health Practitioner

6.05 billion. Of that total,

The Dengue Threat to the United States

4.96 billion is budgeted for programs that serve multiple goals and provide manifold benefits.

Environmental decontamination following a large-scale bioterrorism attack: federal progress and remaining gaps.

Conditions that facilitate sustained dengue transmission exist in the United States, and outbreaks have occurred during the past decade in Texas, Hawaii, and Florida. More outbreaks can also be expected in years to come. To combat dengue, medical and public health practitioners in areas with mosquito vectors that are competent to transmit the virus must be aware of the threat of reemergent dengue, and the need for early reporting and control to reduce the impact of dengue outbreaks. Comprehensive dengue control includes human and vector surveillance, vector management programs, and community engagement efforts. Public health, medical, and vector-control communities must collaborate to prevent and control disease spread. Policy makers should understand the role of mosquito abatement and community engagement in the prevention and control of the disease.

A Survey of Hospitals to Determine the Prevalence and Characteristics of Healthcare Coalitions for Emergency Preparedness and Response

Over the past 3 decades, dengue has spread rapidly and has emerged as one of the worlds most common mosquitoborne viral diseases. Although often found in tropical and semitropical areas, dengue is capable of being transmitted in temperate climates as well. Dengue is currently endemic to Mexico, most other Latin American countries, and parts of the Caribbean, and it has the potential to become reestablished as an endemic disease in the United States. In fact, sustained transmission of dengue has occurred in Florida within the past year. Conditions exist in the U.S. that could facilitate sustained dengue transmission, including environmental factors, competent mosquito vectors, limited vector and dengue surveillance, increased domestic outdoor daytime activities in warmer months, and low public awareness of the disease. If dengue were to be reestablished in the U.S., it could have significant medical, public health, and economic consequences for the country. The impact of dengue as a public health threat could be lessened through enhanced awareness and reporting of cases, increased support for vector surveillance and control programs, and a greater focus on vaccine development.

Community Resilience Roundtable on the Implementation of Homeland Security Presidential Directive 21 (HSPD-21)

The process of environmental decontamination is a key step in a successful response to a large-scale attack involving a biological agent. Costs for the decontamination response following the 2001 anthrax attacks were estimated in the hundreds of millions of dollars, and some facilities could not be reopened for more than 2 years. However, a large-scale biological attack would likely result in an even greater amount of contamination, more areas that need to be cleaned and made safe, and a much greater cost to the American public. This article identifies gaps in decontamination policy and technical practice at the federal level and provides practical recommendations that will better enable the U.S. to undertake a biological decontamination response.

Biosurveillance Where It Happens: State and Local Capabilities and Needs

Previous reports have identified the development of healthcare coalitions as the foundation for disaster response across the United States. This survey of acute care hospitals characterizes the current status of participation by US hospitals in healthcare coalitions for emergency preparedness planning and response. The survey results show the nearly universal nature of a coalition approach to disaster response. The results suggest a need for wide stakeholder involvement but also for flexibility in structure and organization. Based on the survey results, the authors make recommendations to guide the further development of healthcare coalitions and to improve local and national response to disasters.

The Pandemic and All-Hazards Preparedness Act: Its Contributions and New Potential to Increase Public Health Preparedness

269 ON APRIL 23, 2008, THE CENTER for Biosecurity of the University of Pittsburgh Medical Center (UPMC) convened an invitational meeting to discuss community resilience for catastrophic health events and to help inform implementation planning for Homeland Security Presidential Directive 21 (HSPD-21). Released in October of 2007, HSPD-21 identified community resilience as one of the “four most critical components of public health and medical preparedness” alongside biosurveillance, countermeasure distribution, and mass casualty care, and the directive also asserted “the important roles of individuals, families, and communities” in managing public health emergencies.1 Meeting attendees (listed in the sidebar) included officials who authored HSPD-21 and those charged with its execution, grassroots leaders who have prioritized disaster management in their hometowns and among vulnerable populations, public health and emergency management practitioners, scholars of disasters and resilience, and staff to members of Congress with jurisdiction over homeland security and public health matters. Individual comments made during the event were not for attribution. The day’s agenda was organized into 3 structured discussions: roundtable participants considered which definition(s) of community resilience best advanced the policy agenda, they reviewed prior public participation programs for disasters for relevant lessons, and they made recommendations for federal program and budget priorities in keeping with the value placed on resilience by the presidential directive. The organization of this report reflects the 3-part agenda. Opening each conversation was a presentation from the Center for Biosecurity and invited speakers, accompanied by the results of a brief survey circulated in advance of the meeting to spur discussion. Among the issues polled were attendees’ own concepts of community resilience, concrete techniques for building resilience, and the role of the federal government in helping state and local authorities promote resilient communities. A majority of participants (n 20) completed the survey. The following report is an overview of prepared remarks, pre-event survey findings, and the major themes that arose in the roundtable discussions. We first provide some brief background knowledge on HSPD-21.

Medical Reserve Corps volunteers in disasters: a survey of their roles, experiences, and challenges

In recent years, improved biosurveillance has become a bipartisan national security priority. As has been pointed out by the National Biosurveillance Advisory Subcommittee and others, building a national biosurveillance enterprise requires having strong biosurveillance systems at the state and local levels, and additional policies are needed to strengthen their biosurveillance capabilities. Because of the foundational role that state and local health departments play in biosurveillance, we sought to determine to what extent state and local health departments have the right capabilities in place to provide the information needed to detect and manage an epidemic or public health emergency-both for state and local outbreak management and for reporting to federal agencies during national public health crises. We also sought to identify those policies or actions that would improve state and local biosurveillance and make recommendations to federal policymakers who are interested in improving national biosurveillance capabilities.