Nidhi Bouri

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

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.

Absorbing citywide patient surge during Hurricane Sandy: a case study in accommodating multiple hospital evacuations.

STUDY OBJECTIVE Hospital evacuations have myriad effects on all elements of the health care system. We seek to (1) examine the effect of patient surge on hospitals that received patients from evacuating hospitals in New York City during Hurricane Sandy; (2) describe operational challenges those hospitals faced pre- and poststorm; and (3) examine the coordination efforts to distribute patients to receiving hospitals. METHODS We used a qualitative, interview-based method to identify medical surge strategies used at hospitals receiving patients from evacuated health care facilities during and after Hurricane Sandy. We identified 4 hospital systems that received the majority of evacuated patients and those departments most involved in managing patient surge. We invited key staff at those hospitals to participate in on-site group interviews. RESULTS We interviewed 71 key individuals. Although all hospitals had emergency preparedness plans in place before Hurricane Sandy, we identified gaps. Insights gleaned included improvement opportunities in these areas: prolonged increased patient volume, an increase in the number of methadone and dialysis patients, ability to absorb displaced staff, the challenges associated with nursing homes that have evacuated and shelters that have already reached capacity, and reimbursements for transferred patients. CONCLUSION Our qualitative, event-based research identified key opportunities to improve disaster preparedness. The specific opportunities and this structured postevent approach can serve to guide future disaster planning and analyses.

The Dengue Threat to the United States

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.

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

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.

Going mobile: how mobile personal health records can improve health care during emergencies.

Personal health records (PHRs), in contrast to electronic health records (EHRs) or electronic medical records (EMRs), are health records in which data are accessible to patients and not just providers. In recent years, many systems have enabled PHRs to be available in a mobile format. Mobile PHRs (mPHRs) allow patients to access health information via the Internet or telecommunication devices, such as mobile phones, personal digital assistants, and tablet computers. mPHRs have the potential to help patients and providers identify medical conditions and prescriptions from numerous locations, which may minimize medical errors and identify improvements to health behaviors during emergencies, when patients present to a new provider, or EHRs are not accessible. Despite their benefits, numerous challenges inhibit the adoption and further development of mPHRs, including integration into overall health technology infrastructure and legal and security concerns. This paper identifies the benefits of mPHRs during emergencies and the remaining challenges impeding full adoption and use, and provides recommendations to federal agencies to enhance support and use of mPHRs.

Expanding practitioner scopes of practice during public health emergencies: experiences from the 2009 H1N1 pandemic vaccination efforts.

In a public health emergency involving significant surges in patients and shortages of medical staff, supplies, and space, temporarily expanding scopes of practice of certain healthcare practitioners may help to address heightened population health needs. Scopes of practice, which are defined by state practice acts, set forth the range of services that licensed practitioners are authorized to perform. The U.S. has had limited experience with temporarily expanding scopes of practice during emergencies. However, during the 2009 H1N1 pandemic response, many states took some form of action to expand the practice scopes of certain categories of practitioners in order to authorize them to administer the pandemic vaccine. No standard legal approach for expanding scopes of practice during emergencies exists across states, and scope of practice expansions during routine, nonemergency times have been the subject of professional society debate and legal action. These issues raise the question of how states could effectively implement expansions for health services beyond administering vaccine and ensure consistency in expansions across states during catastrophic events that require a shift to crisis standards of care. This article provides an overview of scopes of practice, a summary of the range of legal and regulatory approaches used in the U.S. to expand practice scopes for vaccination during the 2009 H1N1 response, and recommendations for future research.

The adoption of social media and mobile health technologies for emergency preparedness by local health departments: a joint perspective from NACCHO and the UPMC center for health security.

T he American public’s use of social media and mobile technologies has consistently grown in recent years. According to a May 2013 Pew study, 91% of American adults own cell phones, a 9% increase since May 2010. Of those cell phone owners, 81% communicate via text message and 60% access the Internet via phone. The rising use of cell phones and social media by the American public on a day-to-day basis has led to a corresponding rise in communication through these technologies to share and find information during emergencies. Subsequently, recent events such as Hurricane Sandy demonstrate their potential benefits for communicating preparedness messages. According to a 2012 American Red Cross survey, mobile applications and social media are now tied as the fourth most popular ways to get information during an emergency, following only by television, radio, and other online news. Local health departments’ (LHDs’) ability to more quickly communicate preparedness information to their communities could minimize adverse effects of disasters. Evidence suggests that LHDs could use cell phones and social media to provide real-time updates, rapidly exchange information with the public, and enhance situational awareness during emergencies. Despite these and other potential uses and benefits, only a small fraction of LHDs have adopted and used such technology effectively. According to one study, as of early 2012, only 24% of LHDs had a Facebook account and only 8% had a Twitter account.17 The use of

Prevention of Biothreats: A Look Ahead

On October 6, 2009, the Center for Biosecurity of UPMC organized a 1-day conference, ‘‘Prevention of Biothreats: A Look Ahead,’’ in Washington, DC. The conference was hosted in collaboration with the Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, and it was funded by the Alfred P. Sloan Foundation. The meeting was attended by more than 150 administration officials, policy analysts, scientists, health leaders, congressional staff members, and members of the media to discuss strategies for countering biological weapons threats. During the conference, participants discussed a wide range of U.S. government programs, international approaches, and nongovernment efforts aimed at preventing the development and use of biological weapons, including arms control and multilateral agreements; efforts to prevent the unlawful acquisition of materials, equipment, and information; deterrence, intelligence, and surveillance; and improving resilience to biological attacks as a means of dissuasion and prevention. Given the wide range of activities and professional groups engaged in biothreat prevention efforts, it is rare for the entire community to convene as a single group. This meeting accomplished that—the first step toward generating promising new ideas and directions for biothreat prevention and promoting greater coherence in the biopreparation community. This summary report was prepared by the staff of the Center for Biosecurity of UPMC to provide a brief synopsis of each day’s panel discussions and individual presentations. Videos of the day’s discussions, the conference agenda, speaker biographies, and background readings are available on the conference website: www.upmc-biosecurity. org=preventionconf.