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Health Security

Jennifer Snow, James Giordano
No abstract text is available yet for this article.
February 6, 2019: Health Security
Mark G Kortepeter, Theodore J Cieslak
The concept and belief in the idea of "biocontainment" has undergone significant evolution during the past 20 years. The authors believe that the time is right to move to the next phase of this evolution to reassess establishment of formal standards for what constitutes a biocontainment unit and what diseases might be considered for admission to a biocontainment unit.
February 6, 2019: Health Security
Nahid Bhadelia, Lauren Sauer, Theodore J Cieslak, Richard T Davey, Susan McLellan, Timothy M Uyeki, Mark G Kortepeter
Emerging and re-emerging infectious diseases pose growing global public health threats. However, research on and development of medical countermeasures (MCMs) for such pathogens is limited by the sporadic and unpredictable nature of outbreaks, lack of financial incentive for pharmaceutical companies to develop interventions for many of the diseases, lack of clinical research capacity in areas where these diseases are endemic, and the ethical dilemmas related to conducting scientific research in humanitarian emergencies...
February 6, 2019: Health Security
Angie M Boyce, Brian T Garibaldi
Host genomic research on high-consequence infectious diseases is a growing area, but the ethical, legal, and social implications of such findings related to potential applications of the research have not yet been identified. While there is a robust ethical debate about the ethical, legal, and social implications of research during an emergency, there has been less consideration of issues facing research conducted outside of the scope of emergency response. Addressing the implications of research at an early stage (anticipatory ethics) helps define the issue space, facilitates preparedness, and promotes ethically and socially responsible practices...
February 6, 2019: Health Security
Anne L O'Keefe, Bryan F Buss, Samir Koirala, Michael X Gleason, Ashok Mudgapalli, Shelly Schwedhelm
The Ebola epidemic of 2014 demonstrated that outbreaks of high-consequence infectious diseases, even in remote parts of the world, can affect communities anywhere in the developed world and that every healthcare facility must be prepared to identify, isolate, and provide care for infected patients. The Nebraska Biocontainment Unit (NBU), located at Nebraska Medicine in Omaha, Nebraska, cared for 3 American citizens exposed in West Africa and confirmed with Ebola virus disease (EVD). Symptom monitoring of healthcare workers caring for these patients was implemented, which included twice daily contact to document the absence or presence of signs of fever or illness...
February 6, 2019: Health Security
Alan Rudolph, Sarah Nusser, Patrick Stover, Prasant Mohapatra, Robert Wilhelm, Peter Dorhout
No abstract text is available yet for this article.
February 6, 2019: Health Security
Theodore J Cieslak, Laura Evans, Mark G Kortepeter, Amanda Grindle, Lemuel Aigbivbalu, Kate Boulter, Ryan W Carroll, Sylvia Cumplido, Alison G Danforth, Cecilia Fry, James Gaensbauer, Janet R Hume, Amyna Husain, Arlene Kelleher, Christopher J Kratochvil, Claudia Kunrath, Jill S Morgan, Michelle M Schwedhelm, Andi L Shane, Patricia Tennill, Phoebe H Yager, H Dele Davies
During the outbreak of Ebola virus disease that struck West Africa during 2014-2016, a small handful of expatriate patients were evacuated to specialized high-level containment care units, or biocontainment units, in the United States and Western Europe. Given the lower mortality rate (18% versus 40% for those treated in Africa) among these patients, it is likely that high-level containment care will be used in the future with increasing frequency. It is also likely that children infected with Ebola and other highly hazardous communicable diseases will someday require such care...
January 2019: Health Security
Angela Vasa, Syra Madad, LuAnn Larson, Colleen S Kraft, Sharon Vanairsdale, Jonathan D Grein, Jennifer Garland, Virginia Madison Butterworth, Christopher J Kratochvil
The use of investigational therapeutics in the care of patients with Ebola virus disease was documented in the literature following the 2013-2016 outbreak. In order to access these types of therapeutics, facilities must have processes in place to quickly and efficiently activate study protocols, obtain the medications, and administer them in a timely manner. Testing these procedures in advance of a real-world event is crucial to ensuring successful implementation and execution. Drills and exercises are routinely used as part of the emergency preparedness planning process, as they provide a low-risk environment in which to test plans and procedures...
January 2019: Health Security
Lauren M Sauer, Mark Romig, Jennifer Andonian, Jade Borromeo Flinn, Noreen Hynes, Robert Maloney, Lisa L Maragakis, Brian Garibaldi
High-consequence pathogens create a unique problem. To provide effective treatment for infected patients while providing safety for the community, a series of 10 high-level isolation units have been created across the country; they are known as Regional Ebola and Special Pathogen Treatment Centers (RESPTCs). The activation of a high-level isolation unit is a highly resource-intensive activity, with effects that ripple across the healthcare system. The incident command system (ICS), a standard tool for command, control, and coordination in domestic emergencies, is a command structure that may be useful in a biocontainment event...
January 2019: Health Security
Jennifer Andonian, Kelsie E Galusha, Lisa L Maragakis, Brian T Garibaldi
In response to the 2014 Ebola outbreak, the Office of the Assistant Secretary for Preparedness and Response (ASPR) funded the creation of 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs) across the United States. These high-level isolation units are designed to provide care for patients infected with high-consequence pathogens, such as viral hemorrhagic fevers, in an environment that is safe for patients, staff, the hospital, and surrounding communities. This commentary describes the impact on infection prevention and preparedness that the Johns Hopkins biocontainment unit has on the hospital and health system beyond the unit itself...
January 2019: Health Security
Matthew P Shearer, Eric S Toner
No abstract text is available yet for this article.
January 2019: Health Security
Colleen S Kraft, Mark G Kortepeter, Bruce Gordon, Lauren M Sauer, Erica S Shenoy, Daniel P Eiras, LuAnn Larson, Jennifer A Garland, Aneesh K Mehta, Kevin Barrett, Connie S Price, Caroline Croyle, Lauren R West, Brooke Noren, Susan Kline, Christa Arguinchona, Henry Arguinchona, Jonathan D Grein, Chad Connally, Susan McLellan, George F Risi, Timothy M Uyeki, Richard T Davey, Jo Ellen Schweinle, Michelle M Schwedhelm, Melissa Harvey, Richard C Hunt, Christopher J Kratochvil
The 2013-2016 epidemic of Ebola virus disease (EVD) that originated in West Africa underscored many of the challenges to conducting clinical research during an ongoing infectious disease epidemic, both in the most affected countries of Guinea, Liberia, and Sierra Leone, as well as in the United States and Europe, where a total of 27 patients with EVD received care in biocontainment units. The Special Pathogens Research Network (SPRN) was established in the United States in November 2016 to provide an organizational structure to leverage the expertise of the 10 Regional Ebola and Other Special Pathogen Treatment Centers (RESPTCs); it was intended to develop and support infrastructure to improve readiness to conduct clinical research in the United States...
January 2019: Health Security
Benjamin K Kogutt, Jeanne S Sheffield, Dianne Whyne, Lisa L Maragakis, Jennifer Andonian, Jade Flinn, Chris Sulmonte, Adam Dodson, Mark Romig, Lauren Sauer, Robert Maloney, Janis Ferrell, Arthur J Vaught, W Christopher Golden, Brian T Garibaldi
This article describes a large-scale scenario designed to test the capabilities of a US biocontainment unit to manage a pregnant woman infected with a high-consequence pathogen, and to care for a newborn following labor and spontaneous vaginal delivery. We created and executed a multidisciplinary functional exercise with simulation to test the ability of the Johns Hopkins Hospital biocontainment unit (BCU) to manage a pregnant patient in labor with an unknown respiratory illness and to deliver and stabilize her neonate...
January 2019: Health Security
Michael R Snyder, Sanjana J Ravi
2018 marks the centennial of the 1918 influenza pandemic, widely acknowledged as one of the deadliest infectious disease crises in human history. As public health and medical communities of practice reflect on the aftermath of the influenza pandemic and the ways in which it has altered the trajectory of history and informed current practices in health security, it is worth noting that the Spanish flu was preceded by a very different 100-year threat: the first Asiatic cholera pandemic of 1817 to 1824. In this commentary, we offer a historical analysis of the common socioeconomic, political, and environmental factors underlying both pandemics, consider the roles of cholera and Spanish flu in shaping global health norms and modern public health practices, and examine how strategic applications of soft power and broadening the focus of health security to include sustainable development could help the world prepare for pandemics of the future...
December 4, 2018: Health Security
Jacinta Smith, Denise Gangadharan, Mark Hemphill, Samuel Edwin
The Centers for Disease Control and Prevention's Division of Select Agents and Toxins (DSAT) regulates the possession, use, and transfer of select agents and toxins throughout the United States as part of the Federal Select Agent Program. The Department of Health and Human Services (HHS) select agent regulations also include criteria for the exclusion of select agents and toxins from the requirements of the regulations (42 CFR ยง 73.3 and 73.4). An entity may request the exclusion of an attenuated strain of a select agent or a select toxin modified to be less potent or toxic...
December 4, 2018: Health Security
David Manheim
The central argument in this article is that the probability of very large natural pandemics is more uncertain than either previous analyses or the historical record suggest. In public health and health security analyses, global catastrophic biological risks (GCBRs) have the potential to cause "sudden, extraordinary, widespread disaster," with "tens to hundreds of millions of fatalities." Recent analyses focusing on extreme events presume that the most extreme natural events are less likely than artificial sources of GCBRs and should receive proportionately less attention...
November 29, 2018: Health Security
Lacey MenkinSmith, Kathy Lehman-Huskamp, John Schaefer, Myrtede Alfred, Ken Catchpole, Brandy Pockrus, Dulaney A Wilson, J G Reves
This article describes a pilot trial of an internet-distributable online software package that provides course materials and built-in evaluation tools to train healthcare workers in high-risk infectious disease response. It includes (1) an online self-study component, (2) a "hands-on" simulation workshop, and (3) a data-driven performance assessment toolset to support debriefing and course reporting. This study describes a pilot trial of the software package using a course designed to provide education in Ebola response to prepare healthcare workers to safely function as a measurable, high-reliability team in an Ebola simulated environment...
November 29, 2018: Health Security
Tamer Hadi, Christopher Paquet, Naeem Ullah, Beth Maldin Morgenthau
From the Field is a semi-regular column that explores what it means to be a local health professional on the front lines of an emergency. Typically, National Association of County and City Health Officials (NACCHO) members share their stories of preparing for and responding to disasters, epidemics, and other major health issues. Through exploring the analysis of the challenges faced and the solutions developed, readers can learn how these public health champions keep their communities safe even in extreme situations...
November 29, 2018: Health Security
Mitch Stripling, Colin Stimmler, Marisa Raphael, Oxiris Barbot
In late 2017 and early 2018, the New York City Department of Health and Mental Hygiene deployed multiple teams to Puerto Rico and the US Virgin Islands to support public health in those territories. This article is a description of how those teams were conceived, deployed, supported, and reintegrated into the agency. This was an unprecedented mission for our agency, and what follows is a reflection on what worked and what didn't work for us. It is our hope that other jurisdictions can use this information to organize and execute similar missions in the future, and that collectively we can continue to advance the field of public health preparedness and response...
October 6, 2018: Health Security
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