Public Health Emergency Preparedness: Qualitative Analysis of After-Action Reports.

After-Action Reports (AARs) are retrospective summaries that capture key information and lessons learned from emergency response exercises and real incidents. The AAR is a commonly used evaluation tool used by the Centers for Disease Control and Prevention as part of the Public Health Emergency Preparedness (PHEP) program. It is used as a metric of accountability and awardee performance. The objectives of this study were to qualitatively analyze AARs of public health preparedness programs and develop a coding scheme for standardizing future review and analysis of AARs. We evaluated 14 AARs (4 exercises and 10 real incidents) generated between 2012 and 2018. We applied inductive qualitative analyses using ATLAS.Ti software. While, previous exercises focused on medical countermeasure responses, real-world incidents focused on natural disasters and infectious disease outbreaks. Six overarching themes emerged: Communications, Coordination, Resource Distribution, Unified Planning, Surveillance, and Knowledge Sharing. A standardized analysis format is proposed for future use.

Centers for Disease Control and Prevention Participation in Cobalt Magnet National-Level Radiological Exercise.

Since September 11, 2001, the Centers for Disease Control and Prevention (CDC) has increased efforts to prepare the agency and public health partners for response to potential nuclear/radiological disasters. During the week of May 16-20, 2022, the CDC participated in a national-level radiological emergency exercise, Cobalt Magnet 22 (CM22). The exercise scenario consisted of a notional, failed search mission for a radiological dispersal device (RDD, "dirty bomb"), followed by its explosion during a public event in a large US city. Testing radioanalytical laboratory capabilities during a nuclear/radiological incident was an exercise objective, and developing clear messaging on low-dose exposure and long-term health concerns was a primary output of the exercise. The CDC practiced its activation protocols, exercised the establishment of its updated Incident Management System structure for radiation emergencies, and identified critical staffing needs for this type of response.

SARS-CoV-2 outbreak among staff and evacuees at Operation Allies Welcome Safe Havens.

We report on five SARS-CoV-2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings.

Influenza-Related Communication and Community Mitigation Strategies: Results From the 2015 Pandemic Influenza Readiness Assessment.

Emergence of a novel infectious disease, such as pandemic influenza, is the one global crisis most likely to affect the greatest number of people worldwide. Because of the potentially severe and contagious nature of influenza, a rapid multifaceted pandemic response, which includes nonpharmaceutical interventions (NPIs) and effective strategies for communication with the public are essential for a timely response and mitigating the spread of disease. A web-based questionnaire was administered via email in July 2015 to 62 Public Health Emergency Preparedness (PHEP) directors across jurisdictions that receive funding through the Centers for Disease Control and Prevention PHEP cooperative agreement. This report focuses on two modules: Public Information and Communication and Community Mitigation. Consistent and targeted communication are critical for the acceptability and success of NPIs. All 62 jurisdictions have developed or are in the process of developing a communications plan. Community-level NPIs such as home isolation, school closures, and respiratory etiquette play a critical role in mitigating the spread of disease. Effective, ongoing communication with the public is essential to ensuring wide spread compliance of NPI's, especially among non-English-speaking populations. Planning should also include reaching vulnerable populations and identifying the correct legal authorities for closing schools and canceling mass gatherings.

Pandemic Influenza Readiness Report on Laboratory and Epidemiology Capacity-United States and Territories, 2015.

Laboratory and epidemiologic data are vital to identify a novel influenza A virus and inform the public health response, whether it be to a localized outbreak or pandemic. The Centers for Disease Control and Prevention (CDC) developed the Pandemic Influenza Readiness Assessment (PIRA) to evaluate the state of the nation's preparedness for the next influenza pandemic. Representatives from all 62 Public Health Emergency Preparedness (PHEP) awardee jurisdictions were requested to complete the web-based questionnaire in July 2015. The PIRA consists of 7 modules covering key components of pandemic preparedness; this article summarizes results from the laboratory and epidemiology modules. Many of the jurisdictions reported they had the capacity to fulfill most of the laboratory and epidemiology tasks, including the ability to differentiate novel influenza A viruses from seasonal influenza viruses and electronically transfer laboratory, surveillance, and case investigation data. Pandemic preparedness includes transfer of electronic death records and conducting surveillance for influenza-associated mortality in adults. Although most jurisdictions self-reported that they had the epidemiologic and laboratory capabilities that were assessed, additional planning and technical assistance are needed to ensure all states and territories have and maintain all critical capacities. The results from this PIRA can inform how CDC and federal partners focus future training and outreach.

2015 Pandemic Influenza Readiness Assessment Among US Public Health Emergency Preparedness Awardees.

OBJECTIVES: To assess how US Public Health Emergency Preparedness (PHEP) awardees plan to respond to an influenza pandemic with vaccination. METHODS: The Centers for Disease Control and Prevention developed the Pandemic Influenza Readiness Assessment, an online survey sent to PHEP directors, to analyze, in part, the readiness of PHEP awardees to vaccinate 80% of the populations of their jurisdictions with 2 doses of pandemic influenza vaccine, separated by 21 days, within 16 weeks of vaccine availability. RESULTS: Thirty-eight of 60 (63.3%) awardees reported being able to vaccinate their populations within 16 weeks; 38 (63.3%) planned to allocate more than 20% of their pandemic vaccine supply to points of dispensing (PODs). Thirty-four of 58 (58.6%) reported staffing as a challenge to vaccinating 80% of their populations; 28 of 60 (46.7%) reported preparedness workforce decreases, and 22 (36.7%) reported immunization workforce decreases between January 2012 and July 2015. CONCLUSIONS: Awardees relied on PODs to vaccinate segments of their jurisdictions despite workforce decreases. Planners must ensure readiness for POD sites to vaccinate, but should also leverage complementary sites and providers to augment public health response.

Readiness to Vaccinate Critical Personnel During an Influenza Pandemic, United States, 2015.

OBJECTIVES: To assess the readiness to vaccinate critical infrastructure personnel (CIP) involved in managing public works, emergency services, transportation, or any other system or asset that would have an immediate debilitating impact on the community if not maintained. METHODS: We analyzed self-reported planning to vaccinate CIP during an influenza pandemic with data from 2 surveys: (1) the Program Annual Progress Assessment of immunization programs and (2) the Pandemic Influenza Readiness Assessment of public health emergency preparedness programs. Both surveys were conducted in 2015. RESULTS: Twenty-six (43.3%) of 60 responding public health emergency preparedness programs reported having an operational plan to identify and vaccinate CIP, and 16 (26.2%) of 61 responding immunization programs reported knowing the number of CIP in their program's jurisdictions. CONCLUSIONS: Many programs may not be ready to identify and vaccinate CIP during an influenza pandemic. Additional efforts are needed to ensure operational readiness to vaccinate CIP during the next influenza pandemic.

Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017.

When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses.These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces).Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented to underscore the importance of broad and flexible prepandemic planning. Third, a new section on community engagement has been included to highlight that the timely and effective use of NPIs depends on community acceptance and active participation. Fourth, to provide new or updated pandemic assessment and planning tools, the novel influenza virus pandemic intervals tool, the Influenza Risk Assessment Tool, the Pandemic Severity Assessment Framework, and a set of prepandemic planning scenarios are described. Finally, to facilitate implementation of the updated guidelines and to assist states and localities with prepandemic planning and decision-making, this report links to six supplemental prepandemic NPI planning guides for different community settings that are available online (https://www.cdc.gov/nonpharmaceutical-interventions).

Structured Mentoring for Workforce Engagement and Professional Development in Public Health Settings.

Mentoring is commonly used to facilitate professional growth and workforce development in a variety of settings. Organizations can use mentoring to help achieve broader personnel goals including leadership development and succession planning. While mentorship can be incorporated into training programs in public health, there are other examples of structured mentoring, with time commitments ranging from minutes to months or longer. Based on a review of the literature in public health and aggregated personal subject matter expertise of existing programs at the Centers for Disease Control and Prevention, we summarize selected mentoring models that vary primarily by time commitments and meeting frequency and identify specific work situations to which they may be applicable, primarily from the federal job experience point of view. We also suggest specific tasks that mentor-mentee pairs can undertake, including review of writing samples, practice interviews, and development of the mentee's social media presence. The mentor-mentee relationship should be viewed as a reciprocally beneficial one that can be a source of learning and personal growth for individuals at all levels of professional achievement and across the span of their careers.

Improving the Public Health Infrastructure Capacity in the U.S. Pacific Territories.

The public health emergency of 2009 pandemic influenza A (H1N1) virus resulted in supplemental funding provided by Congress to the 62 states and territories. The CDC's response included deployment of personnel to the U.S. Pacific territories, who provided technical assistance on laboratory capacity, information technology, surveillance, planning, and continuity of operations.

Providing Logistics Support to CDC-Deployed Staff for the Ebola Response in Liberia, Guinea, and Sierra Leone.

The first Ebola cases in West Africa were reported by the Guinea Ministry of Health on March 23, 2014, and by June it became the largest recorded Ebola outbreak. Centers for Disease Control and Prevention field teams were deployed to West Africa, including in-country logistics staff who were critical for ensuring the movement of staff, equipment, and supplies to locations where public health knowledge and experience were applied to meet mission-related requirements. The logistics role was critical to creating the support for epidemiologists, medical doctors, laboratory staff, and health communicators involved in health promotion activities to successfully respond to the epidemic, both in the capital cities and in remote villages. Logistics personnel worked to procure equipment, such as portable video projectors, and have health promotion materials printed. Logistics staff also coordinated delivery of communication and health promotion materials to the embassy and provided assistance with distribution to various partners.

Early warning infectious disease surveillance.

The Early Warning Infectious Disease Surveillance program (EWIDS) is part of the Cooperative Agreement on Public Health Preparedness and Response for Bioterrorism administered by the Centers for Disease Control and Prevention (CDC). The purpose of EWIDS is to develop and implement a program to collaborate with states or provinces across international borders, to provide rapid and effective laboratory confirmation, and to expand surveillance capabilities. Prior to September 11, 2001, funds were not allocated to states for improving cross-border epidemiologic and laboratory surveillance activities that would increase cross-border preparedness. States were required through the Cooperative Agreement to self-report data twice a year in progress reports to the Division of State and Local Readiness Management Information System (MIS). An analysis of self-reported activities was conducted to determine the activities that states most frequently chose to implement based on existing public health infrastructure along the U.S. borders, since analysis of preparedness activities on the border has not previously been conducted. This article discusses how states chose to address expanding infrastructure capacity with the EWIDS supplemental funding, the challenges that have prevented U.S. border states from addressing all suggested activities, and the importance of sustained funding for the investment of continued capacity building and collaboration with international partners.