Applying infectious disease forecasting to public health: a path forward using influenza forecasting examples.

BACKGROUND: Infectious disease forecasting aims to predict characteristics of both seasonal epidemics and future pandemics. Accurate and timely infectious disease forecasts could aid public health responses by informing key preparation and mitigation efforts. MAIN BODY: For forecasts to be fully integrated into public health decision-making, federal, state, and local officials must understand how forecasts were made, how to interpret forecasts, and how well the forecasts have performed in the past. Since the 2013-14 influenza season, the Influenza Division at the Centers for Disease Control and Prevention (CDC) has hosted collaborative challenges to forecast the timing, intensity, and short-term trajectory of influenza-like illness in the United States. Additional efforts to advance forecasting science have included influenza initiatives focused on state-level and hospitalization forecasts, as well as other infectious diseases. Using CDC influenza forecasting challenges as an example, this paper provides an overview of infectious disease forecasting; applications of forecasting to public health; and current work to develop best practices for forecast methodology, applications, and communication. CONCLUSIONS: These efforts, along with other infectious disease forecasting initiatives, can foster the continued advancement of forecasting science.

Provider and Public Health Adaptation to Changing Centers for Disease Control and Prevention Guidance for Zika Virus, 2015-2017.

In 2015, Harris County (Texas) Public Health responded to the Zika virus (ZIKV) threat by investigating every report of potential ZIKV infection, including those with negative laboratory results, through December 2017. Before investigations, 40.6% of patients who were indicated for testing received it in accordance with Centers for Disease Control and Prevention guidelines. By investigating reports with negative ZIKV results, we increased the number of patients receiving correct and complete laboratory testing to 54.5%, and improved dissemination of evolving guidelines to partners across the health care spectrum.

Influenza A (H3) Outbreak at a Hurricane Harvey Megashelter in Harris County, Texas: Successes and Challenges in Disease Identification and Control Measure Implementation.

ABSTRACTWhen Hurricane Harvey landed along the Texas coast on August 25, 2017, it caused massive flooding and damage and displaced tens of thousands of residents of Harris County, Texas. Between August 29 and September 23, Harris County, along with community partners, operated a megashelter at NRG Center, which housed 3365 residents at its peak. Harris County Public Health conducted comprehensive public health surveillance and response at NRG, which comprised disease identification through daily medical record reviews, nightly "cot-to-cot" resident health surveys, and epidemiological consultations; messaging and communications; and implementation of control measures including stringent isolation and hygiene practices, vaccinations, and treatment. Despite the lengthy operation at the densely populated shelter, an early seasonal influenza A (H3) outbreak of 20 cases was quickly identified and confined. Influenza outbreaks in large evacuation shelters after a disaster pose a significant threat to populations already experiencing severe stressors. A holistic surveillance and response model, which consists of coordinated partnerships with onsite agencies, in-time epidemiological consultations, predesigned survey tools, trained staff, enhanced isolation and hygiene practices, and sufficient vaccines, is essential for effective disease identification and control. The lessons learned and successes achieved from this outbreak may serve for future disaster response settings. (Disaster Med Public Health Preparedness. 2019;13:97-101).

Do people become better prepared in the aftermath of a natural disaster? The hurricane Ike experience in Houston, Texas.

OBJECTIVE: Despite large-scale efforts and expensive public education campaigns mounted by the government at all levels in the past decade, the improvements in disaster preparedness among the US Gulf Coast residents have been ineffectual at best. Some factors that contribute to better preparedness are past experience, awareness of what to do in a disaster scenario and availability, and access to informational and supportive resources. We examine whether an experience of a natural disaster brings about changes in preparedness and access to resources. DESIGN: Our study is based on data from 2 cross-sectional random-digit-dialing surveys in 2008 (pre-Ike) and 2009 (post-Ike) with sample sizes of 1001 and 1009, respectively. PARTICIPANTS: Adults living in one of the 85 zip codes in Houston, Texas. MAIN OUTCOME MEASURE: Self-reported preparedness, evacuation plan, available resources (informational, financial and emotional). RESULTS: We found no significant changes in preparedness or evacuation plans in residents of Houston prior to and a year after Hurricane Ike. Hispanics and other minority groups reported a significant increase in access to information and all residents reported an increase in perception of availability of financial support, if needed. Perceived availability of tangible (financial) support has been linked to positive physical and mental health effects and can contribute to resiliency and quicker recovery. The unchanged preparedness levels could be attributed to ceiling effects, that is, the already high levels of preparedness reported by Houston residents. Greater access to information reported by Hispanics and other minorities is encouraging and indicative of success in reaching out. CONCLUSIONS: Our results also indicate a greater need for appropriate targeted strategies to reach out to African Americans in Houston since this group reported poorer access to information. This has implications for planning and preparedness officials and the communication strategies used to reach the community.