#Influenza A (#H3) #Outbreak at a #Hurricane #Harvey #Megashelter in Harris County, #Texas: Successes and Challenges in Disease Identification and Control Measure Implementation (Disaster Med Public Health Prep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Disaster Med Public Health Prep. 2019 Feb;13(1):97-101. doi: 10.1017/dmp.2018.159.

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

Liu L1, Haynie A1, Jin S1, Zangeneh A1, Bakota E1, Hornstein BD1, Beckham D1, Reed BC1, Kiger J1, McClendon M1, Perez E1, Schaffer M1, Becker L1, Shah UA1.

Author information: 1 Harris County Public Health,Houston, Texas (Dr. Aisha Haynie is no longer affiliated with the agency).

 

Abstract

When 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).

KEYWORDS: Hurricane Harvey; influenza outbreak; shelter surveillance and response

PMID: 30841952 DOI: 10.1017/dmp.2018.159 [Indexed for MEDLINE]

Keywords: Seasonal Influenza; H3N2; Disaster preparedness; Hurricanes; USA; Texas.

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Concurrent #assessment of #epidemiological and #operational #uncertainties for optimal #outbreak #control: #Ebola as a case study (Proc Roy Soc B., abstract)

[Source: Proceedings of the Royal Society, Biological Sciences, full page: (LINK). Abstract, edited.]

Concurrent assessment of epidemiological and operational uncertainties for optimal outbreak control: Ebola as a case study

Shou-Li Li, Matthew J. Ferrari, Ottar N. Bjørnstad, Michael C. Runge,Christopher J. Fonnesbeck, Michael J. Tildesley, David Pannell and Katriona Shea

Published: 19 June 2019 / DOI: https://doi.org/10.1098/rspb.2019.0774

 

Abstract

Determining how best to manage an infectious disease outbreak may be hindered by both epidemiological uncertainty (i.e. about epidemiological processes) and operational uncertainty (i.e. about the effectiveness of candidate interventions). However, these two uncertainties are rarely addressed concurrently in epidemic studies. We present an approach to simultaneously address both sources of uncertainty, to elucidate which source most impedes decision-making. In the case of the 2014 West African Ebola outbreak, epidemiological uncertainty is represented by a large ensemble of published models. Operational uncertainty about three classes of interventions is assessed for a wide range of potential intervention effectiveness. We ranked each intervention by caseload reduction in each model, initially assuming an unlimited budget as a counterfactual. We then assessed the influence of three candidate cost functions relating intervention effectiveness and cost for different budget levels. The improvement in management outcomes to be gained by resolving uncertainty is generally high in this study; appropriate information gain could reduce expected caseload by more than 50%. The ranking of interventions is jointly determined by the underlying epidemiological process, the effectiveness of the interventions and the size of the budget. An epidemiologically effective intervention might not be optimal if its costs outweigh its epidemiological benefit. Under higher-budget conditions, resolution of epidemiological uncertainty is most valuable. When budgets are tight, however, operational and epidemiological uncertainty are equally important. Overall, our study demonstrates that significant reductions in caseload could result from a careful examination of both epidemiological and operational uncertainties within the same modelling structure. This approach can be applied to decision-making for the management of other diseases for which multiple models and multiple interventions are available.

Keywords: Disaster preparedness; Mathematical models; Ebola.

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Too Many #Patients…A #Framework to Guide Statewide #Allocation of Scarce Mechanical #Ventilation During #Disasters (Chest, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Chest. 2018 Oct 11. pii: S0012-3692(18)32565-0. doi: 10.1016/j.chest.2018.09.025. [Epub ahead of print]

Too Many Patients…A Framework to Guide Statewide Allocation of Scarce Mechanical Ventilation During Disasters.

Daugherty Biddison EL1, Faden R2, Gwon HS3, Mareiniss DP4, Regenberg AC2, Schoch-Spana M5, Schwartz J6, Toner ES5.

Author information: 1 Johns Hopkins University School of Medicine. Electronic address: Lee.biddison@jhmi.edu. 2 Johns Hopkins Berman Institute of Bioethics. 3 Johns Hopkins Medicine. 4 Georgetown University School of Medicine. 5 Johns Hopkins Bloomberg School of Public Health. 6 University of Maryland Carey School of Law.

 

Abstract

The threat of a catastrophic public health emergency causing life threatening illness or injury on a massive scale has prompted extensive federal, state, and local preparedness efforts. Modeling studies suggest that an influenza pandemic similar to that of 1918 would require ICU and mechanical ventilation capacity that is significantly greater than what is available. Several groups have published recommendations for allocating life-support measures during a public health emergency. Because there are multiple ethically permissible approaches to allocating scarce life-sustaining resources and because the public will bear the consequences of these decisions, knowledge of public perspectives and moral points of reference on these issues is critical. Here we describe a critical care disaster resource allocation framework developed following a state-wide community engagement process in Maryland. It is intended to assist hospitals and public health agencies in their independent and coordinated response to an officially declared catastrophic health emergency in which demand for mechanical ventilators exceeds the capabilities of all surge response efforts and in which there has been an executive order to implement scarce resource allocation procedures. The framework, built on a basic scoring system with modifications for specific considerations, also creates an opportunity for the legal community to review existing laws and liability protections in light of a specific disaster response process.

PMID: 30316913 DOI: 10.1016/j.chest.2018.09.025

Keywords: Disaster Preparedness; Pandemic Preparedness; Public Health.

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An #Evaluation of #Global #Hazard #Communication with #Ethical Considerations (PLoS Curr., abstract)

[Source: PLoS Currents Disasters, full page: (LINK). Abstract, edited.]

An Evaluation of Global Hazard Communication with Ethical Considerations

AUGUST 7, 2018 · REVIEW

AUTHORS: Thomas Richardson, Gemma Hayward, Mr. Kevin Blanchard, Professor Virginia Murray

 

ABSTRACT

Introduction:

Despite the large number of hazards occurring every year, it is often only the most catastrophic and rapidly occurring hazards that are covered in detail by major news outlets. This can result in an under-reporting of smaller or slowly evolving hazards such as drought. Furthermore, the type or country in which the hazard occurs may have a bearing on whether it receives media coverage. The Public Health England (PHE) global weekly hazards bulletin is designed to inform subscribers of hazards occurring in the world in a given week regardless of location or type of natural hazard. This paper will aim to examine whether the bulletin is reporting these events in a way that matches a number of international disaster databases.  It will also seek to answer if biases within media outlets reporting of an event is impacting on the types of hazards and events being covered.  Through the analysis of data collected, it is hoped to be able to consider the ethical implications of such a bulletin service and provide recommendations on how the service might be improved in the future.

Methods:

The study used a year’s worth of global hazards bulletins sent by Public Health England.  These bulletins aim to communicate hazards in the form of compiled articles from news outlets around the world. Data from these bulletins was collected and analysed by hazard type and the country in which hazards occurred.  It was then compared to recognised hazard databases to assess similarities and differences in the hazards being reported via media or through dedicated hazard databases. The recognised hazard databases were those run by the Emergency Events Database (EM-DAT), European Civil Protection and Humanitarian Aid Operations (ECHO) and National Aeronautics and Space Administration (NASA) respectively.

Results:

The PHE bulletin overall was found to be comparable to other global hazard or disaster databases in terms of hazards included by both country and type of hazard. The PHE bulletin covered a greater number of unique hazard events than the other databases and also covered more types of hazard. It also gave more frequent coverage to the United Kingdom and Canada than the other databases, with other countries appearing less frequently. More generally, the PHE bulletin and the databases it was compared to appear to focus more on hazards either occurring in developed countries or fast-onset ones such as landslides or floods. On the other hand, slow-onset hazards such as drought or those occurring in developing countries appear to be under-reported and are given less importance in both the bulletin and databases.

Discussion and recommendations

” We recommend that the resources compared review their inclusion criteria and assess whether the discrepancies in hazard type and country can be ratified through changes in how hazards are assessed for inclusion. More research should be undertaken to assess whether similar findings arise when comparing databases in other areas within the remit of public health.

FUNDING STATEMENT

The authors received no specific funding for this work.

Keywords: Disaster Preparedness; UK.

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Knowing What We Know – Reflections on the #Development of Technical #Guidance for Loss Data for the #Sendai #Framework for #Disaster #Risk Reduction (PLoS Curr., abstract)

[Source: PLoS Currents Disasters, full page: (LINK). Abstract, edited.]

Knowing What We Know – Reflections on the Development of Technical Guidance for Loss Data for the Sendai Framework for Disaster Risk Reduction

AUGUST 2, 2018 · RESEARCH ARTICLE

AUTHORS: Mr Lorcan Clarke, Mr Kevin Blanchard, Dr Rishma Maini, Alin Radu, Nuha Eltinay, Zehra Zaidi, Virginia Murray

 

ABSTRACT

Introduction:

To report on activities aligned with the Sendai Framework for Disaster Risk Reduction 2015-2030, national governments will use the Sendai Monitor platform to track progress using a series of indicators that inform seven Global Targets originally agreed in 2015. In February 2017, the UN General Assembly adopted a set of 38 agreed indicators based on work led by an open-ended intergovernmental expert working group (OIEWG) on indicators and terminology relating to disaster risk reduction. In January 2018 the United Nations Office for Disaster Risk Reduction released technical guidance documents in advance of the launch of the Sendai Monitor in March 2018.

Methods:

This paper discusses several challenges to recording and reporting on loss data under the Sendai Framework. Additional insights to elaborate on discussion build upon commentary and examples raised during a workshop held on developing loss data that was hosted by the United Nations Office of Disaster Risk Reduction (UNISDR), the Integrated Research on Disaster Risk (IRDR) programme, and Public Health England (PHE) from February 15-17 2017 at the Royal Society in London, United Kingdom. The meeting’s purpose was to refine technical guidance notes concerning Global Targets A, B, C, and D, which had been drafted in coordination with the work of the OIEWG. The workshop was attended by representatives from UN Agencies, UN Member States, international scientific bodies, academic bodies, the government of the United Kingdom and the private sector.

Results:

Global Targets A, B, C and D of the Sendai Framework have common and specific complexities which require acknowledgement and support in recording, reporting and using disaster loss data. Discussions during the February 2017 loss data workshop highlighted a number of complexities and the need for common standards and principles for loss data. Individual target complexities include attribution of health impacts, assessing impacts, consistently calculating economic losses and measuring disruption to critical infrastructure.

Discussion:

Transparent monitoring is critical to ensure political will, financial efforts and effective evidence support the global shift towards more sustainable development. Data involves common challenges which can undermine accuracy and understanding of reporting across the frameworks that outline the United Nations’ 2030 Agenda. Disaster loss data adds further challenges which require support and innovation to ensure stakeholders across sectors in all sectors have appropriate technical guidance that can support useful loss data management processes. The February 2017 workshop highlighted systemic challenges with working with loss data and highlighted several pertinent pathways to progress on the breadth and reliability of disaster loss data across different settings.

Keywords: Disaster Preparedness.

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#Development and Implementation of the #WHO #EMT: Minimum #Technical #Standards and #Recommendations for Rehabilitation (PLoS Curr., abstract)

[Source: PLoS Currents Disasters, full page: (LINK). Abstract, edited.]

Development and Implementation of the World Health Organization Emergency Medical Teams: Minimum Technical Standards and Recommendations for Rehabilitation

JULY 9, 2018 · DISCUSSION

AUTHORS: Jody-Anne Mills, James Gosney, Fiona Stephenson, Peter Skelton, Ian Norton, Valerie Scherrer, G Geraldine Jacquemin, Barbara Rau

 

ABSTRACT

Emergency medical teams provide urgent medical and surgical care in emergencies characterized by a surge in trauma or disease. Rehabilitation has historically not been included in the acute phase of care, as teams have either not perceived it as their responsibility or have relied on external providers, including local services and international organizations, to provide services. Low- and middle-income countries, which often have limited rehabilitation capacity within their health system,  are particularly vulnerable to disaster and are usually  ill-equipped to address the increased burden of rehabilitation needs that arise. The resulting unmet needs for rehabilitation culminate in unnecessary complications for patients, delayed recovery, reduced functional outcomes, and often impede return to daily activities and life roles. Recognizing the systemic neglect of rehabilitation in global emergency medical response, the World Health Organization, in collaboration with key operational partners and experts, developed technical standards and recommendations for rehabilitation which are integrated into  the WHO verification  process for EMTs. This protocol report presents: 1) the rationale for the development of the standards and accompanying recommendations; 2) the methodology of the development process; 3) the minimum standards and other significant content included in the document; 4) challenges encountered during development and implementation; and 5) current and next steps to continue strengthening the inclusion of rehabilitation in emergency medical response.

FUNDING STATEMENT

Funding for the development of the Emergency medical teams: minimum technical standards and recommendations for rehabilitation was provided by the Spanish Ministry of Foreign Affairs and Cooperation. The funders had no role in the design, decision to publish or preparation of the manuscript.

Keywords: Pandemic Preparedness; Disaster Preparedness; WHO.

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The #Promotion of ‘#GrabBags’ as a #Disaster #Risk Reduction #Strategy (PLoS Curr., abstract)

[Source: PLoS Currents Disasters, full page: (LINK). Abstract, edited.]

The Promotion of ‘Grab Bags’ as a Disaster Risk Reduction Strategy

JULY 6, 2018 · RESEARCH ARTICLE

AUTHORS: Christina J. Pickering, Tracey L. O’Sullivan, Alessia Morris, Carman Mark, David Mc Quirk, Emily YY Chan, Emily Guy, Gloria Chan, Karen Reddin, Ralph Throp, Shinya Tsuzuki, Tiffany Yeung, Virginia Murray

 

ABSTRACT

Introduction:

An all-of-society approach to disaster risk reduction emphasizes inclusion and engagement in preparedness activities. A common recommendation is to promote household preparedness through the preparation of a ‘grab bag’ or ‘disaster kit’, that can be used to shelter-in-place or evacuate. However, there are knowledge gaps related to how this strategy is being used around the world as a disaster risk reduction strategy, and what evidence there is to support recommendations.

Methods:

In this paper, we present an exploratory study undertaken to provide insight into how grab bag guidelines are used to promote preparedness in Canada, China, England, Japan, and Scotland, and supplemented by a literature review to understand existing evidence for this strategy.

Results:

There are gaps in the literature regarding evidence on grab bag effectiveness. We also found variations in how grab bag guidelines are promoted across the five case studies.

Discussion:

While there are clearly common items recommended for household grab bags (such as water and first aid kits), there are gaps in the literature regarding: 1) the evidence base to inform guidelines; 2) uptake of guidelines; and 3) to what extent grab bags reduce demands on essential services and improve disaster resilience.

FUNDING STATEMENT

The authors received no specific funding for this work.

Keywords: Disaster Preparedness.

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