CDC's Evolving Approach to Emergency Response

Insights into the preventive actions of natural compounds against Klebsiella pneumoniae infections and drug resistance

Klebsiella pneumoniae is a type of Gram-negative bacteria that causes a variety of infections, including pneumonia, bloodstream infections, wound infections, and meningitis. The treatment of K. pneumoniae infection depends on the type of infection and the severity of the symptoms. Antibiotics are generally used to treat K. pneumoniae infections. However, some strains of K. pneumoniae have become resistant to antibiotics. This comprehensive review examines the potential of natural compounds as effective strategies against K. pneumonia infections. The alarming rise in antibiotic resistance underscores the urgent need for alternative therapies. This article represents current research on the effects of diverse natural compounds, highlighting their anti-microbial and antibiofilm properties against K. pneumonia. Notably, compounds such as andrographolide, artemisinin, baicalin, berberine, curcumin, epigallocatechin gallate, eugenol, mangiferin, piperine, quercetin, resveratrol, and thymol have been extensively investigated. These compounds exhibit multifaceted mechanisms, including disruption of bacterial biofilms, interference with virulence factors, and augmentation of antibiotic effectiveness. Mechanistic insights into their actions include membrane perturbation, oxidative stress induction, and altered gene expression. While promising, challenges such as limited bioavailability and varied efficacy across bacterial strains are addressed. This review further discusses the potential of natural compounds as better alternatives in combating K. pneumonia infection and emphasizes the need for continued research to harness their full therapeutic potential. As antibiotic resistance persists, these natural compounds offer a promising avenue in the fight against K. pneumonia and other multidrug-resistant pathogens.

Prehospital Cardiac Arrest Should be Considered When Evaluating Coronavirus Disease 2019 Mortality in the United States

BACKGROUND

Public health emergencies leave little time to develop novel surveillance efforts. Understanding which preexisting clinical datasets are fit for surveillance use is of high value. Coronavirus disease 2019 (COVID-19) offers a natural applied informatics experiment to understand the fitness of clinical datasets for use in disease surveillance.

OBJECTIVES

This study evaluates the agreement between legacy surveillance time series data and discovers their relative fitness for use in understanding the severity of the COVID-19 emergency. Here fitness for use means the statistical agreement between events across series.

METHODS

Thirteen weekly clinical event series from before and during the COVID-19 era for the United States were collected and integrated into a (multi) time series event data model. The Centers for Disease Control and Prevention (CDC) COVID-19 attributable mortality, CDC's excess mortality model, national Emergency Medical Services (EMS) calls, and Medicare encounter level claims were the data sources considered in this study. Cases were indexed by week from January 2015 through June of 2021 and fit to Distributed Random Forest models. Models returned the variable importance when predicting the series of interest from the remaining time series.

RESULTS

Model r2 statistics ranged from 0.78 to 0.99 for the share of the volumes predicted correctly. Prehospital data were of high value, and cardiac arrest (CA) prior to EMS arrival was on average the best predictor (tied with study week). COVID-19 Medicare claims volumes can predict COVID-19 death certificates (agreement), while viral respiratory Medicare claim volumes cannot predict Medicare COVID-19 claims (disagreement).

CONCLUSION

Prehospital EMS data should be considered when evaluating the severity of COVID-19 because prehospital CA known to EMS was the strongest predictor on average across indices.

COVID-19 Response Roles among CDC International Public Health Emergency Management Fellowship Graduates

Since 2013, the US Centers for Disease Control and Prevention has offered the Public Health Emergency Management Fellowship to health professionals from around the world. The goal of this program is to build an international workforce to establish public health emergency management programs and operations centers in participating countries. In March 2021, all 141 graduates of the fellowship program were invited to complete a web survey designed to examine their job roles and functions, assess their contributions to their country's COVID-19 response, and identify needs for technical assistance to strengthen national preparedness and response systems. Of 141 fellows, 89 successfully completed the survey. Findings showed that fellowship graduates served key roles in COVID-19 response in many countries, used skills they gained from the fellowship, and desired continuing engagement between the Centers for Disease Control and Prevention and fellowship alumni to strengthen the community of practice for international public health emergency management.

The Role of Public Health Emergency Management in Biodefense: A COVID-19 Case Study

INTRODUCTION

The emergence of the COVID-19 pandemic has had significant impact on human lives as well as economic and social stability. The United States has a complicated history with biosecurity as policy making, biodefense activities, and government transparency have historically been in contention. The terror attacks of September 11, 2001 uncovered various weaknesses in the national public health infrastructure that have persisted into the current pandemic.

METHODS

This study explores the biodefense and public health preparedness landscape for trends in federal support and capacity building. It also investigates the applicability of public health emergency management principles to the biodefense structure. A mixed method was utilized in this study to investigate the qualitative and quantitative factors of the research inquiry. Braun and Clarke's six phase framework for thematic analysis will assist with defining the important information from a review of the literature. The concurrent triangulation design permits that use of qualitative and quantitative data to more accurately define and analyze the relationship among the variables of interest.

RESULTS

The results included the identification of 8 common themes of failure during the COVID-19 response: (1) accountable leadership, (2) statutory authorities and policies, (3) inter-agency coordination, (4) coherent data system for situational awareness, (5) strategic national stockpile and supply chain, (6) testing and surveillance, (7) health care system surge capacity and resilience, and (8) federal funds and the role of public health emergency management in the evolving landscape of biothreats, both intentional and natural.

DISCUSSION

To counter the increasing biothreats, the United States must invest in revamping the biodefense infrastructure to mimic and support public health emergency preparedness initiatives which will increase our resilience to various biothreats.

A Survey of Location-Allocation of Points of Dispensing During Public Health Emergencies

Public health emergencies such as disease outbreaks and bioterrorism attacks require immediate response to ensure the safety and well-being of the affected community and prevent the further spread of infection. The standard method to increase the efficiency of mass dispensing during health emergencies is to create emergency points called points of dispensing (PODs). PODs are sites for distributing medical services such as vaccines or drugs to the affected population within a specific time constraint. These PODs need to be sited in optimal locations and have people (demand points) assigned to them simultaneously; this is known as the location-allocation problem. PODs may need to be selected to serve the entire population (full allocation) or different priority or needs groups (partial allocation). Several previous studies have focused on location problems in different application domains, including healthcare. However, some of these studies focused on healthcare facility location problems without specifying location-allocation problems or the exact domain. This study presents a survey of the PODs location-allocation problem during public health emergencies. This survey aims to review and analyse the existing models for PODs location-allocation during public health emergencies based on full and partial demand points allocation. Moreover, it compares existing models based on their key features, strengths, and limitations. The challenges and future research directions for PODs location-allocation models are also discussed. The results of this survey demonstrated a necessity to develop a variety of techniques to analyse, define and meet the demand of particular groups. It also proved essential that models be developed for different countries, including accounting for variations in population size and density. Moreover, the model constraints, such as those relating to time or prioritizing certain groups, need to be considered in the solution. Finally, additional comparative studies are required to clarify which methods or models are adequate based on predefined criteria.

Applying the Ready, Willing, and Able Framework to Assess Agency Public Health Emergency Preparedness: The CDC Perspective

Public health emergencies in the United States have been complex, frequent, and increasingly costly in the past decade, at times overwhelming government agencies that are primarily resourced for routine, nonemergency health functions. Emergencies are not always predictable, and adequate resources are not always available to prepare staff in advance for emergency response roles and to mobilize them quickly when a new threat emerges. Additionally, real-world data that connect preparedness levels to response outcomes may be difficult to obtain, further limiting continuous quality improvement efforts by public health officials. In this article, we apply the Ready, Willing, and Able (RWA) framework to identify areas for improvement related to organizational and staff readiness, willingness, and ability to respond during a public health emergency. We share emergency response deployment, training, and personnel data collected as part of emergency response activations (2008 to 2018) at the Centers for Disease Control and Prevention to illustrate how the framework may be applied at government agencies to improve response processes and effectiveness. Additionally, we propose potential metrics aligned with the framework constructs that may help emergency managers consistently assess agency preparedness and, over time, be incorporated into broader standardized measurement methods. We conclude that the RWA framework is a practical tool that can complement other preparedness approaches currently in use at government public health agencies.

Social Media Survey and Web Posting Assessment of the COVID-19 Response in China: Health Worker Attitudes Toward Preparedness and Personal Protective Equipment Shortages

BACKGROUND

Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses toward emerging infectious threats, like the coronavirus disease 2019 (COVID-19) pandemic. Availability of accessible personal protective equipment (PPE) is vital to effective care and prevention.

METHODS

We conducted a cross-sectional survey from February 24 to 28, 2020, to assess COVID-19 preparedness among health workers. In addition, we assessed trends from search engine web crawling and text-mining data trending over the Sina Weibo platform from January 1 to March 3, 2020. Data were abstracted on Chinese outbreak preparedness.

RESULTS

In the survey, we engaged 6350 persons, of whom 1065 agreed to participate, and after an eligibility logic check, 1052 participated (16.6%). We accessed 412 internet posts as to PPE availability. Health workers who were satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak from government organizations, and to consider their hospital prepared for outbreak management. Health workers with more confidence in their abilities to respond were those with more faith in their institution's response capacities. Elements of readiness included having airborne infection isolation rooms, visitor control procedures, and training in precautions and PPE use. Both survey and web post assessments suggested that health workers in need were unable to reliably obtain PPE.

CONCLUSIONS

Health workers' self-confidence depends on perceived institutional readiness. Failure to maintain available PPE inventory for emerging infectious diseases preparedness suggests a failure to learn key lessons from the 2003-2004 SARS outbreak in China.

Ready or Not, Patients Will Present: Improving Urban Pandemic Preparedness

Over the past century, society has achieved great gains in medicine, public health, and health-care infrastructure, particularly in the areas of vaccines, antibiotics, sanitation, intensive care and medical technology. Still, despite these developments, infectious diseases are emerging at unprecedented rates around the globe. Large urban centers are particularly vulnerable to communicable disease events, and must have well-prepared response systems, including on the front-line level. In November 2018, the United States' largest municipal health-care delivery system, New York City Health + Hospitals, hosted a half-day executive-level pandemic response workshop, which sought to illustrate the complexity of preparing for, responding to, and recovering from modern-day infectious diseases impacting urban environments. Attendees were subjected to a condensed, plausible, pandemic influenza scenario and asked to simulate the high-level strategic decisions made by leaders by internal (eg, Chief Medical Officer, Chief Nursing Officer, and Legal Affairs) and external (eg, city, state, and federal public health and emergency management entities) partners across an integrated system of acute, postacute, and ambulatory sites, challenging players to question their assumptions about managing the consequences of a highly pathogenic pandemic.

Evolution of the Public Health Preparedness and Response Capability Standards to Support Public Health Emergency Management Practices and Processes

In spring 2011, the Centers for Disease Control and Prevention (CDC) released Public Health Preparedness Capabilities: National Standards for State and Local Planning. The capability standards provide a framework that supports state, local, tribal, and territorial public health agency preparedness planning and response to public health threats and emergencies. In 2017, a project team at the CDC Division of State and Local Readiness incorporated input from subject matter experts, national partners, and stakeholders to update the 2011 capability standards. As a result, CDC released the updated capability standards in October 2018, which were amended in January 2019. The original structure of the 15 capability standards remained unchanged, but updates were made to capability functions, tasks, and resource elements to reflect advances in public health emergency preparedness and response practices since 2011. When the number of functions and tasks in the 2018 capability standards were compared to those in the 2011 capabilities, only 20% (3/15) of the capabilities had a decrease in function number. The majority of changes were at the task level (task numbers changed in 80%, or 12/15, capabilities) in the 2018 version. The capability standards provide public health agencies with a practical framework, informed by updated science and tools, which can guide prioritization of limited resources to strengthen public health agency emergency preparedness and response capacities.

Use of Medical Countermeasures in Small-Scale Emergency Responses

It is well documented that long-standing focus on public health emergency preparedness medical countermeasures (MCMs) distribution and mass dispensing capabilities for mitigation of bioterrorism incidents and a lack of real-world opportunities to test national preparedness for large-scale emergencies has hindered development of a body of evidence-based practices in the United States. To encourage jurisdictions seeking innovative opportunities for continuous improvement, we describe instances when the MCM capabilities were used to address smaller-scale, more-frequent public health emergencies such as disease outbreaks, natural disasters, or routine influenza vaccination. We argue that small-scale events represent a critical opportunity that state, local, tribal, and territorial entities can utilize for greater gains in MCM operational readiness than through exercises or planned reviews. By using and evaluating MCM capabilities during a real response, jurisdictions can advance preparedness science and support the translation of research into practice, thereby increasing their capacity to scale up for larger, rarer, higher-consequence emergencies.

Entomological Efficacy of Aerial Ultra-Low Volume Insecticide Applications Against Aedes aegypti (Diptera: Culicidae) in Mexico

A cluster-randomized controlled trial quantified the entomological efficacy of aerial ultra-low volume (AULV) applications of the insecticide chlorpyrifos against Aedes aegypti in Puerto Vallarta, México, during November-October 2017. The trial involved 16 large (1 × 1 km) clusters distributed between treatment-control arms. Primary endpoint was the abundance of Ae. aegypti indoors (total adults, females, and blood-fed females) collected using Prokopack aspirators. After four consecutive weekly cycles of AULV, all adult Ae. aegypti infestation indices were significantly lower in the treatment arm (OR and IRR ≤ 0.28). Efficacy in reducing indoor Ae. aegypti increased with each weekly application cycle from 30 to 73% (total adults), 33 to 76% (females), and 45.5 to 89% (blood-fed females). Entomological indices remained significantly lower in the treatment arm up to 2 wk after the fourth spraying round. Performing AULV spraying can have significant and lasting entomological impact on Ae. aegypti as long as multiple (ideally four) spray cycles are implemented using an effective insecticide.

Process mapping of vaccines: Understanding the limitations in current response to emerging epidemic threats

Vaccination remains the most successful and effective mechanism of pathogen control. However, their development and deployment in epidemic settings have been limited, and the 2015 Ebola outbreak in West Africa identified several bottlenecks linked to a lack of investment in pathogen research, infrastructure or regulation. Shortly after this outbreak, the UK Government established the UK Vaccine Network to ensure the UK is better prepared to respond to pathogens outbreaks of epidemic potential. As part of their work, the network commissioned the creation of a Vaccine Development Tool (http://www.vaccinedevelopment.org.uk/) to serve as a guide to the key stages in vaccine development. The tool also set out to capture the key, rate-limiting bottlenecks in the development of vaccines against emerging infectious disease such that corrective action could be taken, be it through research, funding, infrastructure and policy, both in the UK and internationally. The main research bottlenecks were related to understanding pathogen biology, identification of appropriate animal models and investment in the manufacturing sciences, especially into process development. Infrastructure gaps in GMP manufacturing and fill-finish were also identified and limitations in GMO regulation and regulatory and ethical approvals, especially for outbreak pathogens required new policy initiatives. The UK Vaccine Network has since begun work to correct for these limitations with a series of funding calls and development programmes. This paper seeks to summarise the Vaccine Development Tool and its key findings.

Readiness for Responding to a Severe Pandemic 100 Years After 1918

The 1918 H1N1 pandemic caused an unprecedented number of deaths worldwide. The tools to deal with the global emergency were limited; there were insufficient surveillance systems and a dearth of diagnostic, treatment, and prevention options. With continuing focus on pandemic planning, technologic advances in surveillance, vaccine capabilities, and 21st century medical care and countermeasures, we are more prepared for a severe pandemic than people were 100 years ago; however, notable gaps remain.

The European Medical Corps: first Public Health Team mission and future perspectives

The 2013-2016 Ebola epidemic in West Africa challenged traditional international mechanisms for public health team mobilisation to control outbreaks. Consequently, in February 2016, the European Union (EU) launched the European Medical Corps (EMC), a mechanism developed in collaboration with the World Health Organization (WHO) to rapidly deploy teams and equipment in response to public health emergencies inside and outside the EU. Public Health Teams (PHTs), a component of the EMC, consist of experts in communicable disease prevention and control from participating countries and the European Centre for Disease Prevention and Control (ECDC), to support affected countries and WHO in risk assessment and outbreak response. The European Commission's Directorate-General European Civil Protection and Humanitarian Aid Operations and Directorate-General Health and Food Safety, and ECDC, plan and support deployments. The first EMC-PHT deployment took place in May 2016, with a team sent to Angola for a yellow fever outbreak. The aims were to evaluate transmission risks to local populations and EU citizens in Angola, the risk of regional spread and importation into the EU, and to advise Angolan and EU authorities on control measures. International actors should gain awareness of the EMC, its response capacities and the means for requesting assistance.

Progress in Public Health Emergency Preparedness-United States, 2001-2016

OBJECTIVES

To evaluate the Public Health Emergency Preparedness (PHEP) program's progress toward meeting public health preparedness capability standards in state, local, and territorial health departments.

METHODS

All 62 PHEP awardees completed the Centers for Disease Control and Prevention's self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016.

RESULTS

Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources.

CONCLUSIONS

Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.