Health security
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While more than a billion people live at risk of neglected tropical diseases in areas of Asia, sub-Saharan Africa, and Latin America, the degree to which such diseases burden countries like the United States is currently unclear. Even though many neglected tropical diseases such as dengue, leishmaniasis, and Chagas disease are not endemic to the United States, the possibility of their emergence is noteworthy, especially in states like Texas, which has high levels of poverty, a large immigrant population, and a climate amenable to the vectors for these diseases and is geographically proximate to endemic areas. Despite the health threat that emerging neglected tropical diseases may pose, little is known about the prevalence of risk factors for them in the United States. ⋯ After reviewing the potential risk factors for transmission in Texas, we developed a 41-question survey that could be implemented using the Community Assessment for Public Health Emergency Response (CASPER) method. In concert with public health surveillance and vector population monitoring, data from CASPERs could be used to quickly and cost-effectively assess the prevalence of risk factors for 10 neglected tropical diseases in Texas or elsewhere in the United States. The data generated by future CASPERs conducted using this survey could be immediately actionable, guiding public health priority setting and decision making.
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In addition to the impact of a disease itself, public reaction could be considered another outbreak to be controlled during an epidemic. Taiwan's experience with SARS in 2003 highlighted the critical role played by the media during crisis communication. After the SARS outbreak, Taiwan's Centers for Disease Control (Taiwan CDC) followed the WHO outbreak communication guidelines on trust, early announcements, transparency, informing the public, and planning, in order to reform its risk communication systems. ⋯ Many communication strategies, ranging from traditional media to social and new media, have been implemented to improve transparency in public communication and promote civic engagement. Taiwan CDC will continue to maintain the strengths of its risk communication systems and resolve challenges as they emerge through active evaluation and monitoring of public opinion to advance Taiwan's capacity in outbreak communication and control. Moreover, Taiwan CDC will continue to implement the IHR (2005) and to promote a global community working together to fight shared risks and to reach the goal of "One World, One Health."
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Anthrax postexposure prophylaxis (PEP) was recommended to 42 people after a laboratory incident that involved potential aerosolization of Bacillus anthracis spores in 2 laboratories at the Centers for Disease Control and Prevention in 2014. At least 31 (74%) individuals who initiated PEP did not complete either the recommended 60 days of antimicrobial therapy or the 3-dose vaccine regimen. ⋯ Individuals taking ciprofloxacin were twice as likely (RR = 2.02, 95% CI = 1.1-3.6) to discontinue antimicrobial prophylaxis when compared to those taking doxycycline. In the event anthrax PEP is recommended, public health messages and patient education materials will need to address potential misconceptions regarding exposure risk and provide information about possible adverse events in order to promote PEP adherence.
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Mass casualty decontamination is a public health intervention that would be employed by emergency responders following a chemical, biological, or radiological incident. The decontamination of large numbers of casualties is currently most often performed with water to remove contaminants from the skin surface. An online survey was conducted to explore US fire departments' decontamination practices and their preparedness for responding to incidents involving mass casualty decontamination. ⋯ The results presented here provide important insights into the ways in which implementation of decontamination guidance can vary between US states. These inconsistencies are thought to reflect established perceived best practices and local adaptation of response plans to address practical and logistical constraints. These outcomes highlight the need for evidence-based national guidelines for conducting mass casualty decontamination.
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The Role of Public Health in Responding to and Recovering from Civil Unrest: Baltimore's Experience.
The death of an African-American man, injured while in police custody, led to protests and several days of civil unrest in Baltimore City beginning on April 27, 2015. This article discusses the role of the Baltimore City Health Department, during and after the initial protests and civil unrest, as the lead agency for ESF-8 response. We review and share initial response actions, short-term recovery operations, long-term recovery efforts, and lessons learned.