In Pennsylvania on February 16, 2006, a New York City resident collapsed with rigors and was hospitalized. On February 21, the Centers for Disease Control and Prevention and the New York City Department of Health and Mental Hygiene were notified that Bacillus anthracis had been identified in the patient's blood. Although the patient's history of working with dried animal hides to make African drums indicated the likelihood of a natural exposure to aerosolized anthrax spores, bioterrorism had to be ruled out first. Ultimately, this case proved to be the first case of naturally occurring inhalational anthrax in 30 years. This article describes the epidemiologic and environmental investigation to identify other cases and persons at risk and to determine the source of exposure and scope of contamination. Because stricter regulation of the importation of animal hides from areas where anthrax is enzootic is difficult, public healthcare officials should consider the possibility of future naturally occurring anthrax cases caused by contaminated hides. Federal protocols are needed to assist in the local response, which should be tempered by our growing understanding of the epidemiology of naturally acquired anthrax. These protocols should include recommended methods for reliable and efficient environmental sample collection and laboratory testing, and environmental risk assessments and remediation.
The world's largest outbreak of Ebola virus disease began in West Africa in 2014. Although few cases were identified in the United States, the possibility of imported cases led US public health systems and health care facilities to focus on preparing the health care system to quickly and safely identify and respond to emerging infectious diseases. In New York City, early, coordinated planning among city and state agencies and the health care delivery system led to a successful response to a single case diagnosed in a returned health care worker. In this article we describe public health and health care system preparedness efforts in New York City to respond to Ebola and conclude that coordinated public health emergency response relies on joint planning and sustained resources for public health emergency response, epidemiology and laboratory capacity, and health care emergency management. (Disaster Med Public Health Preparedness. 2017;11:370-374).
In 2008, the New York City Department of Health and Mental Hygiene (NYC DOHMH) conducted a series of 8 focus groups to determine what improvements could be made to existing plans to ensure that the public would adhere to instructions issued during an emergency that required mass antibiotic distribution following an aerosolized anthrax attack. Discussion focused on perceptions surrounding public health emergencies, overall point-of dispensing (POD) strategy, willingness to pick up medications for others, and additional information that participants would need before and during an emergency. Participation in each group ranged from 7 to 10 members. Most participants indicated a willingness to actively participate in emergency response and to follow directions issued by authorities. Some said they would wait to see how others reacted to medication being provided before taking theirs. Participants expressed a universal desire for education on both dispensing plans and diseases before an incident occurs. They expressed concerns about anxiety levels among the public and maintaining adequate security at dispensing sites, though they felt that NYC's plans were generally realistic. The most trusted sources identified to disseminate information were the mayor, the city health commissioner, and a local cable news channel. While many participants indicated they would use the internet to find information during an emergency, multiple delivery methods must be used to ensure the broadest reach within the community, as not everyone has internet access. Health authorities must partner with the public before, during, and after an emergency to achieve the best possible outcomes from a response effort that relies greatly on public cooperation.
Since 2001, the New York City Department of Health and Mental Hygiene (NYC DOHMH) has built a strong public health preparedness foundation, made possible in large part by funding from the Public Health Emergency Preparedness (PHEP) Cooperative Agreement provided by the Centers for Disease Control and Prevention. While this funding has allowed NYC DOHMH to make great progress in areas such as all-hazards planning, risk communication, disease surveillance, and lab capacity, the erosion of federal preparedness dollars for all-hazards preparedness has the potential to reverse these gains. Since the initiation of the PHEP grant in 2002, PHEP funding has steadily declined nationwide. Specifically, the total federal allocation has decreased approximately 20%, from $862,777,000 in 2005 to $688,914,546 in 2009. With city and state budgets at an all-time low, federal funding cuts will have a significant impact on public health preparedness programs nationwide. In this time of strict budgetary constraints, the nation would be better served by strategically awarding federal preparedness funds to areas at greatest risk. The absence of risk-based funding in determining PHEP grant awards leaves the nation's highest-risk areas, like New York City, with insufficient resources to prepare for and respond to public health emergencies. This article examines the progress New York City has made and what is at stake as federal funding continues to wane.
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