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Public Health Emergency Preparedness: Lessons Learned About Monitoring of Interventions From the National Association of County and City Health Official's Survey of Nonpharmaceutical Interventions for Pandemic H1N1

Cantey, Paul T. MD, MPH; Chuk, Michelle G. MPH; Kohl, Katrin S. MD, PhD, MPH; Herrmann, Jack MSEd, NCC, LMHC; Weiss, Paul MS; Graffunder, Corinne M. DrPH, MPH; Averhoff, Francisco MD, MPH; Kahn, Emily B. PhD, MPH, MA; Painter, John DVM, MPH

Journal of Public Health Management and Practice: January/February 2013 - Volume 19 - Issue 1 - p 70–76
doi: 10.1097/PHH.0b013e31824d4666
Original Articles

Objectives: We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response.

Design: Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made.

Setting: Local health departments during the fall 2009 H1N1 pandemic response.

Participants: Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network.

Main Outcome Measures: Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity.

Results: One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity.

Conclusions: Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity.

This study assessed local health departments ability to provide data on nonpharmaceutical interventions for the mitigation of 2009 H1N1 influenza during the pandemic response.

Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases (Drs Cantey, Kohl, Averhoff, Kahn, and Painter), and Office of the Associate Director for Policy (Dr Graffunder), Centers for Disease Control and Prevention, Atlanta, Georgia; National Association of County and City Health Officials, Washington, District of Columbia (Ms Chuk and Mr Herrmann); and Department of Biostatistics, Rollins School of Public Health, Emory University, Atlanta, Georgia (Mr Weiss).

Correspondence: Paul T. Cantey, MD, MPH, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-06, Atlanta, GA 30333 (pcantey@cdc.gov).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

The study was funded by Cooperative Agreement no. 5U38HM000449-04 from the Centers for Disease Control and Prevention.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors thank all the local health departments that participated in the survey for all the effort they put into completing the survey. They also thank the following individuals for their contributions: Carolyn Leep, Rachel Willard, Gulzar Shah, and Barbara Laymon, NACCHO, and Tarissa Mitchell, CDC.

The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.