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US State Public Health Departments Special Pathogen Planning

Herstein, Jocelyn J., MPH; Biddinger, Paul D., MD; Gibbs, Shawn G., PhD; Le, Aurora B., MPH; Jelden, Katelyn C., MPH; Hewlett, Angela L., MD, MS; Lowe, John J., PhD

Journal of Public Health Management and Practice: September/October 2018 - Volume 24 - Issue 5 - p E28–E33
doi: 10.1097/PHH.0000000000000714
Research Reports: Research Full Report

Context: US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction with the Centers for Disease Control and Prevention.

Objective: To identify existing guidelines and perspectives of state health departments pertaining to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs).

Design: An electronic 8-question survey with subquestions was administered as a fillable PDF.

Setting: The survey was distributed to publicly accessible e-mails of state health department employees.

Participants: State epidemiologists, emergency preparedness directors, or chief medical officers from each of the 50 states and the District of Columbia were contacted; a representative from 36 states and the District of Columbia responded (73%).

Main Outcome Measures: Descriptive statistics were used to identify the proportion of state health departments with various existing protocols.

Results: A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (eg, EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89%) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16%) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59%) had operationally exercised transport of a patient to an HLIU.

Conclusions: Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Recent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.

Departments of Environmental, Agricultural & Occupational Health (Ms Herstein and Dr Lowe) and Internal Medicine, Division of Infectious Diseases (Dr Hewlett) and College of Medicine (Ms Jelden), University of Nebraska Medical Center, Omaha, Nebraska; Department of Emergency Medicine, Division of Emergency Preparedness, Massachusetts General Hospital, Boston, Massachusetts (Dr Biddinger); Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts (Dr Biddinger); Department of Environmental and Occupational Health, Indiana University School of Public Health, Bloomington, Indiana (Dr Gibbs and Ms Le); and Nebraska Biocontainment Unit, Omaha, Nebraska (Drs Hewlett and Lowe).

Correspondence: Jocelyn J. Herstein, MPH, Department of Environmental, Agricultural & Occupational Health College of Public Health, University of Nebraska Medical Center, 985110 Nebraska Medical Center, Omaha, NE 68198 (

The authors declare no conflicts of interest.

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