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June 1, 2018

Volume 7, Issue 11

Emergency Preparedness Hot Topics

CDC Health Alert Network, CDC HAN-00410, May 25, 2018—Outbreak of Life-threatening Coagulopathy Associated with Synthetic Cannabinoids Use (CDC) In this bulletin, the Centers for Disease Control and Prevention (CDC) provides information about: 1) the current status of a multistate outbreak of coagulopathy from exposure to synthetic cannabinoid products containing a vitamin K-dependent antagonist agent, such as brodifacoum; 2) signs and symptoms of presenting patients from this outbreak and which patients are at risk; 3) laboratory testing options that are available to help identify and classify cases; 4) available resources that may help clinicians make decisions, and; 5) to whom to report possible cases. CDC Bulletin

Sens. Rubio, Nelson Applaud Committee Advancement of Emergency Preparedness Bill (Homeland Preparedness News) The Pandemic and All Hazards Preparedness and Advancing Innovation Act aims to improve the United States' preparedness and response to both man-made and naturally occurring threats, including chemical, biological, radiological and nuclear attacks, and emerging infectious diseases, potential pandemics, and antimicrobial resistance. It includes provisions to give direct hire authority to the U.S. Department of Health and Human Services and to protect seniors during natural disasters. Article

New Health Alerts and Advisories

Pennsylvania Health Alert Network (PA-HAN) Health professionals: Sign up for the PA-HAN. 2018 Health Alerts, Advisories and Updates

PA Statewide Knowledge Center (HIMS) Training Available

Pennsylvania health care facilities are requested to contact their HAP Regional Manager to schedule training.

Regional News

HAP regional manager contact info and the latest regional news and reminders are available at HAP's Emergency Preparedness page.

Coalition News

2017-2022 ASPR HPP Health Care Coalition Capabilites Document

CMS Emergency Preparedness Rule Home Page Source for official information about the rule and implementation.

National Preparedness News and Updates

Harvard Study Estimates Thousands Died in Puerto Rico Due to Hurricane Maria (Washington Post) At least 4,645 people died as a result of Hurricane Maria and its devastation across Puerto Rico last year, according to a new Harvard study, an estimate that far exceeds the official government death toll, which stands at 64. Article

The Places in the U.S. Where Disaster Strikes Again and Again (New York Times) About 90 percent of the total losses across the U.S. occurred in ZIP codes that contain less than 20 percent of the population, according to an analysis of data from the Small Business Administration. Article

Fresh from Hurricane Harvey's Flooding, Houston Starts to Build Anew—in the Flood Plain (Washington Post) A city chastened by disastrous flooding just months ago is trying to balance the need for new construction in a region short of housing with the civic fear that Houston is returning to its freewheeling ways. The construction in northwest Houston, which serves as something of a post-Harvey starting gun, is being built to new, stricter standards. Article

Hawaii on Edge as Lava Reaches Power Plant: 'No One Has Faced This Before' (USA Today) Civil defense authorities in Hawaii were scrambling to firm up contingency plans after hot, powerful lava flowing from Hawaii's erupting Kilauea volcano reached the edge of a Big Island power plant. The lava flow entered the 800-acre property of the Puna Geothermal Venture Plant before stalling at a swale about 300 yards from the nearest underground, geothermal well. If lava breaches the well, authorities fear it could release hydrogen sulfide, a toxic and flammable gas. Article

CDC Comes Close to an All-clear on Romaine Lettuce as E. coli Outbreak Nears Historic Level (Washington Post) It's unlikely that anyone currently has edible romaine lettuce that is contaminated with the toxic strain of E. coli bacteria sickening people nationwide since March. That was the recent message from the Centers for Disease Control and Prevention (CDC), and if not exactly a thundering signal of "all clear," it was pretty close. Article

INFECTIOUS DISEASES
Ebola

Rapid Risk Assessment: Ebola Virus Disease Outbreak in Equateur Province, Democratic Republic of the Congo, First Update (ECDC) This is the ninth Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo since the discovery of the virus during 1976. From April 4 until May 20, 2018, 49 cases and 26 deaths have been recorded of which 22 are confirmed, 21 are probable, and 6 are suspected cases. Cases have been reported from the Bikoro health zone, the Iboko health zone, and the Wangata health zone. The current outbreak is taking place in health zones neighboring the Congo River, which is an important pathway of trade and travel. Article

Almost All in Congo City at Immediate Risk of Ebola Now Vaccinated—WHO (Reuters) According to the World Health Organization (WHO), almost all the people it considers at immediate risk from an Ebola outbreak in the Democratic Republic of Congo city of Mbandaka now have been vaccinated against the disease. Article

WHO's Congo Ebola Plan Assumes 100 to 300 Cases Over Three Months (The Globe and Mail) The World Health Organization (WHO) assumes 100 to 300 cases of Ebola in the Democratic Republic of Congo between May and July, in a revised response plan to the outbreak. Article

Two Ebola Patients Who Fled Quarantine May Have Exposed Dozens to Virus (Washington Post) Health officials in Congo are anxious to contain the country's deadly Ebola outbreak—which has already spread to an urban area—before the situation gets any worse. But controlling the virus may have just gotten tougher. A senior Doctors Without Borders aid worker said that two patients infected with Ebola who fled their hospital potentially exposed dozens more to the virus. Article

MERS

Experimental MERS Treatments Enter Clinical Trial (NIH) Enrollment has begun in an early-stage clinical trial testing the safety of two human monoclonal antibodies (mAbs) designed to treat people infected with MERS-CoV. The trial is sponsored by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH), and is funded in part by the Biomedical Advanced Research and Development Authority, part of the Office of the Assistant Secretary for Preparedness and Response, Department Health and Human Services. Article

Influenza

Economic Burden of Seasonal Influenza in the U.S. (Science Direct) Seasonal influenza is a highly pathogenic viral infection. It occurs annually in the U.S., typically from late fall through early-mid spring. In most cases, influenza infection is a self-limiting disease from which individuals will recover without serious complications; however, it can result in severe illness and death. Influenza also results in a substantial economic burden, due to both medical care costs and productivity loss. Article

Other Emerging Diseases

FDA Finalizes Guidance on Developing Anthrax Treatments (Regulatory Focus) The U.S. Food and Drug Administration (FDA) finalized guidance on developing drugs to protect against inhalation anthrax. The guidance finalizes a draft released during 2016, and has been updated to revise the indication of prophylaxis of inhalation anthrax to cover both the pre- and post-exposure settings. The indication now reads "to reduce the risk of disease in persons who have inhaled, or are likely to imminently inhale, aerosolized B. anthracis spores, but who do not yet have the established disease." Article

Nipah Outbreak in Kerala: Experts Suspect Human-to-Human Transmission (Hindustan Times) Epidemiologists and virologists are investigating whether the outbreak in Kerala of Nipah, a zoonotic disease that usually is transmitted to humans from fruit bats, could be the result of human-to-human transmission. Article

New Smallpox-related Virus Found Lurking in Texas Rodents (Live Science) A never-before-seen virus that's a relative of the notorious smallpox virus has been found lurking in rodents in Texas, according to a new study. Researchers discovered the new virus in pygmy mice in east-central Texas. A genetic analysis revealed that the virus was a type of poxvirus, a diverse family of viruses that includes the smallpox virus. Article

Hantavirus—Americas (34): U.S.A. (Washington) Confirmed (ProMed Mail) Health officials announced that they have confirmed a case of Hantavirus Pulmonary Syndrome in a Grant County resident. Grant County Health District officials said the person is believed to have been exposed to contaminated deer mouse droppings while cleaning out their vehicle. The person has been released from the hospital and is expected to make a full recovery. Article

Scientists Issue Fresh Warning on Next Global Pandemic—Disease X (The Guardian) They may not yet know its name, but the next pathogen to cause a deadly global pandemic will most likely be a respiratory disease, spread by a virus that is contagious during incubation or when symptoms are only mild, according to researchers at the Johns Hopkins' Center for Health Security. Article

Chemical Response

Skripal Attack Scared U.K. Doctors: 'We Were Expecting Them Not to Survive' (New York Times) Medical workers in Britain who treated the former Russian spy Sergei V. Skripal and his daughter, Yulia, initially feared that they would be inundated with civilian casualties from a lethal, Soviet-developed nerve agent and that their colleagues had been exposed. Article

Inspectors Confirm 'Likely' Use of Chlorine as Chemical Weapon in Syria in February (npr) Two cylinders that were dropped on the rebel-held Syrian city of Saraqeb during February—sending nearly a dozen people to seek medical help for nausea and other symptoms—had contained chlorine, according to the Organization for the Prohibition of Chemical Weapons. Article

HEALTH SYSTEM PREPAREDNESS

New Global System to Monitor Attacks on Health Care (H5N1) According to a new global surveillance system, 105 attacks on health care facilities, personnel, or resources were reported during the first three months of 2018. With many countries just beginning to submit their data, this number is expected to rise. Article

Call for Independent Monitoring of Disease Outbreak Preparedness (BMJ) Four years ago, a delayed and initially inadequate response to control an outbreak of Ebola virus in west Africa resulted in a devastating regional epidemic. In addition to its heavy toll of death and illness, the epidemic damaged the already fragile health care systems, sharply reduced economic activities, and disrupted the lives of several million people. The costs were borne largely by some of the world's poorest communities. Article (Subscription required)

Grand Jury Faults Local Response to San Diego's Hepatitis Crisis (The San Diego Union-Tribune) A new report released by the San Diego County Grand Jury delivers the toughest critique so far of local efforts to end last year's hepatitis A outbreak. Article

CDC Warns Against Non-Essential Travel to Venezuela: Outbreaks, Breakdown of the Medical Infrastructure (Outbreak News Today) The Centers for Disease Control and Prevention (CDC) is recommending that travelers avoid all nonessential travel to Venezuela. The country is experiencing outbreaks of infectious diseases, and adequate health care currently is not available in most of the country. Article

Ongoing Training Opportunities

The U.S. Centers for Disease Control and Prevention is offering a new online course for health professionals concerning reproductive health and emergency preparedness: Center for Domestic Preparedness Resident Training

 

The Disaster Resistant Communities Group has more than 100 online just-in-time "training videos" to enhance emergency preparedness. Many are related to health care.

Suspicious Activity Reporting (SAR) Training for Health Care Workers

 

The Nationwide SAR Initiative (NSI) recently released the new online training module, Public Health and Health Care Partners, developed to teach workers to recognize suspicious behavior associated with pre-incident terrorist activities. The training also discusses civil rights, privacy, and how and when to report suspicious activity. NSI also offers a two-page PDF resource Suspicious Activity Reporting (SAR) for Public Health and Healthcare Partners. This training module could easily be added to any in-house training for new employees or yearly refresher training for established personnel.

Federal and CDC COCA Partner conference and training information for the next six months.

 

FEMA Emergency Management Institute Training Opportunities Independent Study Courses

Psychological First Aid for Leaders (PFA-L) Training—This interactive, online training has broad utility for response and health care partners as well as those in existing leadership roles. The training takes about 90 minutes to complete.

Public Health Nursing Disaster Surge Course is based upon the 25 Public Health Nursing (PHN) Competencies for disaster surge, and is intended to provide participants with a comprehensive view of PHN surge from preparedness to response to recovery. There is no cost for this course.

TRAIN PA

 

DOH and the Pennsylvania Emergency Management Agency have established Train PA, the Pennsylvania affiliate for the Public Health Foundation’s learning management system and network. TRAIN PA is a free, collaborative resource for public health organizations and academic institutions across the state to assist in their educational and workforce development efforts. Signing up for TRAIN PA allows access to thousands of trainings provided by public health agencies at all levels of government, schools of public health and other academic institutions, and other related organizations. If you already have a TRAIN account through TRAIN National, MRC TRAIN, or CDC TRAIN, you can log in to TRAIN PA using the username and password you use at these other sites. If you have any questions or would like to explore how you could use TRAIN PA as a training provider or administrator, please feel free to contact the TRAIN PA administrator team.

Training Trigger: Tourniquet Use Under Medical Protocols

This one-page document from the Interagency Board for Equipment Standardization and Interoperability provides information about the use of tourniquets in emergency medical services. Lessons learned in recent mass casualty incidents and combat casualty care have shown that a properly applied tourniquet can save the patient's life in cases where severe (critical) blood loss endangers the survival of the patient.

Reference Resources

New From ASPR TRACIE—EMTALA and Disasters (Updated) This fact sheet addresses several frequently asked questions regarding the Emergency Medical Treatment and Labor Act (EMTALA) and disasters, and provides links to resources for more information. Updated information includes additional actions that can be taken to address patient surge without an EMTALA waiver. Note: This document is not intended to be used as regulatory guidance or in place of communications with or guidance from the Centers for Medicare & Medicaid Services (CMS) who oversees EMTALA compliance. Updated Fact Sheet

New—Standard for an Active Shooter/Hostile Event Response (ASHER) Program This standard for active shooter and/or hostile events addresses all aspects of the preparedness, response, and recovery process, from identifying hazards and assessing vulnerability, to planning, resource management, incident management at a command level, competencies for first responders, and recovery. It was developed in concert by experts from a wide range of specialties and sets forth requirements for communities to establish a unified planning response and recovery program, long before an active shooter/hostile event occurs. Document

New—Illnesses on the Rise from Mosquito, Tick, and Flea Bites (CDC) This webpage provides information about bites from mosquitoes, ticks, and fleas, which can be vectors for spreading pathogens and vector-borne disease, like dengue, Zika, Lyme, or plague. It discusses what state and local public health agencies can do, and provides a video and sections about Overview, Problem, Infographic, What Can Be Done, and Issue Details. Webpage

Clinician Outreach and Communication Activity (COCA) provides timely, accurate, and credible information to clinicians related to emergency preparedness and response and emerging public health threats. COCA fosters partnerships with national clinician organizations to strengthen information-sharing networks before, during, and after a public health emergency. COCA invites all clinicians to sign-up for COCA email updates and reminders.

New Bioterrorism App from CDC When responding to a possible bioterrorism incident, first responders need fast, easy access to information. The Centers for Disease Control and Prevention’s (CDC) new Field Facts application provides crucial information to use in the first few moments and hours of a response to a potential bioterrorism incident. Designed for first responders, FBI agents who work with weapons of mass destruction, and any other person who might encounter biological agents, the app describes how to recognize signs and symptoms of disease associated with eight biological agents. The app also provides information to obtain expert help quickly with the contact details for the CDC's Emergency Operations Center, FBI Field Offices, and state public health laboratories.

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