February 10, 2017 | Volume 6, Issue 2

The Hospital & Healthsystem Association of Pennsylvania, Keystone Health Preparedness Digest, Improving Health Preparedness and Response
National Cyber Incident Response Plan
The Department of Homeland Security (DHS) released the National Cyber Incident Response Plan (NCIRP). This is an essential component of DHS’ mission to strengthen the security and resilience of the nation by working to improve the ability of all to manage cyber incidents. The NCIRP:
  • Describes a national approach to dealing with cyber incidents, and the important role that the private sector, states, and multiple federal agencies play in responding to incidents and how the actions of all fit together for an integrated response
  • Reflects and incorporates lessons learned from exercises and real U.S. incidents and policy updates, such as Presidential Policy Directive 41 on Cyber Incident Coordination Policy and the National Cybersecurity Protection Act of 2014
  • Reinforces and describes the roles of the lead federal agencies during a significant cyber incident
New Health Alerts and Advisories
Several Health Alerts and Advisories, including an advisory regarding testing travelers returning from China for Avian Influenza A (H7N9) virus infection, have been issued by the Pennsylvania Department of Health and the U.S. Centers for Disease Control and Prevention (CDC). Please see: Latest News from the Health Alert Network. Sign up to receive PA Health Alert Network messages.
PA Statewide Knowledge Center (HIMS) Training Available
Pennsylvania health care facilities are requested to contact their HAP Regional Manager to schedule training.

National Preparedness News and Updates

Lead Levels Fall Below Federal Limits in Flint (Reuters) Lead levels in Flint, Michigan's drinking water, the focus of a public health crisis, have fallen below federal limits, state officials said, although they cautioned residents to keep using filtered water as the city's old lead pipes are replaced.
Position Paper: Bioterrorism Preparedness & Response (The Interagency Board) A new position paper is available.
Infectious Diseases
China's H7N9 Avian Flu Cases Continue to Climb (CIDRAP) With novel H7N9 avian influenza cases in China this month already topping an early, steep surge seen in December, two provinces reported four more cases, according to official sources, as U.S. officials posted a travel alert because of the spike in infections.
Five Nations Report More, Varied Avian Flu Outbreaks (CIDRAP) Countries in different parts of the world reported more avian flu outbreaks involving different strains, from a recurrence of highly pathogenic H5N1 in India to the detection of H5N5 for the first time in Slovenia.
Flu Now Widespread in 37 States (CIDRAP) All numbers in this update on flu from the CDC show that disease activity rose higher in the third week of 2017.

New Bird Flu Virus Type, H5N5, Confirmed on German Turkey Farm (H5N1) A recent bird flu outbreak in north Germany was of a new subtype called H5N5, the first time the strain has been confirmed on a German farm, the country's national animal disease center said.

Zika Virus

First Non-Travel-Related Zika Virus in Pregnant Texas Woman Confirmed (KSAT) The Texas Department of State Health Services has confirmed the first Zika virus infection of a pregnant Texas woman who did not travel outside the state.

Zika Virus Testing Consideration: Lessons Learned from the First 80 Real-Time Reverse Transcription-PCR-Positive Cases Diagnosed in New York State (Journal of Clinical Microbiology) The performance and interpretation of laboratory tests for Zika virus continue to be evaluated. Serology is cross-reactive, laborious, and frequently difficult to interpret, and serum was initially solely recommended for molecular diagnosis.

Other Infectious Diseases

Investigation of Seoul Virus Outbreak Associated with Home-based, Rat-breeding Facilities in Wisconsin and Illinois (CDC: Emergency Preparedness and Response) CDC and health officials from Wisconsin and Illinois are conducting an investigation of Seoul virus infections among pet rats and persons exposed to rats at rat-breeding facilities in Wisconsin and Illinois.

At Least 27 Killed by Plague in Madagascar (IOL) At least 27 people in southern Madagascar have died from the plague, health authorities on the island said. At least 68 people have been infected with the plague in the Atsimo-Atsinanana and Ihorombe regions.

Outbreak of Yellow Fever in Brazil (ECDC) In Brazil, the authorities have reported only sylvatic cases in 2016 and 2017. However, this outbreak should be carefully monitored as the establishment of an urban yellow fever cycle would have the potential to quickly affect a large number of people. Therefore, EU/EEA member states should consider a range of options for response.

Health System Preparedness

Hospitals Need to Plan for Mass Casualties (Medscape: subscription required) A disaster plan was in place at the Orlando Regional Medical Center, just two and a half blocks away from Pulse, and drills had been run three months before a shooter entered the nightclub and changed everything.

Dangerous Superbug Appears to Be Spreading Stealthily in U.S. Hospitals (STAT News) A dangerous type of superbug has more tricks up its sleeves than we may be giving it credit for, a new study suggests. The researchers found that this class of bacteria, CREs (short for carbapenem-resistant Enterobacteriaceae) has more ways to evade antibiotics than have been currently identified, and that these bugs share their tricks readily across the families of bacteria that make up this grouping.

Why the CDC's Power to Quarantine Should Worry Us (New York Times) The CDC issued new regulations that give it broad authority to quarantine Americans. The rules outline for the first time how the federal government can restrict interstate travel during a health crisis, and they establish in-house oversight of whether someone should be detained, without providing a clear and direct path to challenge a quarantine order in federal court.

Regional News

HAP regional manager contact information and the latest regional news and reminders are available on the Emergency Preparedness page of the HAP website.

Training and Educational Opportunities
Examining Opportunities for the Future of Medical and Public Health Preparedness: A Workshop
March 8 and 9, 2017, in Washington D.C. Sponsored by National Academies of Science Engineering and Medicine Forum on Medical and Public Health Preparedness for Catastrophic Events.
2017 AHEP Annual Conference
November 7 through 9, 2017, in Dallas, Texas. The Association of Healthcare Emergency Preparedness Professionals (AHEP) is seeking applications for presenters. Applications are due March 31, 2017.
2017 American Trauma Society, PA Chapter Conference
April 11 and 12 at the Hershey Lodge and Convention Center. This year's theme is "Helping the Helpers: Trauma Prevention and Treatment in Our Communities." Register by April 1. For more details, contact Rachel Bryson at (717) 766-1616.
DHS Active Shooter Preparedness Workshop
April 13, 2017, at Ramada Inn and Conference Center, 1450 South Atherton Street, State College, PA. More information about the Department of Homeland Security Active Shooter Program and registration information is available online. Please register by April 11, 2017. Limited seating: please reserve no more than five slots per organization.
Preparedness Summit
April 25 through 28, 2017, in Atlanta. This year's theme is "Forces of Change: Capabilities, Innovation and Partnerships." Registration now open.
Ongoing Training Opportunities
The CDC 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.
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.
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.
Reference Resources