With the outbreak of the 2009 pandemic influenza A (H1N1) comes the need to evaluate the preparedness level of government entities that had preparedness plans. This study looks at the preparedness level for pandemic influenza among key leaders in Brazos County according to their Brazos County Pandemic Influenza Preparedness Plan. Ten key leaders were recruited to participate in interviews. Interviews were transcribed and analyzed for salient themes. Main themes that emerged from interviews were categorized into vaccinations, communication, logistical issues, and the need for evaluations and feedback. Recommendations for increasing preparedness include addressing contingency plans, increasing education through public health efforts, addressing biosecurity, increasing use of technology, and increasing funding and research.

Indiana University-Purdue University Indianapolis (IUPUI) / Influenza pandemics are a fact of nature. Our human history is marked by global influenza outbreaks that have stricken large numbers of people with illness, caused many deaths, and disrupted the social and economic life of many communities, states, and nations. A novel influenza virus spreading efficiently human to human and causing severe illness causes an influenza pandemic. In the last three hundred years there have been at least ten influenza pandemics (IOM 2005; Osterholm 2005a). The twentieth century alone experienced three pandemics in 1918, 1957, and 1968 (HHS 2005). There is no single ethical framework robust enough to adequately address the various issues that arise in pandemic planning and response. Pandemic influenza is a social problem that requires a social effort in planning, preparedness, and response. The values of participation, loyalty, and solidarity are fundamental social values that are critical to sustain the life of communities. The study of these values will assist local officials with an ethical approach for developing pandemic response plans that ensures community participation, incorporates fundamental values, and minimizes conflicting obligations in the planning stages, which in turn inspires loyalty to the response effort and fosters an attitude of solidarity in the community during the pandemic.

Thesis (M.A.)--Indiana University, 2008. / Department of Philosophy, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Jason T. Eberl. Includes vita. Includes bibliographical references (leaves 62-68).

Avec l’entrée d’internet dans notre quotidien, avec les réseaux sociaux, dans un monde de plus en plus numérique et mobile, le recours à la communication par internet est indispensable dans les stratégies de communication, et particulièrement en communication de crise. Une enquête, auprès d’universités françaises, permet d’analyser, à partir de l’exemple de la grippe A, comment internet est devenu un outil majeur dans la communication des universités en situation de crise. La communication par internet est d’abord une aide. Elle permet de diffuser largement les messages d’information et de prévention. A ce titre, elle est une communication interne. Elle aide aussi l’établissement à assurer la continuité du service public d’enseignement, grâce aux outils numériques qu’il développe. Mais la communication par internet présente aussi des risques. Elle peut être brouillée, altérant ainsi les effets attendus, comme il a été constaté lors de la campagne de communication sur la vaccination. Elle peut aussi être victime d’attaques, parce que toute communication empruntant la voie internet est menacée, posant ainsi le problème de la sécurité des systèmes d’information. En cas de crise, les établissements seraient confrontés, d’une part à la nécessité de maîtriser les techniques de communication, d’autre part aux besoins liés à l’utilisation des outils numériques ; mais aussi aux risques pesant sur les systèmes d’information. Prévoir, dans la mesure du possible, la survenance de problèmes qui pourraient se poser en cas de crise, est nécessaire. En se préparant à l’avance à la gestion de crise, grâce notamment à la mutualisation des moyens et à une prise de conscience des risques, les universités pourraient mieux maîtriser ces difficultés. / Internet communication is now generally acknowledged as indispensable in communication strategies, and particularly in crisis communication. A survey of French universities makes it possible to analyze, through the example of the H1N1 flu pandemic, how the Internet became a major tool for the communication of universities in a crisis. At the internal level, Internet communication appears as a reliable resource, allowing the diffusion of informative and preventive messages. It also helps the institution to ensure the continuity of public educational services through digital tools. But Internet communication also involves risks. Messages can be blurred, thus altering their expected effects, as became clear during the communication campaign on immunization. Messages can also be the victim of attacks, because any communication via the Internet channel may be threatened in various ways. This poses the problem of the security of information systems. In sum, institutions in crisis must face not only the necessity to master digital techniques of communication, and to comply with the requirements inherent in the use of digital tools, but also to manage risks that are specific to digital information systems. Anticipating, so far as is possible, the occurrence of problems that might arise in a crisis is essential. By preparing to cope with crises, including through the pooling of resources and the awareness of risks, universities may better control these difficulties. The study of this crisis reveals not only the pertinent issues, but also how such preparation might be most effectively undertaken.

This work is a compilation of four manuscripts, three of which are published and one is in the second round of review, all in refereed journals. All four manuscripts focus on analysis of stochastic disruptions to support design of capacitated engineered networks. The work is motivated by limited ability to mitigate elevated risk exposure of large-scale capacitated enterprise networks functioning in lean environments. Such inability to sustain enterprise capacity in the face of disruptions of various origins has been causing multi-billion enterprise forfeitures and hefty insurance premiums. At the same time, decision support methodologies for reliable design of dynamic capacitated networks have been largely unavailable. This work is organized as follows. Paper 1 presents a methodology to analyze ca- pacitated healthcare supply chains using a framework of forward ow-matching networks with multiple points of delivery. Special emphasis is given to developing stochastic models for capturing capacity trajectories at the points of delivery. Paper 2 focuses on assuring capacity availability for a critical vertex exposed to random stepwise capacity disruptions with exponentially distributed interarrival times and uniformly distributed magnitudes. We explore two countermeasure policies for a risk-neutral decision maker who seeks to maxi- mize the long-run average reward. We present an extensive numerical analysis as well as a sensitivity study on the uctuations of some system parameter values. Paper 3 extends the capacity assurance analysis for critical vertices by considering stepwise partial system capacity loss accumulating over time. We examine implementation of a countermeasure policy, aimed at reducing the disruption rate, for a risk-neutral decision maker who seeks to maximize long-run average return. We explore how the policy of maintaining the optimal disruption rate is aected by a number of system parameters. Finally, Paper 4 presents a dynamic predictive methodology for mitigation of cross-regional pandemic outbreaks which can be used to estimate workforce capacity loss for critical vertices due to such societal disasters.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

The concern for pharmaceutically active compounds (PhACs) as contaminants in the environment and the need to assess their environmental risk have greatly increased since the early nineties. Among PhACs, antibiotics and antiviral drugs are of important concern due to their role in growing antibiotic and antiviral drugs resistance among pathogenic bacteria and influenza viruses, respectively. Besides resistance issue, the compounds may upset sensitive ecosystems as they are designed to be highly bioactive. Clinically-important antibiotics are virtually ubiquitous contaminants in sewage water and surface water. Notably, recent emergence of novel influenza and use of anti-influenza drugs (specially Tamiflu®) during seasonal influenza、 influenza epidemics and for future pandemic are of emerging concern. Every year seasonal influenza epidemic causes tens of millions of respiratory illnesses and 250, 000 to 500, 000 deaths worldwide. WHO (World Health Organization) recommend the use of antiviral drug Tamiflu® during pandemic, as they are easy to use. Currently only Japan uses over eighty percent of Tamiflu® prescribed globally during common seasonal influenza. It is a fact that a huge amount of antiviral drugs and antibiotics ( for post infection cure of respiratory illness) will be used during an influenza pandemic and will arrive to sewage treatment plants (STPs).Unfortunately, these compounds behaviors are mostly unknown in both conventional and advanced STPs. The exposure of antiviral drug in the wild fowl gut and its implications for hastening the generation of antiviral-resistance in avian influenza viruses are also an emerging issue. The major objective of this thesis work was to investigate the occurrence of antibiotics and antiviral drugs in sewage treatment plants and their fate in different sewage treatment plants. The specific objectives were as follows: (a) to established appropriate analytical method for the selected antibiotics and antiviral drugs in sewage treatment plants, (b) to investigate the occurrence and removal of antibiotics and antiviral drugs in sewage treatment plants differ in technology and operation conditions; and (c) to predicts environmental concentration of the target compounds during a pandemics and appraisal of appropriate technology to reduce the risk associated with widespread use under pandemic conditions. In this study we selected twenty antibiotics: one beta-lactam: ampicillin; four macrolides: azithromycin, clarithromycin and roxithromycin; five quinolones: ciprofloxacin, enrofloxacin, levofloxacin, nalidixic acid and norfloxacin; two tetracycline: tetracycline and oxytetracycline; five sulfonamides: sulfadimethoxine, sulfadimizine, sulfamerazine, sulfam- ethoxazole and sulfamonomethoxine; and four others: lincomycin, novobiocin, salinomycin and trimethoprim. Oseltamivir Carboxylate (OC), the active metabolite of oseltamivir phosphate (Tamiflu®) and amantadine (AMN) were selected as antiviral drugs. This dissertation consists of nine chapters: Chapter I describe the background and objective of the study and chapter II represent a brief literature review. In Chapter III, analytical methods for selected antibiotics and antiviral drugs (for the first time) in water and wastewater were described. In Chapter IV, the occurrences and fate of antibiotics in sewage treatment plants were investigated in Japan and China. Clarithromycin was detected in the highest concentration in influent (1129 to 4820　ng/L), followed by azithromycin (160 to 1347　ng/L), levofloxacin (255 to 587　ng/L) and norfloxacin ( 155 to 486 ng/L) and sulfamethoxazole (159 to 176ng/L) in Japan. Ozonation as tertiary treatment of secondary effluent for wastewater reclamation provided significant elimination of antibiotics. Fifty present of the selected antibiotics were removed over eighty percent during ozonation. There was no elimination of antibiotics in dissolve phase during ultra filtration. From Chapter IV a hypothesis was drawn on antibiotics removal and its relation with longer sludge retention time (SRT) in STPs and in Chapter V the role of nitrifier in antibiotics removal was evaluated to verify the hypothesis established from Chapter IV. Nitrifying activated sludge (NAS) can biodegrade the tested antibiotics with different biodegradation rate between　2.74 to 9.95 L/gSS/d. Sulfamethoxazole and sulfamerazine degraded faster than trimethoprim, clarithromycin and enrofloxacin. In Chapter VI, occurrence of antiviral drugs in sewage water discharge and in river water in Japan was conducted during seasonal influenza epidemic and their fate in different sewage treatment facilities were evaluated in Chapter VII. This is the fist findings of antiviral (anti-influenza) drugs in the environment in the world and for the first time the removal mechanism in STPs was elucidated. Finally, it was observed that only primary and secondary treatment processes in STPs were not sufficient to remove these compounds significantly. Overall OC and AMN removal in STP with ozonation as tertiary treatment was 90% and 96% respectively. In ozonation batch experiment, Chapter VIII, ( feed ozone gas concentration 4.0mg/L, ozone gas flow rate 0.23L/min to maintain ozone feed rate of 0.6 mg/L/min), it was observed that AMN and OC concentration decreased linearly with time in all the experiments conducted and it can be, therefore, said that the degradation reactions follow pseudo first-order reaction. The k'O3 (pseudo first-order rate constant for O3) of AMN was 0.596/min (0.00993/sec), and OC was 0.524 /min (0.008725/sec) and over 99% removal within 10min. Chapter VIII described the predicted OC and antibiotics concentration in STPs influent, secondary effluent, after advance tertiary treatment (ozonation) and receiving water during a pandemic with three expected infection scenario ( according to US CDC FluAid model 2.0) in Kyoto city. Both antiviral drugs and antibiotics pose an environmental risk associated to there widespread use during a future pandemic. Ozonation as tertiary treatment can provide a technological solution to reduce the ecotoxicological effect of antibiotics and antiviral drugs uses during a pandemic. In a full scale STP, the antiviral drugs (OC and AMN) reduction were over 90% from secondary effluent after ozonation during seasonal influenza outbreak in Kyoto city in 2008/2009. Finally, (1) analytical methods for commonly used antibiotics and antiviral drugs in water sample was developed with an excellent precision and accuracies, (2) both antibiotics and antiviral drugs were detected in environmental sample, and their behavior in STPs were elucidated. Antivirals in this study were the first time findings in sewage water. This study will provide a surrogate for planning a pandemic preparedness action plan for sewage treatment pants for ecotoxicological risk management. / Kyoto University (京都大学) / 0048 / 新制・課程博士 / 博士(工学) / 甲第14931号 / 工博第3158号 / 新制||工||1474(附属図書館) / 27369 / UT51-2009-M845 / 京都大学大学院工学研究科都市環境工学専攻 / (主査)教授 田中 宏明, 教授 伊藤 禎彦, 教授 藤井 滋穂 / 学位規則第4条第1項該当

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

For centuries, pandemic influenza has emerged at irregular and unpredictable intervals to cause widespread illness, hospitalization and death. Uncertainty surrounding the timing and severity of future influenza pandemics present challenges for preparedness and response efforts. The objective of this dissertation is to advance pandemic influenza knowledge and preparedness, through a series of interrelated articles that address the follow research questions: 1. What are the likely consequences of a pandemic flu event in Canada? 2. What do mathematical models tell us about preparing for such an event? 3. What is the best way to mitigate the consequences of an influenza pandemic? Six articles were prepared for submission in scientific, peer-reviewed journals. The first is a historical review of the burden of pandemic influenza. The second and third are systematic reviews of the effectiveness of interventions to interrupt pandemic influenza transmission. The fourth and fifth are research papers presenting a novel mathematical model, assessing the preparedness of the Canadian hospital system to accommodate expected surges in patient demand and evaluating intervention strategies to mitigate impact. The sixth is a policy-oriented paper discussing pandemic policy options within the context of public health ethics and risk management principles. Pandemic vaccination, antiviral treatment, voluntary isolation and personal protective measures were identified as the most cost-effective interventions available. Antiviral prophylaxis, community-contact reduction, school closure and quarantine were less effective, and tended to be associated with higher associated economic burdens. The timely implementation of layered intervention strategies appears likely to protect hospital-resource adequacy, though areas of Southwestern Ontario appear to be more vulnerable to surges in patient demand. However, the potential for high health and economic burdens, coupled with the uncertain severity of future pandemics, necessitates a flexibility in preparedness and response plans.

Pandemic influenza outbreaks have historically entailed significant societal and economic disruptions. Today, our quality of life is threatened by our inadequate preparedness for the imminent pandemic. The key challenges we are facing stem from a significant uncertainty in virus epidemiology, limited response resources, inadequate international collaboration, and the lack of appropriate science-based decision support tools. The existing literature falls short of comprehensive models for global pandemic spread and mitigation which incorporate the heterogeneity of the world regions and realistic travel networks. In addition, there exist virtually no studies which quantify the impact of resource sharing strategies among multiple countries. This dissertation presents three related models that contribute to filling the existing vacuum. The first model develops optimal capacity management strategies for multi-region pandemic surveillance. The second model estimates the pandemic propagation time from the onset to a likely pandemic export region, such as a major transportation hub. The model builds on a large-scale agent-based simulation and geographic information systems (GIS). The model is tested on a hypothetical outbreak in Mexico involving 155 regions and over 100 million people. The third model develops an empirical relationship to quantify the impact of various U.S. - Mexico antiviral sharing strategies under several pandemic detection and response scenarios.