Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, September 2009. / Thesis Advisor(s): Richter, Anke ; Bergin, Richard. "September 2009." Description based on title screen as viewed on November 5, 2009. Author(s) subject terms: Patient Tracking, Public Health, Emergency Medical Services, Patient Movement, Evacuation, Public Health Preparedness. Includes bibliographical references (p. 139-140). Also available in print.

The public health emergencies, such as bioterrorist attacks or pandemic outbreaks, have gained serious public and government attentions since the 2001 anthrax attacks and the SARS outbreak in 2003. These events require large-scale and timely dispensing of critical medical countermeasures for protection of the general population. This thesis research focuses on developing mathematical models, real-time algorithms, and computerized decision support systems that enable (1) systematic coordination to tackle multifaceted nature of mass dispensing, (2) fast disease propagation module to allow immediate mitigation response to on-site uncertainties, and (3) user-friendly platform to facilitate modeling-solution integration and cross-domain collaboration. The work translates operations research methodologies into practical decision support tools for public health emergency professionals. Under the framework of modeling and optimizing the public health infrastructure for biological and pandemic emergency responses, the task first determines adequate number of point-of-dispensing sites (POD), by placing them strategically for best possible population coverage. Individual POD layout design and associated staffing can thus be optimized to maximize throughput and/or minimize resource requirement for an input throughput. Mass dispensing creates a large influx of individuals to dispensing facilities, thus raising the risk of high degree of intra-facility infections. Our work characterizes the interaction between POD operations and disease propagation. Specifically, fast genetic algorithm-based heuristics were developed for solving the integer-programming-based facility location instances. The approach has been applied to the metro-Atlanta area with a population of 5.2 million people spreading over 11 districts. Among the 2,904 instances, the state-of-the-art specialized integer programming solver solved all except one instance to optimality within 300,000 CPU seconds and solved all except 5 to optimality within 40,000 CPU seconds. Our fast heuristic algorithm returns good feasible solutions that are within 8 percent to optimality in 15 minutes. This algorithm was embedded within an interactive web-based decision support system, RealOpt-Regional©. The system allows public health users to contour the region of interest and determine the network of PODs for their affected population. Along with the fast optimization engine, the system features geographical, demographical, and spatial visualization that facilitate real-time usage. The client-server architecture facilities front-end user interactive design on Google Maps© while the facility location mathematical instances are generated and solved in the back-end server. In the analysis of disease propagation and mitigation strategies, we first extended the 6-stage ordinary differential equation-based (ODE) compartmental model to accommodate POD operations. This allows us to characterize the intra-facility infections of highly contagious diseases during local outbreak when large dispensing is in process. The disease propagation module was then implemented into the CDC-RealOpt-POD© discrete-event-simulation-optimization. CDC-RealOpt-POD is a widely used emergency response decision support system that includes simulation-optimization for determining optimal staffing and operations. We employed the CDC-RealOpt-POD environment to analyze the interactions between POD operations and disease parameters and identified effective mitigation strategies. The disease propagation module allows us to analyze the efficient frontier between operational efficiencies and intra-POD infections. Emergency response POD planners and epidemiologists can collaborate under the familiar CDC-RealOpt-POD environment, e.g., design the most efficient plan by designing and analyzing both POD operations and disease compartmental model in a unified platform. Corresponding problem instances are formed automatically by combining and transforming graphical inputs and numerical parameters from users. To facilitate the operations of receiving, staging and storage (RSS) of medical countermeasures, we expanded the CDC-RealOpt-POD layout design functions by integrating it with the process flow. The resulting RSS system allows modeling of both system processes along with spatial constraints for optimal operations and process design. In addition, agent-based simulation was incorporated inside where integrated process flow and layout design allow analysis of crowd movement and congestion. We developed the hybrid agent behavior where individual agents make decision through system-defined process flow and autonomous discretion. The system was applied successfully to determine guest movement strategies for the new Georgia Aquarium Dolphin Tales exhibit. The goal was to enhance guest experience while mitigating overall congestion.

Indiana University-Purdue University Indianapolis (IUPUI) / Background and Purpose - State Health Officials (SHOs), as the leaders of state governmental public health agencies, play a critical role in their respective states. Their decisions guide the overall actions of their organizations in executing programs, policies and activities that ultimately affect the health of the state’s population. This study will add to the research and serve as a potential guide to future SHO training, specific to decision making, in a public health emergency Methods – Twenty-one individuals, who are either currently working as SHOs or who were former SHOs, were interviewed to understand their perspectives on issues that may impact their response to a public health emergency: decision-making, interaction with the public and the media and the role of politics in public health, and other areas of consequence. Results – While the study was focused more broadly, all of the respondents specifically mentioned the COVID19 pandemic as the most complicated public health emergency they have responded to as a SHO. All respondents also mentioned that they did not have a specific decision-making tool to utilize during this emergency and primarily relied on a consensus-driven decision-making process. Additionally, issues such as the challenges of managing the media and the politicization of public health during this pandemic, were mentioned by many of the respondents. Conclusion - These findings pointed to the need for a step-by-step decision-making tool to be utilized by SHOs in a public health emergency. This has the potential to lead to a more methodical approach to SHOs decision-making during a public health emergency, including a focus on various operational aspects such as understanding the role of the media in a public health emergency, managing elected officials in a public health emergency, and lessons learned from past public health emergencies.

AN ABSTRACT OF THE DISSERTATION OF Amy L. Mathes, for Doctor of Philosophy degree in HEALTH EDUCATION, presented on May 8, 2013, at Southern Illinois University Carbondale. TITLE: PROMISING PRACTICES: A CASE STUDY ON PUBLIC HEALTH EMERGENCY PREPAREDNESS MAJOR PROFESSOR: Dr. Kathleen Welshimer There is little published literature on operational coordination during a real time disaster regardless of the setting. This study describes a university's emergency management plan and its execution in response to a specific natural disaster, the May 8, 2009 "inland hurricane," which was later classified as a "Super Derecho." The case study design allowed for an in-depth exploration into the intricacy and complexity of an emergency response by interviewing individuals present in the CEOC and others from State Police, local EMA agencies, local health departments, and IEMA, document analysis of the Campus All-Hazards Emergency Preparedness and Violence Prevention Plan (CAHEPVPP), Situation Reports, Illinois Emergency Management Agency (IEMA), Federal Emergency Management Agency (FEMA), and National Incident Management Agency (NIMS) documents. This study will assist public health emergency preparedness officials in higher education to educate students and development of proactive development of planning and response during a real disaster. This study will also provide contributions to universities regarding mitigation, planning, response, and recovery activities. It shows the value of proactive, forward-thinking leadership from day-to-day preparedness activities to response and recovery efforts.

Introdução: A Emergência de Saúde Pública de Importância Internacional foi declarada pela Organização Mundial da Saúde em fevereiro de 2016, em decorrência da notificação e resposta do governo brasileiro ao aumento da prevalência de microcefalia e outras alterações do sistema nervoso central. Esse evento é considerado uma das epidemias de maior complexidade e impacto da história da saúde pública. Objetivo: Descrever os principais marcos da epidemia de Zika vírus (ZIKAV) no Brasil, relacionando às ações de saúde pública adotadas e caracterizar as diferenças regionais com base nas taxas de incidência de ZIKAV em gestantes e de prevalência de microcefalia em casos registrados no Sistema de Informação de Agravos de Notificação e no formulário de Registro de Eventos de Saúde Pública, no período de janeiro de 2015 a novembro de 2016. Metodologia: Foi realizada a revisão da literatura nas principais bases de dados e também da literatura cinzenta (protocolos, portarias, manuais e informes) buscando elementos que fundamentaram as ações de saúde pública e fatos que marcaram o histórico desta epidemia no Brasil. Também foi realizada análise descritiva e comparativa das bases de dados do Sistema de Informação de Agravos de Notificação (SINAN) e do formulário de Registro de Eventos de Saúde Pública (RESP), no Brasil no período de janeiro de 2015 a novembro de 2016. Resultados: Em 22 de outubro de 2015, a Secretaria de Saúde de Pernambuco notificou o aumento na prevalência de microcefalia, no Estado. Em 11 de novembro foi declarada a emergência de saúde pública de importância nacional e em 1º de fevereiro de 2016, a Organização Mundial da Saúde declara emergência de saúde pública de importância internacional. Entre 2015 e 2016, foram notificadas 41.473 gestantes com quadro clínico compatível com ZIKAV e, no mesmo período, foram notificados e confirmados 1.950 casos de microcefalia. Destes, 70% foram confirmados por método de imagem. Observou-se que em 2015 a região mais afetada foi a nordeste e em 2016, apesar de não apresentar a mesma magnitude, observou-se uma possível segunda onda de casos de microcefalia a partir do mês de junho, principalmente na região centro-oeste, corroborando com a maior circulação de casos de ZIKAV no primeiro semestre. Limitações: O uso de dados secundários (oportunidade, completitude, representatividade, subnotificação etc), a indisponibilidade de testes laboratoriais para ZIKAV, principalmente no início da epidemia em 2015, o conhecimento limitado sobre a doença e suas consequências, apesar dos avanços nos últimos meses, a indisponibilidade de série histórica de microcefalia e outras anomalias congênitas para essa condição e o proxy de infecção pelo ZIKAV: casos negativos de dengue e chikungunya e microcefalia relacionada à infecção. Conclusões: Conclui-se que o desencadeamento da resposta em suas quatro fases operacionais foi oportuno, apesar das limitações do conhecimento; fundamentou-se na Legislação e instrumentos próprios para resposta às ESP e na melhor evidência disponível em cada fase operacional. Até o final de 2016, a magnitude da Síndrome Congênita Associada à Infecção pelo Vírus Zika vírus (SCZ) não apresentou o mesmo padrão observado em 2015, sendo que a região Nordeste apresentou maior magnitude somente na primeira onda (setembro/2015-abril/2016); Em 2016, a região Centro-Oeste apresentou a maior magnitude de casos de SCZ, seguida das regiões Sudeste e Norte. Esse padrão corrobora com o nexo causal entre infecção pelo ZIKAV na gestação e a manifestação da SCZ. Muitos avanços foram alcançados nos últimos dois anos. No entanto, ainda há importantes lacunas no conhecimento científico sobre o espectro clínico dessa nova doença e fatores relacionados à transmissão e endemicidade. / Introduction: On February 2016, The World Health Organization declared Public Health Emergency of International Concern (PHEIC). This action, due to the Brazilian notification and response, after the prevalence of microcephaly and other Central Nervous System disorders increase in Northeast Region. This event is one of the most complex epidemics of the Public Health history. Objective: Describe the sequence of events which occurred from January 2015 to November 2016 in Brazil, as a result of Zika virus outbreaks and the related congenital syndrome; to characterize the main elements of the Brazilian National response to the epidemics describing the course of the dual epidemics of Zika virus (ZIKV) infection during pregnancy and microcephaly, from the registered cases at Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) forms up to the first anniversary of this declaration in Brazil. Methods: To obtain a comprehensive chronologic description, of the main epidemiologic events and of the Brazilian response, we conducted a literature review and used third party (gray literature), and fundamental elements registered at the Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) from January 2015 up to November 12th 2016. In order to describe the Brazilian response, we divided in four phases the operational response to the emergency in Brazil. Results: On October 22nd 2015 the Pernambuco Health Secretary notified the prevalence of Microcephaly increase. On November 11th 2016 the Ministry of Health declared Public Health Emergency of National Concern. On February 1st 2016 the World Health Organization declared (PHEIC) Public Health Emergency of International Concern, 41,473 pregnant women with some clinical signs, compatible with Zika virus, were notified between 2015 and 2016. In the same period, 1,950 cases of Microcephaly were reported and confirmed. From the reported cases, 70% cases were confirmed by imaging method. The Northeast Region was the most affected in 2015 and in 2016, although it did not present the same magnitude, a potential second wave of Microcephaly cases were observed, mainly in the Central Western Region. Limitations: Secondary data (opportunity, completeness, representativeness, underreporting etc.), the unavailability of laboratory tests for ZIKAV were used, mainly at the beginning of the epidemic in 2015. The limited knowledge about the disease and its consequences, despite of advanced months at the time being, combined with the unavailability of a historical series of Microcephaly and other congenital anomalies for this condition and the proxy of infection by ZIKAV: negative cases of Dengue and Chikungunya and Microcephaly related to infection. Conclusion: It was concluded that the triggering of the response, in its four operational phases, was timely despite of the knowledge limitations; it was based on the Legislation and its own instruments to respond to PHEIC, and on the most update existing evidences of the disease (self-limiting), its diagnostic and therapeutic method. To date, the magnitude of congenital syndrome associated with ZIKAV infection (SCZ) in 2016 did not follow the same pattern observed in 2015, and the Northeast Region was the region with the greatest impact of the SCZ epidemic during September 2015 thru April 2016, although with a very low expression in the end of the following year. In 2016, the pattern observed in the Central Western Region, and to a lesser extent in the Southeast and North Regions, corroborates the causal link between ZIKAV infection in pregnancy and the manifestation of Congenital Syndrome, and there are still important gaps as, scientific knowledge about the clinic aspect of this new disease and the related factors to the transmission and endemicity.

Introdução: A Emergência de Saúde Pública de Importância Internacional foi declarada pela Organização Mundial da Saúde em fevereiro de 2016, em decorrência da notificação e resposta do governo brasileiro ao aumento da prevalência de microcefalia e outras alterações do sistema nervoso central. Esse evento é considerado uma das epidemias de maior complexidade e impacto da história da saúde pública. Objetivo: Descrever os principais marcos da epidemia de Zika vírus (ZIKAV) no Brasil, relacionando às ações de saúde pública adotadas e caracterizar as diferenças regionais com base nas taxas de incidência de ZIKAV em gestantes e de prevalência de microcefalia em casos registrados no Sistema de Informação de Agravos de Notificação e no formulário de Registro de Eventos de Saúde Pública, no período de janeiro de 2015 a novembro de 2016. Metodologia: Foi realizada a revisão da literatura nas principais bases de dados e também da literatura cinzenta (protocolos, portarias, manuais e informes) buscando elementos que fundamentaram as ações de saúde pública e fatos que marcaram o histórico desta epidemia no Brasil. Também foi realizada análise descritiva e comparativa das bases de dados do Sistema de Informação de Agravos de Notificação (SINAN) e do formulário de Registro de Eventos de Saúde Pública (RESP), no Brasil no período de janeiro de 2015 a novembro de 2016. Resultados: Em 22 de outubro de 2015, a Secretaria de Saúde de Pernambuco notificou o aumento na prevalência de microcefalia, no Estado. Em 11 de novembro foi declarada a emergência de saúde pública de importância nacional e em 1º de fevereiro de 2016, a Organização Mundial da Saúde declara emergência de saúde pública de importância internacional. Entre 2015 e 2016, foram notificadas 41.473 gestantes com quadro clínico compatível com ZIKAV e, no mesmo período, foram notificados e confirmados 1.950 casos de microcefalia. Destes, 70% foram confirmados por método de imagem. Observou-se que em 2015 a região mais afetada foi a nordeste e em 2016, apesar de não apresentar a mesma magnitude, observou-se uma possível segunda onda de casos de microcefalia a partir do mês de junho, principalmente na região centro-oeste, corroborando com a maior circulação de casos de ZIKAV no primeiro semestre. Limitações: O uso de dados secundários (oportunidade, completitude, representatividade, subnotificação etc), a indisponibilidade de testes laboratoriais para ZIKAV, principalmente no início da epidemia em 2015, o conhecimento limitado sobre a doença e suas consequências, apesar dos avanços nos últimos meses, a indisponibilidade de série histórica de microcefalia e outras anomalias congênitas para essa condição e o proxy de infecção pelo ZIKAV: casos negativos de dengue e chikungunya e microcefalia relacionada à infecção. Conclusões: Conclui-se que o desencadeamento da resposta em suas quatro fases operacionais foi oportuno, apesar das limitações do conhecimento; fundamentou-se na Legislação e instrumentos próprios para resposta às ESP e na melhor evidência disponível em cada fase operacional. Até o final de 2016, a magnitude da Síndrome Congênita Associada à Infecção pelo Vírus Zika vírus (SCZ) não apresentou o mesmo padrão observado em 2015, sendo que a região Nordeste apresentou maior magnitude somente na primeira onda (setembro/2015-abril/2016); Em 2016, a região Centro-Oeste apresentou a maior magnitude de casos de SCZ, seguida das regiões Sudeste e Norte. Esse padrão corrobora com o nexo causal entre infecção pelo ZIKAV na gestação e a manifestação da SCZ. Muitos avanços foram alcançados nos últimos dois anos. No entanto, ainda há importantes lacunas no conhecimento científico sobre o espectro clínico dessa nova doença e fatores relacionados à transmissão e endemicidade. / Introduction: On February 2016, The World Health Organization declared Public Health Emergency of International Concern (PHEIC). This action, due to the Brazilian notification and response, after the prevalence of microcephaly and other Central Nervous System disorders increase in Northeast Region. This event is one of the most complex epidemics of the Public Health history. Objective: Describe the sequence of events which occurred from January 2015 to November 2016 in Brazil, as a result of Zika virus outbreaks and the related congenital syndrome; to characterize the main elements of the Brazilian National response to the epidemics describing the course of the dual epidemics of Zika virus (ZIKV) infection during pregnancy and microcephaly, from the registered cases at Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) forms up to the first anniversary of this declaration in Brazil. Methods: To obtain a comprehensive chronologic description, of the main epidemiologic events and of the Brazilian response, we conducted a literature review and used third party (gray literature), and fundamental elements registered at the Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) from January 2015 up to November 12th 2016. In order to describe the Brazilian response, we divided in four phases the operational response to the emergency in Brazil. Results: On October 22nd 2015 the Pernambuco Health Secretary notified the prevalence of Microcephaly increase. On November 11th 2016 the Ministry of Health declared Public Health Emergency of National Concern. On February 1st 2016 the World Health Organization declared (PHEIC) Public Health Emergency of International Concern, 41,473 pregnant women with some clinical signs, compatible with Zika virus, were notified between 2015 and 2016. In the same period, 1,950 cases of Microcephaly were reported and confirmed. From the reported cases, 70% cases were confirmed by imaging method. The Northeast Region was the most affected in 2015 and in 2016, although it did not present the same magnitude, a potential second wave of Microcephaly cases were observed, mainly in the Central Western Region. Limitations: Secondary data (opportunity, completeness, representativeness, underreporting etc.), the unavailability of laboratory tests for ZIKAV were used, mainly at the beginning of the epidemic in 2015. The limited knowledge about the disease and its consequences, despite of advanced months at the time being, combined with the unavailability of a historical series of Microcephaly and other congenital anomalies for this condition and the proxy of infection by ZIKAV: negative cases of Dengue and Chikungunya and Microcephaly related to infection. Conclusion: It was concluded that the triggering of the response, in its four operational phases, was timely despite of the knowledge limitations; it was based on the Legislation and its own instruments to respond to PHEIC, and on the most update existing evidences of the disease (self-limiting), its diagnostic and therapeutic method. To date, the magnitude of congenital syndrome associated with ZIKAV infection (SCZ) in 2016 did not follow the same pattern observed in 2015, and the Northeast Region was the region with the greatest impact of the SCZ epidemic during September 2015 thru April 2016, although with a very low expression in the end of the following year. In 2016, the pattern observed in the Central Western Region, and to a lesser extent in the Southeast and North Regions, corroborates the causal link between ZIKAV infection in pregnancy and the manifestation of Congenital Syndrome, and there are still important gaps as, scientific knowledge about the clinic aspect of this new disease and the related factors to the transmission and endemicity.

Introdução: A Emergência de Saúde Pública de Importância Internacional foi declarada pela Organização Mundial da Saúde em fevereiro de 2016, em decorrência da notificação e resposta do governo brasileiro ao aumento da prevalência de microcefalia e outras alterações do sistema nervoso central. Esse evento é considerado uma das epidemias de maior complexidade e impacto da história da saúde pública. Objetivo: Descrever os principais marcos da epidemia de Zika vírus (ZIKAV) no Brasil, relacionando às ações de saúde pública adotadas e caracterizar as diferenças regionais com base nas taxas de incidência de ZIKAV em gestantes e de prevalência de microcefalia em casos registrados no Sistema de Informação de Agravos de Notificação e no formulário de Registro de Eventos de Saúde Pública, no período de janeiro de 2015 a novembro de 2016. Metodologia: Foi realizada a revisão da literatura nas principais bases de dados e também da literatura cinzenta (protocolos, portarias, manuais e informes) buscando elementos que fundamentaram as ações de saúde pública e fatos que marcaram o histórico desta epidemia no Brasil. Também foi realizada análise descritiva e comparativa das bases de dados do Sistema de Informação de Agravos de Notificação (SINAN) e do formulário de Registro de Eventos de Saúde Pública (RESP), no Brasil no período de janeiro de 2015 a novembro de 2016. Resultados: Em 22 de outubro de 2015, a Secretaria de Saúde de Pernambuco notificou o aumento na prevalência de microcefalia, no Estado. Em 11 de novembro foi declarada a emergência de saúde pública de importância nacional e em 1º de fevereiro de 2016, a Organização Mundial da Saúde declara emergência de saúde pública de importância internacional. Entre 2015 e 2016, foram notificadas 41.473 gestantes com quadro clínico compatível com ZIKAV e, no mesmo período, foram notificados e confirmados 1.950 casos de microcefalia. Destes, 70% foram confirmados por método de imagem. Observou-se que em 2015 a região mais afetada foi a nordeste e em 2016, apesar de não apresentar a mesma magnitude, observou-se uma possível segunda onda de casos de microcefalia a partir do mês de junho, principalmente na região centro-oeste, corroborando com a maior circulação de casos de ZIKAV no primeiro semestre. Limitações: O uso de dados secundários (oportunidade, completitude, representatividade, subnotificação etc), a indisponibilidade de testes laboratoriais para ZIKAV, principalmente no início da epidemia em 2015, o conhecimento limitado sobre a doença e suas consequências, apesar dos avanços nos últimos meses, a indisponibilidade de série histórica de microcefalia e outras anomalias congênitas para essa condição e o proxy de infecção pelo ZIKAV: casos negativos de dengue e chikungunya e microcefalia relacionada à infecção. Conclusões: Conclui-se que o desencadeamento da resposta em suas quatro fases operacionais foi oportuno, apesar das limitações do conhecimento; fundamentou-se na Legislação e instrumentos próprios para resposta às ESP e na melhor evidência disponível em cada fase operacional. Até o final de 2016, a magnitude da Síndrome Congênita Associada à Infecção pelo Vírus Zika vírus (SCZ) não apresentou o mesmo padrão observado em 2015, sendo que a região Nordeste apresentou maior magnitude somente na primeira onda (setembro/2015-abril/2016); Em 2016, a região Centro-Oeste apresentou a maior magnitude de casos de SCZ, seguida das regiões Sudeste e Norte. Esse padrão corrobora com o nexo causal entre infecção pelo ZIKAV na gestação e a manifestação da SCZ. Muitos avanços foram alcançados nos últimos dois anos. No entanto, ainda há importantes lacunas no conhecimento científico sobre o espectro clínico dessa nova doença e fatores relacionados à transmissão e endemicidade. / Introduction: On February 2016, The World Health Organization declared Public Health Emergency of International Concern (PHEIC). This action, due to the Brazilian notification and response, after the prevalence of microcephaly and other Central Nervous System disorders increase in Northeast Region. This event is one of the most complex epidemics of the Public Health history. Objective: Describe the sequence of events which occurred from January 2015 to November 2016 in Brazil, as a result of Zika virus outbreaks and the related congenital syndrome; to characterize the main elements of the Brazilian National response to the epidemics describing the course of the dual epidemics of Zika virus (ZIKV) infection during pregnancy and microcephaly, from the registered cases at Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) forms up to the first anniversary of this declaration in Brazil. Methods: To obtain a comprehensive chronologic description, of the main epidemiologic events and of the Brazilian response, we conducted a literature review and used third party (gray literature), and fundamental elements registered at the Brazilian National Notifiable Diseases Information System (SINAN) and Public Health Events Registry (RESP) from January 2015 up to November 12th 2016. In order to describe the Brazilian response, we divided in four phases the operational response to the emergency in Brazil. Results: On October 22nd 2015 the Pernambuco Health Secretary notified the prevalence of Microcephaly increase. On November 11th 2016 the Ministry of Health declared Public Health Emergency of National Concern. On February 1st 2016 the World Health Organization declared (PHEIC) Public Health Emergency of International Concern, 41,473 pregnant women with some clinical signs, compatible with Zika virus, were notified between 2015 and 2016. In the same period, 1,950 cases of Microcephaly were reported and confirmed. From the reported cases, 70% cases were confirmed by imaging method. The Northeast Region was the most affected in 2015 and in 2016, although it did not present the same magnitude, a potential second wave of Microcephaly cases were observed, mainly in the Central Western Region. Limitations: Secondary data (opportunity, completeness, representativeness, underreporting etc.), the unavailability of laboratory tests for ZIKAV were used, mainly at the beginning of the epidemic in 2015. The limited knowledge about the disease and its consequences, despite of advanced months at the time being, combined with the unavailability of a historical series of Microcephaly and other congenital anomalies for this condition and the proxy of infection by ZIKAV: negative cases of Dengue and Chikungunya and Microcephaly related to infection. Conclusion: It was concluded that the triggering of the response, in its four operational phases, was timely despite of the knowledge limitations; it was based on the Legislation and its own instruments to respond to PHEIC, and on the most update existing evidences of the disease (self-limiting), its diagnostic and therapeutic method. To date, the magnitude of congenital syndrome associated with ZIKAV infection (SCZ) in 2016 did not follow the same pattern observed in 2015, and the Northeast Region was the region with the greatest impact of the SCZ epidemic during September 2015 thru April 2016, although with a very low expression in the end of the following year. In 2016, the pattern observed in the Central Western Region, and to a lesser extent in the Southeast and North Regions, corroborates the causal link between ZIKAV infection in pregnancy and the manifestation of Congenital Syndrome, and there are still important gaps as, scientific knowledge about the clinic aspect of this new disease and the related factors to the transmission and endemicity.

The Strategic National Stockpile (SNS) is a program that provides medical countermeasures during a public health emergency. A public health emergency can be a natural or man-made disaster, an act of terrorism, or a pandemic. The Cities Readiness Initiative (CRI) was created to help the nation’s largest metropolitan regions develop the ability to provide SNS life-saving medications in the event of a large-scale bioterrorist attack or naturally occurring disease outbreak. To address the risks associated with a public health emergency the Center for Disease Control and Prevention (CDC) requires a comprehensive emergency response plan for distributing SNS/CRI materials quickly and efficiently. The Fulton County Department of Health and Wellness (FCDHW) is tasked with responsibility for distributing and dispensing of SNS/CRI medical assets delivered during a public health emergency. FCDHW is also tasked with the development of a comprehensive response plan. Past TAR scores revealed that passing SNS/CRI audits has been a challenge for FCDHW. A case study was conducted to note if the development of an information management system could facilitate successful future SNS/CRI audits. A needs assessment revealed that an information management system for emergency preparedness and response compliance was needed. Microsoft SharePoint 2007 was used to develop the information management system. SharePoint contains a secure document repository that linked the work products of all relevant internal and external stakeholders and revealed compliance deficiencies early enough to allow for corrective actions. The result was a passing TAR score that was a 59 point increase from the last published score.

Outbreaks of novel influenza viruses are continually occurring on many places on our planet, with the ultimate and most extreme consequence being a full-scale pandemic. Modern communication technology is widely used for risk communication regarding recommended change in behavior patterns and other precautions in order to mitigate the transmission. However, the assumption and bias that modern communication technology constitutes the norm causes vulnerable groups to be at possible risk of systematic exclusion to correct and updated information. Through conducting a literature- and case analysis, the aim of this study is to identify insufficient or inadequate risk communication efforts in South Korea and Vietnam during influenza outbreaks, especially with concern of vulnerable groups. Further, to analyze how national influenza preparedness plans observe or ignore these insufficiencies. Results show that vulnerable groups are explicitly recognized in the preparedness plan of Vietnam. However, the South Korean preparedness plan show a more homogenous approach. Both South Korea and Vietnam showed a broad variety of channels used in their risk communication strategies which could be positive in terms of a broad outreach to a heterogenous population, including vulnerable groups. Four key factors that moderate the outcomes of risk communication were identified: Channels, Messages, Transparency and Trust.