Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in Ne... more Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in New York City and other recent incidents demonstrate how important public health is as a frontline defense against emerging infections, bioterrorism, and other unexpected emergencies. A wellprepared public health workforce is more critical than ever. The challenges are particularly great in urban areas, which traditionally serve as ports of entry, may be appealing targets to terrorists, and have large and diverse populations with complex health risk factors. To better prepare the public health workforce to carry out routine functions effectively and fulfill the additional roles required in emergencies, a national network of "Centers for Public Health Preparedness" has been established by the Centers for Disease Control and Prevention (CDC). The network currently includes seven academic Centers funded through a cooperative agreement with the Association of Schools of Public Health (ASPH). Goals include the development of competency-based public health practice courses primarily designed to utilize distance-learning technology (such as World Wide Web-based instruction) that can be implemented locally and replicated nationally.
Introduction During the COVID-19 pandemic, there was an unprecedented and forced closure of denta... more Introduction During the COVID-19 pandemic, there was an unprecedented and forced closure of dental offices worldwide. As American state recommendations differed considerably during this period, this research strives to better define the effects of this pause on dental care. A 16-question Qualtrics survey was sent to the membership of the New York State Dental Association (NYSDA) and Georgia Dental Association (GDA). Licenced, actively practising dental members of the NYSDA and GDA (n = 680) answered questions about their practice demographics, appointment cancellations, reopening times and the volume of individual dental procedures performed from 1 March through to 1 August 2020, compared to the same five-month period in 2019. Results Demographic characteristics of respondent NYSDA and GDA members were statistically similar. Nonetheless, NYSDA members reported significantly larger decreases in provision of all types of dental procedures, except for antibiotic prescription, including prophylaxis, elective care, emergency dental care and speciality procedures. Discussion and conclusions All dental procedures declined significantly during the COVID-19 pandemic, with greater decrease in New York than in Georgia. This study raises concerns about the negative impact of the pandemic on oral public health and mandates both further research and clinical strategies to mitigate against this future risk.
Epidemiology has been a major contributor to the success of the disease control efforts of the pa... more Epidemiology has been a major contributor to the success of the disease control efforts of the past century, culminating in such signal triumphs as the global eradication of smallpox and the eradication of polio from the Western Hemisphere. However, in recent years, partly because these very successes led to a pervasive optimism about infectious diseases in the future, there has been a waning interest in infectious disease epidemiology even though infectious diseases remain the leading cause of death worldwide and an important cause of death in the United States (1-3). In addition, the tragic recent explosion of the acquired immunodeficiency syndrome (AIDS) pandemic and the emergence of multiple drug resistant tuberculosis forcefully reminded us that infectious diseases could not be relegated to the past. AIDS, like many of the plagues of the past, falls into the category of emerging infections, seemingly new diseases that appear suddenly and unexpectedly. Emerging infections can be defined as those that either have newly appeared in a population or that are rapidly increasing their incidence or expanding their geographic range (4, 5). Other recent examples include hantavirus pulmonary syndrome, Lyme disease, hemorrhagic colitis, and hemolytic uremic syndrome (resulting from a foodborne infection caused by certain strains of Escherichia coli), and Ebola hemorrhagic fever in Africa (6). Past scourges can also recur and are referred to as reemerging diseases, which are often conventionally understood and well recognized public health threats that have increased or reappeared because previously active public health measures have lapsed or sanitary infrastructure has deteriorated. Specific factors precipitating disease emergence can be identified in virtually all cases (2, 4, 5). These include
Reappearances of influenza are due to two distinct mechanisms: Annual or biennial epidemics invol... more Reappearances of influenza are due to two distinct mechanisms: Annual or biennial epidemics involving new variants due to antigenic drift (point mutations, primarily in the gene for the surface protein, hemagglutinin) and pandemic strains, arising from antigenic shift (genetic reassortment, generally between avian and mammalian influenza strains).
Objectives. We compared the impact of three household interventions-education, education with alc... more Objectives. We compared the impact of three household interventions-education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks-on incidence and secondary transmission of upper respiratory infections (URIs) and influenza, knowledge of transmission of URIs, and vaccination rates. Methods. A total of 509 primarily Hispanic households participated. Participants reported symptoms twice weekly, and nasal swabs were collected from those with an influenza-like illness (ILI). Households were followed for up to 19 months and home visits were made at least every two months. Results. We recorded 5,034 URIs, of which 669 cases reported ILIs and 78 were laboratory-confirmed cases of influenza. Demographic factors significantly associated with infection rates included age, gender, birth location, education, and employment. The Hand Sanitizer group was significantly more likely to report that no household member had symptoms (p,0.01), but there were no significant differences in rates of infection by intervention group in multivariate analyses. Knowledge improved significantly more in the Hand Sanitizer group (p,0.0001). The proportion of households that reported $50% of members receiving influenza vaccine increased during the study (p,0.001). Despite the fact that compliance with mask wearing was poor, mask wearing as well as increased crowding, lower education levels of caretakers, and index cases 0-5 years of age (compared with adults) were associated with significantly lower secondary transmission rates (all p,0.02). Conclusions. In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations. During the study period, community concern about methicillin-resistant Staphylococcus aureus was occurring, perhaps contributing to the use of hand sanitizer in the Education control group, and diluting the intervention's measurable impact.
the US National Academy of Sciences held a discussion meeting on the balance between scientific o... more the US National Academy of Sciences held a discussion meeting on the balance between scientific openness and security (see Nature 421, 197; 2003). The next day, a group of editors met to discuss the issues with specific reference to the scientific publication process. The following statement has emerged from that meeting. The statement was conceived in a US context, but the principles discussed will be considered and followed through by Nature and its related journals in their international arenas.
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2008
The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched ne... more The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched nearly to the point of urban legend, in part because of incomplete articulation of the scientific basis for microbial risk assessment, particularly dose-response assessment. Risk analysis (ie, risk assessment, risk communication, risk management) necessitates transparency: distinguishing scientific facts, hypotheses, judgments, biases in interpretations, and potential misinformation. The difficulty in achieving transparency for biothreat risk is magnified by misinformation and poor characterization of both dose-response relationships and the driving mechanisms that cause susceptibility or resistance to disease progression. Regrettably, this entrenchment unnecessarily restricts preparedness planning to a single response scenario: decontaminate until no spores are detectable in air, water, or on surfaces-essentially forcing a zero-tolerance policy inconsistent with the biology of anthrax. We present evidence about inhalation anthrax dose-response relationships, including reports from multiple studies documenting exposures insufficient to cause inhalation anthrax in laboratory animals and humans. The emphasis of the article is clarification about what is known from objective scientific evidence for doses of anthrax spores associated with survival and mortality. From this knowledge base, we discuss the need for future applications of more formal risk analysis processes to guide development of alternative non-zero criteria or standards based on science to inform preparedness planning and other risk management activities.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The QuickVue Influenza A+B Test (Quidel) was used to test nasal swab specimens obtained from pers... more The QuickVue Influenza A+B Test (Quidel) was used to test nasal swab specimens obtained from persons with influenzalike illness in 3 different populations. Compared with reverse-transcriptase polymerase chain reaction, the test sensitivity was low for all populations (median, 27%; range, 19%-32%), whereas the specificity was high (median, 97%; range, 96%-99.6%).
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2012
Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban ... more Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban areas acknowledge the formidable technical and social challenges of consequence management. Effective risk and crisis communication is one priority to strengthen the U.S.'s response and resilience. However, several notable risk events since September 11, 2001, have revealed vulnerabilities in risk/crisis communication strategies and infrastructure of agencies responsible for protecting civilian populations. During recovery from a significant biocontamination event, 2 goals are essential: (1) effective communication of changing risk circumstances and uncertainties related to cleanup, restoration, and reoccupancy; and (2) adequate responsiveness to emerging information needs and priorities of diverse populations in high-threat, vulnerable locations. This telephone survey study explored predictors of public reactions to uncertainty communications and reassurances from leaders related to the remediation stage of an urban-based bioterrorism incident. African American and Hispanic adults (N = 320) were randomly sampled from 2 ethnically and socioeconomically diverse geographic areas in New York and California assessed as high threat, high vulnerability for terrorism and other public health emergencies. Results suggest that considerable heterogeneity exists in risk perspectives and information needs within certain sociodemographic groups; that success of risk/crisis communication during recovery is likely to be uneven; that common assumptions about public responsiveness to particular risk communications need further consideration; and that communication effectiveness depends partly on preexisting
In June 2006, the Centers for Disease Control and Prevention released a request for applications ... more In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.
Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in Ne... more Public health will face major challenges in the coming decades. The 1999 West Nile outbreak in New York City and other recent incidents demonstrate how important public health is as a frontline defense against emerging infections, bioterrorism, and other unexpected emergencies. A wellprepared public health workforce is more critical than ever. The challenges are particularly great in urban areas, which traditionally serve as ports of entry, may be appealing targets to terrorists, and have large and diverse populations with complex health risk factors. To better prepare the public health workforce to carry out routine functions effectively and fulfill the additional roles required in emergencies, a national network of "Centers for Public Health Preparedness" has been established by the Centers for Disease Control and Prevention (CDC). The network currently includes seven academic Centers funded through a cooperative agreement with the Association of Schools of Public Health (ASPH). Goals include the development of competency-based public health practice courses primarily designed to utilize distance-learning technology (such as World Wide Web-based instruction) that can be implemented locally and replicated nationally.
Introduction During the COVID-19 pandemic, there was an unprecedented and forced closure of denta... more Introduction During the COVID-19 pandemic, there was an unprecedented and forced closure of dental offices worldwide. As American state recommendations differed considerably during this period, this research strives to better define the effects of this pause on dental care. A 16-question Qualtrics survey was sent to the membership of the New York State Dental Association (NYSDA) and Georgia Dental Association (GDA). Licenced, actively practising dental members of the NYSDA and GDA (n = 680) answered questions about their practice demographics, appointment cancellations, reopening times and the volume of individual dental procedures performed from 1 March through to 1 August 2020, compared to the same five-month period in 2019. Results Demographic characteristics of respondent NYSDA and GDA members were statistically similar. Nonetheless, NYSDA members reported significantly larger decreases in provision of all types of dental procedures, except for antibiotic prescription, including prophylaxis, elective care, emergency dental care and speciality procedures. Discussion and conclusions All dental procedures declined significantly during the COVID-19 pandemic, with greater decrease in New York than in Georgia. This study raises concerns about the negative impact of the pandemic on oral public health and mandates both further research and clinical strategies to mitigate against this future risk.
Epidemiology has been a major contributor to the success of the disease control efforts of the pa... more Epidemiology has been a major contributor to the success of the disease control efforts of the past century, culminating in such signal triumphs as the global eradication of smallpox and the eradication of polio from the Western Hemisphere. However, in recent years, partly because these very successes led to a pervasive optimism about infectious diseases in the future, there has been a waning interest in infectious disease epidemiology even though infectious diseases remain the leading cause of death worldwide and an important cause of death in the United States (1-3). In addition, the tragic recent explosion of the acquired immunodeficiency syndrome (AIDS) pandemic and the emergence of multiple drug resistant tuberculosis forcefully reminded us that infectious diseases could not be relegated to the past. AIDS, like many of the plagues of the past, falls into the category of emerging infections, seemingly new diseases that appear suddenly and unexpectedly. Emerging infections can be defined as those that either have newly appeared in a population or that are rapidly increasing their incidence or expanding their geographic range (4, 5). Other recent examples include hantavirus pulmonary syndrome, Lyme disease, hemorrhagic colitis, and hemolytic uremic syndrome (resulting from a foodborne infection caused by certain strains of Escherichia coli), and Ebola hemorrhagic fever in Africa (6). Past scourges can also recur and are referred to as reemerging diseases, which are often conventionally understood and well recognized public health threats that have increased or reappeared because previously active public health measures have lapsed or sanitary infrastructure has deteriorated. Specific factors precipitating disease emergence can be identified in virtually all cases (2, 4, 5). These include
Reappearances of influenza are due to two distinct mechanisms: Annual or biennial epidemics invol... more Reappearances of influenza are due to two distinct mechanisms: Annual or biennial epidemics involving new variants due to antigenic drift (point mutations, primarily in the gene for the surface protein, hemagglutinin) and pandemic strains, arising from antigenic shift (genetic reassortment, generally between avian and mammalian influenza strains).
Objectives. We compared the impact of three household interventions-education, education with alc... more Objectives. We compared the impact of three household interventions-education, education with alcohol-based hand sanitizer, and education with hand sanitizer and face masks-on incidence and secondary transmission of upper respiratory infections (URIs) and influenza, knowledge of transmission of URIs, and vaccination rates. Methods. A total of 509 primarily Hispanic households participated. Participants reported symptoms twice weekly, and nasal swabs were collected from those with an influenza-like illness (ILI). Households were followed for up to 19 months and home visits were made at least every two months. Results. We recorded 5,034 URIs, of which 669 cases reported ILIs and 78 were laboratory-confirmed cases of influenza. Demographic factors significantly associated with infection rates included age, gender, birth location, education, and employment. The Hand Sanitizer group was significantly more likely to report that no household member had symptoms (p,0.01), but there were no significant differences in rates of infection by intervention group in multivariate analyses. Knowledge improved significantly more in the Hand Sanitizer group (p,0.0001). The proportion of households that reported $50% of members receiving influenza vaccine increased during the study (p,0.001). Despite the fact that compliance with mask wearing was poor, mask wearing as well as increased crowding, lower education levels of caretakers, and index cases 0-5 years of age (compared with adults) were associated with significantly lower secondary transmission rates (all p,0.02). Conclusions. In this population, there was no detectable additional benefit of hand sanitizer or face masks over targeted education on overall rates of URIs, but mask wearing was associated with reduced secondary transmission and should be encouraged during outbreak situations. During the study period, community concern about methicillin-resistant Staphylococcus aureus was occurring, perhaps contributing to the use of hand sanitizer in the Education control group, and diluting the intervention's measurable impact.
the US National Academy of Sciences held a discussion meeting on the balance between scientific o... more the US National Academy of Sciences held a discussion meeting on the balance between scientific openness and security (see Nature 421, 197; 2003). The next day, a group of editors met to discuss the issues with specific reference to the scientific publication process. The following statement has emerged from that meeting. The statement was conceived in a US context, but the principles discussed will be considered and followed through by Nature and its related journals in their international arenas.
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2008
The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched ne... more The notion that inhalation of a single Bacillus anthracis spore is fatal has become entrenched nearly to the point of urban legend, in part because of incomplete articulation of the scientific basis for microbial risk assessment, particularly dose-response assessment. Risk analysis (ie, risk assessment, risk communication, risk management) necessitates transparency: distinguishing scientific facts, hypotheses, judgments, biases in interpretations, and potential misinformation. The difficulty in achieving transparency for biothreat risk is magnified by misinformation and poor characterization of both dose-response relationships and the driving mechanisms that cause susceptibility or resistance to disease progression. Regrettably, this entrenchment unnecessarily restricts preparedness planning to a single response scenario: decontaminate until no spores are detectable in air, water, or on surfaces-essentially forcing a zero-tolerance policy inconsistent with the biology of anthrax. We present evidence about inhalation anthrax dose-response relationships, including reports from multiple studies documenting exposures insufficient to cause inhalation anthrax in laboratory animals and humans. The emphasis of the article is clarification about what is known from objective scientific evidence for doses of anthrax spores associated with survival and mortality. From this knowledge base, we discuss the need for future applications of more formal risk analysis processes to guide development of alternative non-zero criteria or standards based on science to inform preparedness planning and other risk management activities.
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
The QuickVue Influenza A+B Test (Quidel) was used to test nasal swab specimens obtained from pers... more The QuickVue Influenza A+B Test (Quidel) was used to test nasal swab specimens obtained from persons with influenzalike illness in 3 different populations. Compared with reverse-transcriptase polymerase chain reaction, the test sensitivity was low for all populations (median, 27%; range, 19%-32%), whereas the specificity was high (median, 97%; range, 96%-99.6%).
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2012
Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban ... more Recent national plans for recovery from bioterrorism acts perpetrated in densely populated urban areas acknowledge the formidable technical and social challenges of consequence management. Effective risk and crisis communication is one priority to strengthen the U.S.'s response and resilience. However, several notable risk events since September 11, 2001, have revealed vulnerabilities in risk/crisis communication strategies and infrastructure of agencies responsible for protecting civilian populations. During recovery from a significant biocontamination event, 2 goals are essential: (1) effective communication of changing risk circumstances and uncertainties related to cleanup, restoration, and reoccupancy; and (2) adequate responsiveness to emerging information needs and priorities of diverse populations in high-threat, vulnerable locations. This telephone survey study explored predictors of public reactions to uncertainty communications and reassurances from leaders related to the remediation stage of an urban-based bioterrorism incident. African American and Hispanic adults (N = 320) were randomly sampled from 2 ethnically and socioeconomically diverse geographic areas in New York and California assessed as high threat, high vulnerability for terrorism and other public health emergencies. Results suggest that considerable heterogeneity exists in risk perspectives and information needs within certain sociodemographic groups; that success of risk/crisis communication during recovery is likely to be uneven; that common assumptions about public responsiveness to particular risk communications need further consideration; and that communication effectiveness depends partly on preexisting
In June 2006, the Centers for Disease Control and Prevention released a request for applications ... more In June 2006, the Centers for Disease Control and Prevention released a request for applications to identify, improve, and evaluate the effectiveness of nonpharmaceutical interventions (NPIs)-strategies other than vaccines and antiviral medications-to mitigate the spread of pandemic influenza within communities and across international borders (RFA-CI06-010). These studies have provided major contributions to seasonal and pandemic influenza knowledge. Nonetheless, key concerns were identified related to the acceptability and protective efficacy of NPIs. Large-scale intervention studies conducted over multiple influenza epidemics, as well as smaller studies in controlled laboratory settings, are needed to address the gaps in the research on transmission and mitigation of influenza in the community setting. The current novel influenza A (H1N1) pandemic underscores the importance of influenza research.
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