Household transmission of influenza A and B in a school-based study of non-pharmaceutical interventions.

The effect of school-based non-pharmaceutical interventions (NPIs) on influenza A and B transmission in children's households has not been estimated in published literature. We use data from a large school-based cluster randomized trial of improved hand and respiratory hygiene measures to explore the secondary transmission of influenza A and B in households of laboratory confirmed influenza cases. Data were taken from the Pittsburgh Influenza Prevention Project, a cluster-randomized trial of NPIs conducted in ten Pittsburgh, PA elementary schools during the 2007-2008 influenza season.

The adaptive response metric: toward an all-hazards tool for planning, decision support, and after-action analytics.

Local health departments are organized, resourced, and operated primarily for routine public health services. For them, responding to emergencies and disasters requires adaptation to meet the demands of an emergency, and they must reallocate or augment resources, adjust work schedules, and, depending on severity and duration of the event, even compromise routine service outputs. These adaptations occur to varying degrees regardless of the type of emergency or disaster.

Local variations in spatial synchrony of influenza epidemics.

Background: Understanding the mechanism of influenza spread across multiple geographic scales is not complete. While the mechanism of dissemination across regions and states of the United States has been described, understanding the determinants of dissemination between counties has not been elucidated. The paucity of high resolution spatial-temporal influenza incidence data to evaluate disease structure is often not available.

Preparedness for pandemics: does variation among states affect the nation as a whole?

Objective: Since states' public health systems differ as to pandemic preparedness, this study explored whether such heterogeneity among states could affect the nation's overall influenza rate.

Design: The Centers for Disease Control and Prevention produced a uniform set of scores on a 100-point scale from its 2008 national evaluation of state preparedness to distribute materiel from the Strategic National Stockpile (SNS). This study used these SNS scores to represent each state's relative preparedness to distribute influenza vaccine in a timely manner and assumed that "optimal" vaccine distribution would reach at least 35% of the state's population within 4 weeks.

Local spatial and temporal processes of influenza in Pennsylvania, USA: 2003-2009.

Background: Influenza is a contagious respiratory disease responsible for annual seasonal epidemics in temperate climates. An understanding of how influenza spreads geographically and temporally within regions could result in improved public health prevention programs. The purpose of this study was to summarize the spatial and temporal spread of influenza using data obtained from the Pennsylvania Department of Health's influenza surveillance system.

Developing a measure of local agency adaptation to emergencies: a metric.

Local public health agencies often must respond to health-related emergencies or disasters, while continuing to fulfill all public health functions for which they are funded. This article reports the development and initial pilot test of a method for measuring the nature and degree of a public health agency's response to such an emergency or disaster. How the instrument was developed as well as the initial results from the pilot study of four local public health systems (LPHSs) are presented and discussed.

Public Health Area of Concentration: a model for integration into medical school curricula.

Calls for more public health education for medical students date back at least 150 years. In recent years, medical schools have increased their required coursework in core public health topics such as epidemiology, biostatistics, and behavioral determinants of health. Some schools have created more in-depth alternatives, including combined or concurrent master's degrees; MD/PhD programs with a public health track; certificates in public health; or complete re-envisioning of the school into an integrated medical and public health institution.

Reduction in the incidence of influenza A but not influenza B associated with use of hand sanitizer and cough hygiene in schools: a randomized controlled trial.

Background: Laboratory-based evidence is lacking regarding the efficacy of nonpharmaceutical interventions (NPIs) such as alcohol-based hand sanitizer and respiratory hygiene to reduce the spread of influenza.

Methods: The Pittsburgh Influenza Prevention Project was a cluster-randomized trial conducted in 10 elementary schools in Pittsburgh, PA, during the 2007 to 2008 influenza season. Children in 5 intervention schools received training in hand and respiratory hygiene, and were provided and encouraged to use hand sanitizer regularly.

Sensitivity and specificity of rapid influenza testing of children in a community setting.

Introduction: Rapid influenza testing (RFT) allows for a rapid point-of-care diagnosis of influenza. The Quidel QuickVue Influenza A+B test (QuickVue) has a reported manufacturer's sensitivity and specificity of 73% and 96%, respectively, with nasal swabs. However, investigators have shown sensitivities ranging from 22% to 77% in community settings.

The effect of grade on compliance using nonpharmaceutical interventions to reduce influenza in an urban elementary school setting.

Objectives: The Pittsburgh Influenza Prevention Project (PIPP) has previously shown that school-aged children in grades K-5 can learn hygiene-based, nonpharmaceutical interventions (NPIs) and persist in these behaviors over the duration of an influenza season. The purpose of this study was to determine whether age (as estimated by grade) plays any role in this ability.

Methods: The Pittsburgh Influenza Prevention Project is a prospective, controlled, randomized trial of the effectiveness of a suite of NPIs in 10 elementary schools.

State courts and public health: building partnerships to enhance preparedness.

Laws and regulations can facilitate or impede emergency preparedness and response activities. State legislators, judges, and lawyers play critically important roles in creating and interpreting laws that affect the ability of public health practitioners and their partners to effectively respond to emergencies. In an age when political unrest, global travel, and emerging biological threats can combine to create social and economic havoc worldwide, it is critical that those responsible for upholding the rule of law during emergencies understand the law and its implications.

Compliance with a multilayered nonpharmaceutical intervention in an urban elementary school setting.

Objectives: The purpose of this study was to determine to what extent school-aged children can learn hygiene-based nonpharmaceutical interventions (NPIs) and persist in these behavioral changes over the duration of an influenza season. If this can be done successfully, it may be a preferable pandemic mitigation strategy to much more disruptive strategies such as whole-scale school closure.

Methods: The Pittsburgh Influenza Prevention Project (PIPP) is a prospective, controlled, randomized trial of the effectiveness of a suite of hygiene-based NPIs in controlling influenza and related illnesses in elementary schools in the City of Pittsburgh.

Research findings from nonpharmaceutical intervention studies for pandemic influenza and current gaps in the research.

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.

Preserving lessons learned in disease outbreaks and other emergency responses.

Background: Public health departments often miss the opportunity to both learn from outbreaks and disasters and share any 'lessons learned' with other public health partners. These missed opportunities inhibit the public health system's ability to improve, change and adapt in an organized way.

Methods: In 2003, Western Pennsylvania experienced the largest documented hepatitis A outbreak in US history.

Low sensitivity of rapid diagnostic test for influenza.

The QuickVue Influenza A+B Test (Quidel) was used to test nasal swab specimens obtained from persons with influenza-like 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%).

Using nonpharmaceutical interventions to prevent influenza transmission in elementary school children: parent and teacher perspectives.

Objectives: Schools act as "amplifying sites" for the spread of infectious diseases, outbreaks, and pandemics. This project assessed which nonpharmaceutical interventions (NPIs) are most acceptable to parents and teachers of school children in grades K-5 to K-8 in Pittsburgh public schools.

Methods: During the spring of 2007, the Pittsburgh Influenza Prevention Project surveyed 134 teachers and 151 parents representing nine elementary schools regarding attitudes toward NPIs and their usage by adults and school children during seasonal influenza outbreaks.

Rotavirus: disease and vaccine update, 2007.

Rotavirus infection is a ubiquitous illness, infecting the vast majority of children worldwide in the first 5 years of life. Rotavirus is one of the major causes of severe diarrhea in infants and young children throughout the developing and developed world. An estimated 500,000 deaths per year occur, with the burden of morbidity and mortality highest in the poorest nations.