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CDC: Excerpts from Public Health Law News - FluTrackers

Excerpts from CDC’s Public Health Law News that may be of interest to FT readers.: Comments in italics are mine. J. Wednesday, February 21, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ Is there an opportunity here for FT? *** CDC Invites Applications for Research on Implementation of Public Health Interventions.

CDC’s Office of Public Health Research has announced availability of $10 million to support peer-reviewed research on factors that encourage effective “translation” of public health interventions into actual health impact, including, among others, law-based interventions.

Letters of intent are due by March 12;

Full applications are due by April 10.

The full announcement (CDC RFA-CD-07-005 - Improving Public Health Practice through Translation Research) is accessible at http://www.grants.gov/ . Ethics, law and pandemics… *** Ethical Challenges in Pandemic Preparedness Lecture (2/28).

The University of South Carolina Law School will host a lecture entitled “Ethical Challenges in Preparing for a Pandemic,” to be held February 28, 2007 at 12:30 p.m.

ET. For more information, visit http://www.law.sc.edu/jandj/20070228.shtml . If the pandemic-hurricane analogy can be extended, can we expect similar reasons for non-compliance to preparedness interventions and prevention-oriented laws? “The public’s preparedness for hurricanes in four affected regions” Public Health Reports (03-04/07) Robert J.

Blendon, John M. Benson, and others http://www.publichealthreports.org/u...-2_167-176.pdf The authors of this study examined preparedness issues in communities that were affected by Hurricanes Katrina and Rita, but which were outside the main areas of devastation.

Over 2,000 individuals in Mississippi, Alabama, East Baton Rouge Parish, Louisiana, and Harris County, Texas, were interviewed for their opinions on evacuation, preparedness, aid to displaced persons, and stress.

The authors found that “A sizeable minority of respondents might not comply with future government orders to evacuate if another major hurricane threatened their community.” They posited that there are two sets of reasons for noncompliance: a lack of trust in forecasts or a belief that their home will survive;

And a need for specific information and services to aid them.

For the first group, the authors recommend that emergency planners use “specific education messages … to focus on the damage done to populations that ignored evacuation orders prior to major hurricanes and remained in these areas.” For the second, they suggest that state and local plans should be in place well before hurricane season.

The interviews also revealed that, “A substantial proportion of respondents in all of these areas reported that they are not prepared for evacuation from a future hurricane.” Others said they were concerned that evacuees in their community would cause an increase in infectious disease, as well as a strain on local resources.

The researchers also found widespread feelings of stress and recommend that public health systems increase education and the availability of mental health services. Could genetic testing for influenza exposure be used by employers or insurance companies for screening purposes?

If so, this legislation may apply. LAW BEHIND THE NEWS

Another set of excerpts from the CDC Health Law News that may be of interest to FT readers: J. Wednesday, April 11, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Pandemic Influenza and Public Health Law DVD.

The California Distance Learning Health Network has released “Pandemic Influenza and Public Health Law: What Public Health Departments Need to Know.” This DVD self-study course facilitates partnering between local health departments and other key agencies (law enforcement, county counsels, etc.) within their jurisdictions to explore “what if” scenarios and clarify their respective roles.

For more information, visit http://cdlhn.com/default.htm . *** Public Health Emergency Preparedness Articles .

Last week, the American Journal of Public Health released a series of articles concerning emergency preparedness, public health, and the law.

Included in the series are such titles as “Conceptualizing and Defining Public Health Emergency Preparedness;” “The Law and Emergencies: Surveillance for Public Health-Related Legal Issues During Hurricanes Katrina and Rita;” “The Courts, Public Health, and Legal Preparedness;” “Encouraging Compliance With Quarantine: A Proposal to Provide Job Security and Income Replacement;” and “Variation in Quarantine Powers Among the 10 Most Populous U.S.

States in 2004.” To locate articles in this series, visit http://www.ajph.org/first_look.shtml .

These articles are soon to be released in a special Supplement to the Journal. Mutual aid agreements: essential legal tools for public health preparedness and response American Journal of Public Health (04/07) Daniel D.

Stier and Richard A.

Goodman http://www.ajph.org/cgi/reprint/AJPH.2006.101626v1 The authors of this analysis reviewed the current status of the law regarding agreements to share supplies, equipment, personnel, and information across political boundaries in a public health emergency.

“Mutual aid” agreements like the Emergency Management Assistance Compact (EMAC) are essential to facilitate an effective response to disasters, by “establishing the rules, processes, and procedures to be followed in sharing information, resources, or personnel.” In this article, the authors describe the basic legal framework for mutual aid agreements, identify gaps in that framework, and make recommendations for addressing those gaps.

Mutual aid comprises at least five categories “over a gradient of potential liability, including the sharing of planning information, epidemiological and laboratory data or information, equipment and supplies, unlicensed personnel, and licensed personnel.” The authors describe international cooperative agreements, such as those between the United States and Canada, and the United States and Mexico.

According to the authors, states may, in some circumstances, lack the authority to share confidential health information across international borders.

With regard to both international and interstate cooperation, the U.S.

Constitution has provided an added complication in the compact clause, which may affect the ability of states to enter into binding agreements without the consent of Congress.

However, interstate cooperation has had the support of Congress.

For example, Congress has directed the Secretary of Health and Human Services to develop an Emergency System for Advance Registration of Volunteer Health Professionals.

Finally, the authors suggest that states share and use lessons learned while developing new agreements, further analyze the compact clause, and cultivate relationships with attorneys from Canada and Mexico.

Experts from the CDC Health Law News that may be of interest to FT members: Wednesday, April 18, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Avian Influenza Conference (5/31-6/1).

Paris Anti-Avian Influenza 2007 will be held at the Institut Pasteur in Paris, France from May 31-June 1, 2007.

For more information, visit http://www.isanh.com/avian-influenza/index.php . “Public health interventions and epidemic intensity during the 1918 influenza pandemic” Proceedings of the National Academy of Sciences (04/06/07) Richard Hatchett and others http://www.pnas.org/cgi/doi/10.1073/pnas.0610941104 The authors of this article assessed the impact of nonpharmaceutical interventions (NPIs) on the 1918 U.S.

Influenza epidemic.

NPIs include such measures as voluntary quarantine, closure of schools, and bans on public gatherings.

While many authorities have supported the use of NPIs in a future pandemic, this study investigated whether early implementation of such interventions actually reduces disease transmission.

The authors analyzed the type and timing of NPIs used in 17 cities during the fall wave of the 1918 pandemic.

They then tied that information to the peak weekly death rate and the cumulative excess pneumonia and influenza death rate (CEPID) during the months September to December 1918.

The authors found that the CEPID was 50 percent lower in cities that implemented multiple NPIs than in cities that intervened late or not at all.

But the study further found that most of the NPIs were relaxed within two to eight weeks, allowing opportunities for reintroduction and transmission of the virus for many months afterward.

As a result, second waves of the pandemic occurred after the relaxation of NPIs.

The authors offer several possible explanations for the findings.

They conclude, “Communities that prepare to implement layered NPIs aggressively are likely to achieve better outcomes than communities that introduce such interventions reactively, and they may be better positioned to manage the disruption caused by the more stringent interventions, such as school closure.” Finally, the authors indicate that an area for further study is the question of when to relax NPIs. “The Pandemic and All-Hazards Preparedness Act” Journal of the American Medical Association (04/18/07) James Hodge and others http://jama.ama-assn.org/cgi/content/full/297/15/1708 The authors of this commentary analyze the Pandemic and All-Hazards Preparedness Act (PAHPA) intended to improve the “organization, direction, and utility” of public health emergency preparedness efforts.

According to the authors, PAHPA fails to address some long-standing issues.

For example, the Act recognizes that tribal, state, and local entities must participate in public health emergencies, but, according to the authors, “does not specify how federal entities should align with tribal, state, and local governments.” PAHPA mandates that subnational entities create and implement emergency preparedness plans consistent with “measurable evidence-based benchmarks and objective standards.” The authors argue that the use of benchmarks rather than evidence-based public health policies could lead to unintended consequences.

PAHPA requires the U.S.

Department of Health and Human Services (DHHS) to establish a national electronic network to collect and analyze public health data.

The authors suggest that while a database should improve public health surveillance, the collection of such data could jeopardize the security of identifiable, sensitive, and private health information.

The authors suggest provisions that could be codified in DHHS regulations to protect the privacy of individuals.

The law also authorizes DHHS to oversee federal health personnel, including volunteers.

But PAHPA does not speak to the issue of liability protection, which was a recurrent issue during the Hurricane Katrina response.

The authors conclude that while PAHPA does address some pivotal issues in public health emergency preparedness, it does not resolve many “complex, long-standing issues.” [Editor’s note: To read the text of the Pandemic and All-Hazards Preparedness Act, visit http://frwebgate.access.gpo.gov/cgi-...8enr.txt.pdf.] Canada: Plaintiff who allegedly contracted TB at hospital denied compensation “Judge rejects TB lawsuit against Vancouver hospital” CBC News (04/11/07) http://www.cbc.ca/canada/british-col...t.html?ref=rss 1.

Judge rejects TB lawsuit against Vancouver hospital A Vancouver man who contracted tuberculosis after visiting a patient at St.

Paul's Hospital has lost his lawsuit seeking compensation from the hospital. Derek Downey had gone to the hospital in downtown Vancouver in July 2001 to visit a friend being treated for AIDS. He did not know that his friend — described in court documents only as "M.L." — also had tuberculosis.

It was only diagnosed later. During the visit, Downey's friend coughed on him.

The following month, Downey, too, was diagnosed with TB. He sued St.

Paul's along with Providence Health Care, which runs the hospital, for failing to ensure his safety.

Downey argued a patient suspected of having an infectious disease should have been placed in isolation. The hospital argued Downey might have contracted TB elsewhere, since he was living in an area where he was exposed to intravenous drug users. In his decision, B.C.

Supreme Court Justice Richard Goepel describes that as speculation. But he also dismissed Downey's suit.

The judge writes that hospitals contain sick people who can infect others.

And he says visitors know that. Goepel said the hospital had determined that M.L.

Did not require isolation — and officials had no duty to warn visitors he might have TB.

On that last item, Plaintiff who allegedly contracted TB at hospital denied compensation, the full case is here: http://www.canlii.org/eliisa/highlig...07bcsc478.html The transmission occured on July 18, with the TB diagnosis on July 20.

The Act referred to is the Occupier's Liability Act - this type of action would usually be framed in negligence.

And the last few paragraphs containing the judge's reasoning are below: [90]The decision on whether to order respiratory isolation is complex, involving a consideration of a number of factors, not the least of which is a clinical assessment of the patient.

For this reason, the attending physician is responsible for making the determination of whether to put a patient in respiratory isolation.

In this case, there is no evidence that suggests that Dr.

McKenna or Dr. Reynolds fell below the appropriate standard of care in determining that M.L.

Need not be isolated.

All the medical evidence supports the decisions they made. [91] I do not accept that the Hospital failed to follow the Policy.

The Policy left the decision, as to whether to enforce restrictive isolation, to the treating doctor.

The Hospital was entitled to rely on the medical judgment of Dr.

McKenna and Dr. Reynolds.

In this case, the doctors concluded that there was no necessity to place M.L.

In isolation. That decision was consistent with established standards and practice.

The Hospital’s duty is to isolate patients whom they suspect are contagious.

The treating physicians did not suspect that M.L.

Was contagious. The Hospital did not fail to take the care that was reasonable in the circumstances of this case. [92] I do not accept Mr.

Downey’s submission that the Hospital breached its duty of care by failing to warn him that M.L.

Might possibly be contagious.

The duty to warn cannot be divorced from the duty to isolate.

The Hospital’s duty is to take reasonable steps to ensure that patients do not infect others.

Having decided that a patient did not require isolation, the Hospital is not required to warn visitors that the patient might possibly have TB.

To do so would hold the Hospital to a higher standard than the Act requires. [93] The Act requires the Hospital to be reasonably safe for visitors.

The Hospital is not an insurer of the health of visitors.

Hospitals contain sick people.

Sick people, for various reasons, can infect others.

Visitors to hospitals know there are sick people present.

Anyone with a respiratory illness could theoretically have TB.

Few, in fact, do.

Having properly determined that a respiratory patient does not require isolation, it is not reasonable or necessary to require hospitals to warn visitors that the patient could possibly have TB.

Such warnings could dilute the effectiveness of warnings for patients who are in isolation.

In the circumstances of this case, the Hospital, having determined that M.L.

Did not require isolation, was under no duty to warn all who may come into contact with him that he might possibly have TB. [94] In the result, I find that the Hospital did not breach the duty of care it owed to Mr.

Downey. The action is dismissed.

Two excerpts from the CDC's Health Law News.

The first on allowing uninspected poultry meat for sale in Vermont;

The second on guidlines for use of face masks during a pandemic. J. Wednesday, May 9, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ “Bill would ease state’s poultry rules” Rutland Herald (05/04/07) http://www.rutlandherald.com/apps/pb...48/1004/NEWS03 Vermont legislators have approved a bill to allow uninspected poultry to be sold in restaurants and farmers markets.

The bill is intended to create new markets for small-scale poultry farmers, allowing those who sell less than 1,000 birds a year to bypass the inspections.

Such meat would be labeled as “uninspected.” But some lawmakers say they are concerned about potential damage to the agriculture industry if a consumer was sickened by uninspected meat.

“One unfortunate incident involving an uninspected bird could extract a price from all producers,” said Sen.

Jane Kitchel, former head of the state’s Agency of Human Services, who opposed the provision.

Sen. Richard Mazza also urged the Senate not to pass the bill: “This is not the time to weaken the rules on food safety.

We must maintain the highest level of food safety for Vermont products.” The state’s Department of Health and Department of Agriculture also oppose selling uninspected poultry in restaurants.

But Amy Shollenberger of Rural Vermont, a small farm advocacy group that supported the bill, said, “I think it will increase the number of people who sell poultry.

It will open up new opportunities for them.” “U.S.

Issues guidelines on use of face masks in flu outbreak” The New York Times (05/04/07) Donald G.

McNeil Jr. http://www.nytimes.com/2007/05/04/he...620&ei=5087%0A CDC has released guidelines for the use of face masks during an influenza outbreak.

According to Dr. Michael Bell of CDC’s National Center for Preparedness, Detection and Control of Infectious Diseases, the agency debated the guidance for years because, in part, there is little scientific data proving that masks protect against the influenza virus.

“If there were a fail-safe, perfect solution, we’d recommend it absolutely.

But there isn’t a crisp, hard guideline.

It’s not like a seat belt, something you should wear at all times,” said Bell.

The guidelines suggest that surgical masks “should be considered” by people in a crowd, and thicker industrial masks “should be considered” by anyone caring for the sick.

The guidelines also re-emphasize the need to adhere to social distancing measures, including avoiding crowds and close contact with others at work or school.

According to CDC Director Dr.

Julie Gerberding, masks are most useful for people who are already sick, and for healthcare workers who are working with influenza patients.

Public health officials are concerned that a rush to buy masks for home use may create a shortage for healthcare workers.

For that reason, although federal, state, and city governments are building mask stockpiles, the national influenza plan does not rely as heavily on the use of masks as do other countries, such as France.

But according to Dr.

Didier Houssin, Chief Medical Officer for Influenza at the Paris Hospital Center, the decision to rely on masks was made “not so much from medical reasons as from psychological and political reasons.” [Editor’s note: To read “Interim Public Health Guidance for the Use of Facemasks and Respirators in Non-Occupational Community Settings during an Influenza Pandemic,” visit http://www.pandemicflu.gov/plan/comm...mmunity.html.]

Two excerpts from the CDC Health Law News that may be of interest to FT readers: military pandemic preparedness;

Mock disasters. Wednesday, May 16, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ "U.S.

Military begins planning for avian flu pandemic" Agence France Presse (05/10/07) Jim Mannion http://news.yahoo.com/s/afp/20070510...y_070510181445 Last week, the U.S.

Department of Defense (DoD) released its plan to prepare the nation's military for a role in a potential avian influenza pandemic.

The Pentagon's Implementation Plan for Pandemic Influenza provides information and guidelines for military services and combatant commands.

The document prepares for a pandemic that would move quickly and involve catastrophic waves of disease, leading to overwhelmed health facilities and crippled state and local authorities.

According to the document, the U.S.

Military's highest priority is to preserve DoD's operational effectiveness, but another priority would be to evacuate non-infected people from where they are living abroad, and to help the country's allies.

Troops will also play a role in distributing medical supplies and medications, and providing security for the production and shipment of vaccines.

Finally, the military may assist with the isolation and quarantine of people to contain the spread of influenza.

"When directed by the president, DoD will provide support to civil authorities in the event of a civil disturbance.

DoD will augment civilian law enforcement efforts to restore and maintain order in accordance with existing statutes." [Editor's note: To read the Department of Defense Implementation Plan for Pandemic Influenza, visit http://fhp.osd.mil/aiWatchboard/pdf/..._Release.pdf.] "Mock disasters challenge federal, state and local responders" Associated Press (05/10/07) Deanna Martin http://www.wabashplaindealer.com/art...ews/state2.txt Since April 30, federal emergency workers across the United States have been conducting the largest exercise ever undertaken by U.S.

Northern Command.

Dubbed Ardent Sentry/Northern Edge, the training was developed to find better ways for local first responders to work with the military and federal officials who arrive later in an emergency.

Responders in Indiana have simulated a nuclear disaster;

In Alaska a series of simulated terrorist attacks have targeted the state's oil pipeline and refineries and other energy resources;

And Rhode Island and four other New England states have been hit by a hypothetical Category 3 hurricane.

The nuclear disaster in Indianapolis marked the first time officials responded to a national-level disaster without pre-positioning staging equipment.

And, for the first time, local and state responders conducted around-the-clock operations for the initial 72 hours after the disaster began.

"You've got to practice, and you just can't practice something of this magnitude by just moving a little icon around on a screen.

You've got to get out here and sweat," said Maj.

Gen. Martin Umbarger, Adjutant General of the Indiana National Guard.

The goal of all the operations was to overwhelm authorities with evacuations, failed communications, and destroyed infrastructure.

According to Brittan Bates, a Rhode Island exercise officer, "We saw some gaps with [the Federal Emergency Management Agency], and we now know we have to have some conversations with them to figure out exactly how that needs to be done." The simulation will continue through May 18. [Editor's note: To learn more about Ardent Sentry/Northern Edge, visit http://www.northcom.mil/News/2007/AS...ct_sheet.pdf.]

Excerpts from today's Health Law News that may be of interest.

The first item on Florida quarintine law is very instructive. Wednesday, May 30, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Florida Courts and Pandemic Preparedness.

The Florida Court Education Council’s Publications Committee has released Pandemic Influenza Benchguide: Legal Issues Concerning Quarantine and Isolation, available at http://www.flcourts.org/gen_public/c...benchguide.pdf *** American Health Lawyers Association 2007 Annual Meeting (6/24-6/27).

AHLA will hold its 2007 Annual Meeting and In-House Counsel Program June 24-27 in Chicago.

For more information, visit http://www.healthlawyers.org/Templat...nual_Meeting07 “TB patient isolated after taking two flights” The New York Times (05/30/07) Lawrence K.

Altman http://www.nytimes.com/2007/05/30/us...hp&oref=slogin An Atlanta man is under federally enforced isolation after being diagnosed with XDR TB (extensively drug-resistant tuberculosis).

Federal and international officials have begun an airline contact investigation to track down passengers and crew from two trans-Atlantic flights on which the man was a passenger earlier this month.

CDC is advising passengers and crew members -- particularly passengers who were seated within two of the man, to be tested for tuberculosis.

Contact passengers from the two flights, a May 12 flight from Atlanta to Paris and a May 24 flight from Prague to Montreal, will also be advised to undergo a medical evaluation with a follow-up test eight to ten weeks later.

“We’re not concerned about a generic threat to travelers,” said CDC Director Dr.

Julie L. Gerberding.

The agency advised contact testing out of an abundance of caution, even though the risk of infection is believed to be low, she said, noting that the number of tuberculosis bacteria in the infected man’s sputum were too low to be detected, but still enough to infect others.

The man had been advised of the results of tests taken before he left for Europe and not to take commercial flights home.

But while CDC worked with a U.S.

Embassy to provide assistance, the man flew to Montreal and drove into the United States.

He was then isolated for 72 hours in a New York hospital, and is now in isolation in an Atlanta hospital.

XDR TB is often fatal, extremely resistant to standard antibiotics, and represents a growing public health threat in many countries.

CDC has not yet determined the source of the man’s infection.

Those who think they may have been exposed to TB or XDR TB can call (800) CDC-INFO for more information. [Editor’s note: To learn more about XDR TB, and to read the CDC Health Advisory and a transcript from CDC’s press conference on this investigation, visit http://www.cdc.gov/tb/xdrtb/.] Isolation and quarantine are two common public health strategies designed to protect the public by preventing exposure to infected or potentially infected persons.

In general, isolation refers to the separation and restriction of movement of persons who have a specific infectious illness from those who are healthy.

Quarantine generally refers to the separation and restriction of movement of persons who have been exposed to an infectious agent and therefore may become infectious.

Both isolation and quarantine are intended to stop the spread of infectious disease, and both may be either voluntary or compelled through legal authority.

States generally have intrastate quarantine authority, i.e,.

The authority to compel isolation and quarantine within their borders.

The Federal government, however, generally acting through CDC, has foreign and interstate quarantine authority, i.e., the authority to prevent the introduction, transmission, and spread of communicable diseases from foreign countries into the United States, and from one state into another.

Federal quarantine authority is primarily found in the U.S.

Code at 42 U.S.C.

Section 264 and in the Code of Federal Regulations at 42 C.F.R., Parts 70 and 71.

In exercising its quarantine authority, the Federal government is empowered to detain, medically examine, or conditionally release persons suspected of carrying specified communicable diseases.

The specified communicable diseases for which federal isolation and quarantine are authorized are set forth through Executive Order 13295 (as amended) and include, among other illnesses, infectious tuberculosis. To read 42 U.S.C.

Section 264, click here: http://www2a.cdc.gov/phlp/docs/sec264.pdf . To read the existing federal quarantine regulations, 42 C.F.R.

Parts 70 and 71, visit: http://www.access.gpo.gov/nara/cfr/w...2cfr70_03.html . and http://www.access.gpo.gov/nara/cfr/w...2cfr71_03.html . To read the proposed federal quarantine regulations, click here: http://www.cdc.gov/ncidod/dq/nprm/index.htm . To read Executive Order 13295, click here: http://www.cdc.gov/ncidod/sars/executiveorder040403.htm .

This weeks' excerpts from CDC's Health Law News....lots on TB cases... Wednesday, June 6, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ “Quarantines not rare for tuberculosis patients” Associated Press (06/03/07) Colleen Slevin http://www.examiner.com/a-761261~Qua..._patients.html While CDC’s isolation order against extensively drug-resistant tuberculosis (XDR TB) patient Andrew Speaker is thought to be the first such federal order in at least 40 years, states have regularly invoked their quarantine powers to isolate tuberculosis patients.

Speaker was recently diagnosed with XDR TB while on his honeymoon in Europe, and CDC issued an order for his isolation.

CDC lifted the order on Saturday, when Speaker checked into National Jewish Medical and Research Center in Denver, Colorado.

Denver health authorities issued a local quarantine order, as they have done for previous XDR TB patients, according to CDC’s Website.

Speaker is one of many tuberculosis patients under court order.

A New Mexico resident is also at the facility in Denver;

17 TB patients in Texas were placed in an involuntary quarantine facility in San Antonio;

And California reported detaining four TB patients in 2006.

The Colorado quarantine law was updated in 2002 in response to a rise in multidrug-resistant TB cases.

The Colorado chief medical officer has the authority to issue a quarantine or isolation order for any multidrug-resistant TB patient who refuses to take prescription medications, even if the patient is not considered to be contagious.

According to CDC, 49 cases of XDR TB have been reported in the United States in the last 13 years, and about ten percent of the world’s two billion TB-infected people have XDR TB. “ACLU files lawsuit against county for treatment of TB patient” Arizona Republic (05/30/07) Dennis Wagner http://www.azcentral.com/news/articl...tbguy0530.html The American Civil Liberties Union (ACLU) has filed a federal lawsuit on behalf of an extensively drug-resistant tuberculosis (XDR TB) patient held in an Arizona jail.

Under court order, Robert Daniels has been held in isolation in a jail ward at the Maricopa Medical Center for ten months, since public health officials discovered that he had failed to take his medications and went out in public without a mask.

While under the custody of Sheriff Joe Arpaio, Daniels has been held without a phone, television, radio, shower, or hot water, and with lights on 24 hours a day, according to court records.

The lawsuit charges the Maricopa County Sheriff’s Office with violating Daniels’ constitutional rights and also the Americans with Disabilities Act.

Linda Cosme, an ACLU attorney, said Daniels is extremely depressed, and she expects to file motions seeking an expedited hearing and an injunction to immediately improve Daniels’ treatment.

Arpaio defended the conditions under which Daniels is being held: “I run a safe jail, and he’s going to be treated like anyone else.” Daniels recently learned that his condition might require surgery.

“I’m slowly dying in this room,” he said.

“I didn’t realize how serious this (TB) was, and I regret that, but nothing justifies the kind of treatment I’ve received in here.

The solitary confinement starts to mess with your head and it has taken a serious toll on my body.” “Vaccine claims to get their day in court” Associated Press (06/04/07) Kevin Freking http://www.sfgate.com/cgi-bin/articl...&type=politics The debate over the relationship between childhood vaccines, mercury, and autism is slated to have its day in court.

Of more than 4,800 claims filed against the U.S.

Government, one has been chosen to test the theory that autism is caused by the measles, mumps, and rubella vaccine that once contained the preservative thimerosal.

Thimerosal contains a form of mercury.

In 1999, the government asked vaccine makers to eliminate or reduce the mercury content of vaccines to avoid any chance that infants might be exposed to more mercury than considered safe by federal guidelines.

But experts, including the Institute of Medicine (IOM), say vaccines do not cause autism.

A 2004 IOM report reviewed five large studies and found no association between autism and vaccines with thimerosal.

Dr. Paul Offit, chief of the division of infectious diseases at the Children’s Hospital of Philadelphia, suggested that because mercury is part of the natural environment, children are regularly exposed.

The National Autism Association believes drug manufacturers and federal regulators work too closely together, leading the government to protect the industry from liability.

Three special masters will hear the case in the U.S.

Court of Federal Claims.

The hearing will be open to the public, and transcripts will be posted on the Court’s Website after each day’s proceedings. [Editor’s note: To follow the Omnibus Autism Proceeding and the case Cedillo v.

HHS, in the U.S. Court of Federal Claims, visit http://www.uscfc.uscourts.gov/OSM/OSMAutism.htm .

To read the IOM report, Immunization Safety Review: Vaccines and Autism, visit http://books.nap.edu/catalog.php?record_id=10997 .

To learn CDC’s position on mercury and vaccines, visit http://www.cdc.gov/od/science/iso/co...imerosal.htm.] National: Legal experts weigh in on XDR TB case “TB quarantine raises legal questions” Associated Press (06/01/07) Mike Stobbe http://www.losangeleschronicle.com/a...rticleID=28609

Lots more on the TB situation.... Wednesday, June 13, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** XDR TB Quarantine Orders.

CDC has released the text of the three orders issued for the detention of an XDR TB patient between May 25 and May 30, 2007, and the final order, issued June 2, 2007, rescinding the earlier orders.

The Order for Provisional Quarantine is available at http://www2a.cdc.gov/phlp/docs/quarantine1.pdf;

The Order Pursuant to Section 361 is available at http://www2a.cdc.gov/phlp/docs/quarantine2.pdf;

The Revised Order Pursuant to Section 361 is at http://www2a.cdc.gov/phlp/docs/quarantine3.pdf;

And the Order Rescinding Movement Restrictions is available at http://www2a.cdc.gov/phlp/docs/quarantine4.pdf . *** Bench Books.

The Public Health Law Program has added three new benchbooks, from Arizona, Florida, and Utah to the growing portfolio.

Please visit http://www2a.cdc.gov/phlp/port_bench.asp *** Disaster Management Conference (7/8-7/11).

The Canadian Centre for Emergency Preparedness will present the 17th World Conference on Disaster Management, July 8-11, 2007, in Toronto.

For more information, visit http://www.wcdm.org/ . *** Biosecurity Policies Seminar (7/23-7/25).

The Massachusetts Institute of Technology Professional Institute will present “Combating Bioterrorism / Pandemics: Implementing Policies for Biosecurity,” July 23-25, 2007, in Cambridge, Massachusetts.

The course will look at the collaborations between public health, law enforcement, and national security agencies during threats of bioterrorism and global pandemics.

Experts will explore the obstacles agencies must overcome when groups with deeply embedded professional norms and organizational cultures collaborate with each other. Visit http://web.mit.edu/mitpep/pi/courses...terrorism.html for more information. National: Historian looks at tuberculosis “Return of the White Plague” Washington Post (06/10/07) Howard Markel http://www.washingtonpost.com/wp-dyn...060802480.html Czech Republic: Criminal complaint filed against American XDR TB patient “Czech airline takes legal action against U.S.

Tuberculosis patient” Associated Press (06/07/07) http://www.iht.com/articles/ap/2007/...-Infection.php

Further excerpts from the CDC's Public Health Law News... Wednesday, June 20, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** AMA Launches Preparedness Journal.

The American Medical Association has launched a new journal, Disaster Medicine and Public Health Preparedness.

The journal intends to support the integration of clinical medicine with public health preparedness and to provide individual healthcare providers with a resource to support their public health activities.

For more information or to submit an article, visit http://www.ama-assn.org/ama1/pub/upl...r-medicine.pdf . *** Gulf Coast Hurricanes Lessons Learned Report.

The American Health Lawyers Association has released Lessons Learned from the Gulf Coast Hurricanes, a follow-up publication to the 2004 Emergency Preparedness, Response & Recovery Checklist: Beyond the Emergency Management Plan in the American Health Lawyers Association’s Public Information Series.

Visit http://www.healthlawyers.org/Content...onsLearned.pdf . “New global rules to fight health threats come into force” Agence France Presse (06/14/07 http://news.yahoo.com/s/afp/20070614...e_070614145019 The World Health Organization’s (WHO) Revised International Health Regulations (IHR), designed to bolster international cooperation during a global public health threat, entered into force on June 15, 2007.

Over 190 nations signed on to the new rules in 2005.

The IHR are intended to ensure “Faster and better detection and evaluation of health emergencies with an international scope, those that have the potential to cross frontiers,” said Guenael Rodier, WHO’s IHR coordinator.

The rules were developed in response to the emergence of SARS (Severe Acute Respiratory Syndrome), Ebola virus, and avian influenza.

Under the IHR, countries are obligated to alert WHO about health threats that may have implications for the global community, from contaminated food to chemical agents.

Rules for quarantines, surveillance of travelers, and around-the-clock alert systems are also clarified, the list of named diseases is now open-ended, and countries are now under greater pressure to be transparent in their decisionmaking.

According to WHO officials, two-thirds of countries that signed on to the IHR need to make major progress before being able to meet the standards of the new requirements.

“It will be a very great challenge for countries to develop their core capacities, especially the low income countries,” said David Heymann, WHO assistant director-general for communicable diseases. [Editor’s note: To read the new IHR, see Law Behind the News, below.] The News originally featured the revised International Health Regulations (IHR) in the December 20, 2006 issue, when they were accepted by the United States.

[See http://www2a.cdc.gov/phlp/dailynews/...specific=377.] The IHR went into effect this week, and in recognition of this public health milestone, the News is pleased to feature them once again.

Of particular interest are the rules delineating “special provisions for travelers,” found in Chapter III, Articles 30-32. Among the provisions for travelers: If there is evidence of an imminent public health risk, the State Party may, in accordance with its national law and to the extent necessary to control such a risk, compel the traveler to undergo or advise the traveler, pursuant to paragraph 3 of Article 23, to undergo: (a) the least invasive and intrusive medical examination that would achieve the public health objective; (b) vaccination or other prophylaxis;

Or (c) additional established health measures that prevent or control the spread of disease, including isolation, quarantine or placing the traveler under public health observation. To read the full text of the IHR, visit http://www2a.cdc.gov/phlp/docs/IHRWHA58_3-en.pdf .

Further excerpts from the CDC's Health Law News... Wednesday, June 27, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** MRSA Study Results.

The Association for Professionals in Infection Control and Epidemiology has released its Methicillin Resistant Staphylococcus aureus (MRSA) Study Results.

The study is the first to quantify the prevalence of MRSA nationwide, and is available at http://www.apic.org/Content/Navigati...dy_Results.htm . *** Disaster Management Conference (7/8-7/11).

The Canadian Centre for Emergency Preparedness will present the 18th World Conference on Disaster Management, July 8-11, 2007, in Toronto.

For more information, visit http://www.wcdm.org/ . “Duck farmer sues over registration rule” Associated Press (06/22/07) http://www.chron.com/disp/story.mpl/ap/fn/4913036.html A Mennonite farmer is suing the Pennsylvania Department of Agriculture for its enforcement of a federal law requiring the registration of farms engaged in the interstate selling of poultry.

While Pennsylvania does not require registration, New York state does require monitoring or private testing of poultry before live birds can be sold there.

This year, for the first time, Pennsylvania officials have said farms must register with the U.S.

Department of Agriculture to participate in the program, which monitors for poultry-borne disease.

James Landis is seeking a religious exemption from the law, which would require him to obtain a registration number to continue selling his ducks at live bird markets in New York City.

He also contends that Pennsylvania lacks the authority to mandate participation in a voluntary federal program.

At the heart of the lawsuit is Landis’ belief that the biblical book of Revelation warns that such numbering systems are the work of the Antichrist.

“He sincerely (believes) that if he, as a Christian, were to participate in such a numbering system, it would result in his eternal damnation,” says the lawsuit.

According to Landis, the registration requirement violates his religious freedom as guaranteed in Pennsylvania’s Constitution.

A hearing was scheduled to be held in the state Commonwealth Court last Thursday. [Editor’s note: To learn more about the federal Poultry Products Inspection Act, visit http://www.fsis.usda.gov/Regulations...p#Sec.%20460.] Effect of widespread restrictions on the use of hospital services during SARS outbreak Canadian Medical Association Journal (06/19/07) Michael J.

Schull and others http://www.cmaj.ca/cgi/content/full/cmaj;176/13/1827 The authors of this study sought to determine the effect of restrictions on the non-urgent use of hospitals in Toronto, Canada, during the 2003 SARS (severe acute respiratory syndrome) epidemic.

At the beginning of the outbreak, provincial officials declared a health emergency, triggering restrictions on the use of all 32 hospitals in the Greater Toronto Area, including the restriction of surgeries to urgent cases.

The authors’ objectives were to determine how well the restrictions actually reduced the elective (non-emergency) use of hospital-based services;

Whether the restrictions disrupted urgent services or affected vulnerable patients;

And whether patients instead received treatment in other sectors of the healthcare system or other locations not subject to the restrictions.

The researchers used data from two other regions as a baseline.

They then reviewed patient records and determined rates of hospital admissions, emergency department and outpatient visits, diagnostic testing, and drug prescribing for the period from March 2000 to April 2004.

The researchers found that the restrictions resulted in a 12 percent decrease in the overall rate of hospital admissions in Toronto, and found they had the greatest effect on reducing the number of elective admissions and procedures.

The study did surface some unintended consequences, including the likelihood that “some potentially seriously ill patients did not present to hospital, and access to specialized care may have been more limited than in the pre-SARS period.” The authors advise that “Plans to increase surge capacity by restricting non-urgent use of hospital services result in only modest increases in capacity.”

Further excerpts that may be of interest to FT's... From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ Wednesday, August 15, 2007 *** Planning for a Pandemic.

Michael O. Leavitt, Secretary of the Department of Health and Human Services, has released "Pandemic Planning Update IV." The document reports generally on the state of influenza pandemic preparedness.

To view the report, visit http://www.pandemicflu.gov/plan/panflureport4.pdf . Nonpharmaceutical interventions implemented during the 1918-1919 influenza pandemic Journal of the American Medical Association (08/08/07) Howard Markel and others http://jama.ama-assn.org/cgi/content/short/298/6/644 (subscription required) This study sought to assess the nonpharmaceutical interventions (NPIs) implemented in 43 U.S.

Cities during the 1918-1919 influenza pandemic to determine whether variations in mortality were associated with the interventions.

Nonpharmaceutical interventions, or social distancing measures, typically include: isolation of the ill and quarantine of people suspected of having contact with the ill;

School and business closure;

And public gathering bans.

The authors of this study reviewed data from 43 of the most populous U.S.

Cities. Using "historical data collection and contemporary epidemiological and statistical analytic tools," the authors computed the weekly excess death rates (EDR) and determined the use of NPIs.

The authors found there were 115,340 excess pneumonia and influenza deaths in the 43 cities during the weeks analyzed.

Every city had adopted at least one of the three major types of NPIs, and 15 had applied all three types concurrently.

Cities that implemented the interventions earlier reached peak mortality later, had lower peak mortality rates, and lower total mortality.

Also, the relationship between increased duration of NPIs and reduced total mortality burden was statistically significant.

Upon analysis, the authors found that "[l]ate interventions, regardless of their duration or permutation of use, almost always were associated with worse outcomes.

However, timing alone was not consistently associated with success.

The combination and choice of NPIs also appeared to be critical." They also found that, in cities that experienced two peaks of excess mortality, "activation of nonpharmaceutical interventions was followed by a diminution of deaths and, typically, when nonpharmaceutical interventions were deactivated, death rates increased." National: Man smuggling monkey may have violated health laws, international treaty "Man smuggles monkey into NYC airport" Associated Press (08/07/07) http://www.freepress.com/apps/pbcs.d...06/1009/NEWS07 "It is kind of a spirited monkey." -- Alison Russell, a Spirit Airlines spokesperson, on an attempt to smuggle a marmoset monkey into the United States under a man's hat last week.

The monkey was discovered on the last leg of a flight from Peru to Florida to New York when it was found swinging on the man's ponytail during the flight.

Federal public health officials confiscated the monkey upon arrival in New York, and will hold it in quarantine for 31 days.

[See Briefly Noted item, above.] LAW BEHIND THE NEWS

In math it is good practice to upload used combinatorical data, so the results can be checked. in virology it's good practice to upload sequences to genbank, so it can be checked. And even better would be, if the used data are available in easy computer readable format. In epidemiology it's good practice to upload used statistical data so the results can be checked. But I rarely see this. Why is it ?

Are those people afraid someone else could compete for the grants ?

Why don't public institutions like Universities, foundations support availability of data ? Why is most data still only available to subscribers of journals ? Why do Universities (who historically first used the internet !) apparantly see the internet now as an unwanted competition and don't support online-research , don't make lectures public ? (that's what I feel) Is it conform with their public funding ? (assuming most Universities are public)

Wednesday, August 29, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Continental Pandemic Influenza Plan.

Mexico, the U.S.A., and Canada have developed the North American Plan for Avian and Pandemic Influenza, as part of the Security and Prosperity Partnership of North America.

View the plan at, http://www.spp.gov/pdf/nap_flu07.pdf . Canada: Nurses to receive respirators, needles to combat job-related infections like SARS "Ontario to supply safety needles" The Globe and Mail (08/24/07) Steve Rennie http://www.theglobeandmail.com/servl....wontneedles24 "Study says biolab not a threat to S.

End" Boston Globe (08/24/07) Stephen Smith and Felicia Mello http://www.boston.com/news/local/art...reat_to_s_end/ In response to pending litigation, the National Institutes of Health (NIH) were asked to assess the safety of a high-security research laboratory being built in Boston's South End neighborhood.

The Boston University (BU), NIH-funded lab is currently under construction in the crowded South End.

It is designed to be a Biosafety Level-4 facility, housing biological agents that could potentially be used by terrorists, including viruses, bacteria, and fungi.

South End residents and a conservation group have sued in state and federal court to stop construction of the lab, which they say poses a threat to area residents.

The NIH study was conducted to address concerns raised in the suits that BU had not considered other locations for the lab, and that it will create an undue burden on the South End's low-income, racially diverse population.

The report compares a germ leak from the lab into the South End neighborhood with what might happen if the lab had been built on more secluded property.

"[u]nder realistic conditions, infectious diseases would not occur in the communities as a result," the report concluded.

But some bioterrorism specialists opposed to the lab say the report failed to examine pathogens that are easily spread from person to person.

"These scenarios are really contrived.

The diseases which have been picked are ones which are really not that contagious.

And the diseases which have been avoided are the ones we really need to be worried about, like avian flu and SARS," said Jeanne Guillemin, a senior fellow at the MIT Security Studies Program.

NIH will hold a public meeting in Boston on September 20, 2007 to discuss the report.

Last August, a state judge ruled that BU must supplement its environmental impact statement, and called the state's approval of the project "arbitrary and capricious." A hearing in that case is scheduled for September. [Editor's note: To read the text of the NIH report, "Draft Supplementary Risk Assessments and Site Suitability Analyses for the National Emerging Infectious Diseases Laboratory Boston University," visit http://www.nems.nih.gov/aspects/nat_...ms/nepa2.cfm.]

Further excerpts from the CCDC...nice to see Winnipeg is on the map for something other than Ebola Wednesday, September 26, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Federal Pandemic Preparedness Hearing (09/28).

The U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia will hold a hearing at 10 a.m.

ET on September 28.

The hearing, in Dirksen Senate Office Building, Room 342, is entitled "The Role of Federal Executive Boards' in Pandemic Preparedness." For more details, visit http://hsgac.senate.gov/index.cfm?Fu...&HearingID=483 . *** Capital District Pandemic Preparedness Hearing (10/03).

The U.S. Senate Committee on Homeland Security and Governmental Affairs Subcommittee on Oversight of Government Management, the Federal Workforce, and the District of Columbia will also hold "Preparing the National Capital Region for a Pandemic." This hearing is at 10 a.m.

ET on October 3, in Room 342 of Dirksen Senate Office Building.

For details, visit http://hsgac.senate.gov/index.cfm?Fu...&HearingID=485 . *** Pandemic Influenza Checklist, Law Enforcement.

The Department of Health and Human Services (DHHS) has developed a checklist for law enforcement agencies, to provide a general framework for creating a pandemic influenza plan.

The checklist is accessible via http://www.pandemicflu.gov/plan/work...nforcement.pdf . *** Pandemic Influenza Checklist, Correctional Facilities.

DHHS has also developed a checklist for prison and jail systems to self-assess and improve their preparedness for responding to pandemic influenza.

For details, see http://www.pandemicflu.gov/plan/work...nchecklist.pdf . *** WHO Report.

The World Health Organization has released World Health Report 2007 -- A safer future: global public health security in the 21st century.

To read the report, visit http://who.int/whr/2007/en/index.html . "Preparing racially and ethnically diverse communities for public health emergencies" Health Affairs (09/07) Dennis P.

Andrulis and others http://content.healthaffairs.org/cgi...ract/26/5/1269 The authors of a Drexel University School of Public Health study say the needs of racial and ethnic minorities are being left out of the nation's public health emergency plans.

According to the authors, studies have shown that minority communities are more vulnerable than others before and after a public health disaster.

They suggest several reasons for the disparity, including "socioeconomic differences, culture and language barriers, lower perceived personal risk from emergencies, distrust of warning messengers, lack of preparation and protective action, and reliance on informal sources of information." The research team's review of reports and peer-reviewed publications on emergency preparedness found a general lack of information focusing on racial/ethnic minorities.

Nearly half of the Websites on emergency preparedness reviewed made no mention of racial/ethnic minorities, and only 12.6 percent provided information or materials on preparing diverse communities.

The researchers identified five initiative areas for consideration, and suggest strategies for integrating diverse communities into emergency preparedness: "emergency risk communication;

Training and education;

Resource guides for planners and responders;

Measurement and evaluation;

And policy and program initiatives." Among their recommendations include the need to "tailor public health messages, [and] use trusted messengers;" coordinate local government agencies and grass-roots groups representing diverse constituents, and centralize information and resources;

And "assess the effectiveness of preparedness programs .

[by] including measures to determine the presence of disparities in both processes and outcomes." Finally, the authors recommend drawing on "the expertise and integrat[ing] the perspectives of key organizations and individuals in the fields of cultural competence and disparities reduction with public health preparedness." [Editor's note: Visit the National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities, at http://www.diversitypreparedness.org/.] "I'm dealing in caffeine and sugar." -- Julian Schioler, a Winnipeg, Canada, high-school student currently earning a living selling black-market soda to classmates.

A new school division policy has recently ended the sale of soft drinks, potato chips, and chocolate in school cafeterias.

According to Schioler, he recently sold 48 cans of Coke in two days to caffeine-deprived students.

[See Briefly Noted item, above.]

Excerpts from today's CDC Health Law News. Quite a lot related to pandemic influenza.

Note the first item in relation to the ProMed mapping tool: Wednesday, October 24, 2007 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** History of Privacy and Disease Surveillance Book.

The University of California Press has announced the publication of Searching Eyes: Privacy, the State, and Disease Surveillance in America, written by Amy L.

Fairchild, Ronald Bayer, and James Colgrove.

The book details the history of public health surveillance and the reporting of names in the United States.

For more information about the book, including the table of contents, visit http://go.ucpress.edu/Fairchild . *** Influenza Report.

The American Academy of Pediatrics and the Trust for America’s Health recently released a report entitled “Pandemic Influenza: Warning, Children At-Risk,” available at http://healthyamericans.org/reports/...andemicFlu.pdf “Parents use religion to avoid vaccines” Associated Press (10/17/07) http://www.nytimes.com/aponline/us/A...-Skeptics.html State vaccination records and CDC data show that parents around the country are increasingly claiming religious exemptions to avoid vaccinating their children.

While some of these parents hold genuine beliefs, a growing number of parents use the religious exemption because it is the only way to avoid having their children vaccinated under their state’s law, according to an Associated Press analysis.

“I find it very troubling, but for my son’s safety, I feel this is the only option we have,” said Sabrina Rahim, who claimed a religious exemption for her son.

All states require children to be immunized against such diseases as measles, mumps, and chickenpox, but exemptions are provided.

Twenty states allow parents to opt out of vaccines for medical, religious, personal, or philosophical reasons, and two states allow medical exemptions only.

The other 28 states permit medical or religious exemptions only, and in 20 of those 28 states, the rate of granted religious exemptions for kindergartners has, in some cases, doubled or tripled over the past four years.

Parents who use religious exemptions for non-religious reasons generally are not convinced that vaccines are effective or they fear that vaccines put their children at risk for illnesses such as autism, despite studies that show no link between vaccines and autism.

However, health officials worry that non-vaccinated children could cause an outbreak.

“When you choose not to get a vaccine, you’re not just making a choice for yourself, you’re making a choice for the person sitting next to you,” said Dr.

Lance Rodewald, director of CDC’s Immunization Services Division. [Editor’s note: For an example of a state law that only allows medical or religious exemptions, see Mass.

Gen. Laws ch. 76 §15, at http://www.mass.gov/legis/laws/mgl/76-15.htm .

To see a state law that allows exemptions for “personal beliefs,” see Cal.

Health and Safety Code § 120325(c), at http://www.7mac.com/academy/Health_Safety_Vaccines.htm .

To learn more about thimerosal, a mercury-containing preservative used in some vaccines, visit http://www.cdc.gov/od/science/iso/co...imerosal.htm.] “After an attack, plan B has its limits” Newsday (10/18/07) Carol Eisenberg http://www.latimes.com/news/nationwo...tory?track=rss While backup facilities for Manhattan companies were erected during initial post-9/11 disaster preparedness planning, the emphasis has now shifted to pandemic influenza plans.

Immediately after 9/11, business organizations with an eye toward disaster preparedness were focusing on “redundancy” and “geographic dispersal.” The idea was for businesses to develop alternative headquarters, backup data centers, and contingency plans.

Shortly after 9/11, many Manhattan companies established secondary sites in Long Island, New Jersey, and Westchester County.

The New York Mercantile Exchange even replicated its trading floor at an undisclosed location on Long Island.

The companies’ secondary sites largely reflect October 2003 recommendations by the Securities and Exchange Commission that such secondary sites be located on different grids for power, transportation, and communications.

“Scenarios that were dismissed as farfetched in the days before 9/11 became operative presumptions the day after,” said Brian Jenkins, Rand Corporation senior analyst.

However, while secondary site measures protect data and business operations to an extent, a March report by the Government Accountability Office said that trading remains vulnerable because “all key trading staff are still concentrated in one geographic area.” Hence, more than 1,600 financial companies are currently testing contingency plans in a three-week influenza pandemic simulation to see how Wall Street would handle a situation with likely quarantines and shuttered transportation.

“The intent is to understand what will happen to the markets and the financial infrastructure if a pandemic does hit in a severe way,” said Howard Sprow of the Securities Industry and Financial Management Association. “Pandemic vaccine to be given in order” USA Today (10/22/07) Anita Manning http://www.usatoday.com/news/health/...ic-order_N.htm A report presented this week at a meeting of the National Vaccine Advisory Committee (NVAC) sets out guidelines for determining which groups should receive influenza vaccines in the early phase of a pandemic.

The plan was developed by the NVAC as well as scientific, business, and community representatives over several months.

“Once a pandemic starts, vaccine will come rolling off the line in lots, so there has to be a priority scheme on who would receive it first,” said Dr.

William Raub, science advisor to Health and Human Services Secretary Michael Leavitt.

“The committee tried to identify those who would be critical to national and homeland security, critical to fighting the flu itself, and critical to maintaining a functioning society,” he said.

Pregnant women and children were considered a priority, as were members of the military, and medical and emergency workers.

But the plan allows for flexibility based on local needs and severity of the pandemic.

In a mild outbreak, in which fewer deaths will be seen among the young and healthy, vulnerable groups with potentially weaker immune systems, such as the elderly, might be moved higher on the list.

In a severe pandemic, groups vital to the functioning of essential services, including utility workers or essential government employees, would be given priority.

The report envisions nearly 23 million people will be among the first to receive the vaccine;

74 million sick and elderly and 122 million healthy people ages 19-64 may have to wait. [Editor’s note: See New Tools in Public Health Law, below, for more.] PHL NEWS QUOTATION OF THE WEEK “Children are inherently more at risk because they congregate in groups.

They like to ‘share’ their secretions.

They won’t share their toys, but are happy to share their germs.” -- Dr.

Margaret C. Fisher, of The Children’s Hospital at Monmouth Medical Center, Long Branch, New Jersey, on the need to address the issue of pandemic influenza in children.

According to a new report from the Trust for America’s Health and the American Academy of Pediatrics, school children are the group most responsible for transmission of contagious respiratory viruses, including influenza.

[See Announcement item, above.] LAW BEHIND THE NEWS

Updates from the CDC Health Law News that may be of interest to FT readers: J. Wednesday, January 23, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** School Infectious Disease Plans.

The U.S. Department of Education recently released "Managing an Infectious Disease Outbreak in a School." The document, available at http://rems.ed.gov/views/documents/LL_Vol2Issue3.pdf , provides suggestions for school districts to consider when developing emergency management plans that incorporate planning for an infectious disease outbreak. *** Patent Law and Biodefense Paper.

The Science Advisory Board has published an online article by News reader Dana Perkins, PhD, concerning the impact of biomedical patents and associated litigation on biodefense/public health preparedness efforts.

The article is available at http://www.scienceboard.net/communit...tives.198.html . "Disaster plan is set for release" Washington Post (01/20/08) Spencer S.

Hsu http://www.washingtonpost.com/wp-dyn...011901081.html This week, the U.S.

Department of Homeland Security (DHS) announced a revised disaster and emergency plan for federal, state and local governments.

The National Response Framework, to replace the National Response Plan, restores power to the Federal Emergency Management Agency (FEMA), giving FEMA authority to name the top officer to coordinate most disaster responses.

Under the previous plan -- completed nine months prior to Hurricane Katrina -- the DHS secretary appointed the coordinating officer.

"They've finally woken up and gone back to, in essence, the old [plan] that said who's on first, which is what we needed," said Michael D.

Brown, named by DHS Secretary Michael Chertoff as the coordinating officer for Hurricane Katrina.

Allowing FEMA to appoint the top coordinating officer clarifies responsibility and ends confusion that has caused critical delays, according to states.

"The country will have a much better response with this plan than we had with the previous plan," said Tim Manning, director of homeland security and emergency management for New Mexico and spokesman for the National Emergency Management Association, whose members include his counterparts in the 49 other states.

The new plan also eliminates the requirement for the DHS secretary to declare an Incident of National Significance to trigger a more aggressive response -- a step delayed during Hurricane Katrina.

The shorter, revised National Response Framework is intended to be easier for government and private sector executives to use, with detailed explanation in some 30 online annexes.

The Framework takes effect March 22, 2008. [Editor's note: To enter the National Response Framework Resource Center, which includes a copy of the framework, the annexes, and training courses, see http://www.fema.gov/emergency/nrf/.]

An excerpt from the CDC Health Law News which may be of interest to FT readers Wednesday, February 20, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ National: A dozen states will consider paid sick day bills this year “States lead push for paid sick days” Stateline (02/13/08) Christine Vestal http://www.stateline.org/live/detail...ntentId=280734 LAW BEHIND THE NEWS A dozen states, Washington D.C., and the U.S.

Senate are considering legislation that could make paid sick days a basic labor standard.

Advocates claim that such legislation would prevent the spread of seasonal illnesses by making it easier for employees to decide to stay home sick rather than expose coworkers to illness. Jen Kern of the Association for Community Organizations for Reform Now (ACORN) said that Connecticut and Washington D.C.

Are closest to enacting sick-day laws.

The Connecticut bill, as it is written now, would require employers, at a minimum, to provide “paid sick leave annually…at the rate of one hour of paid sick leave for each forty hours worked.” Employees would be entitled to use accrued sick leave beginning on the ninetieth day of employment although employers could agree to an earlier date.

Sick leave would be permitted for: physical or mental illness, injury, and health condition;

Diagnosis, treatment, or care of such illness, injury or condition;

And medical care and counseling for victims of family violence, sexual assault, or stalking.

The bill also includes confidentiality, anti-retaliation, and advance notice provisions. Alaska, California, Colorado, Connecticut, Massachusetts, Minnesota, North Carolina, Pennsylvania, Ohio, Rhode Island, West Virginia, and Wyoming join Connecticut and Washington D.C in considering sick-day bills. [Connecticut’s Raised Bill No.

217, “An Act Mandating Employers Provide Paid Sick Leave to Employees,” is available at http://www2a.cdc.gov/phlp/docs/2008SB-00217-R00-SB.pdf .

For more on sick-day bills, see Briefly Noted item, above.]

Further excerpts from the CDC Health Law News that may be of interest to FT readers. A moderator may wish to parse the article in the middle about chicken farms... J. Wednesday, February 27, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** 1918 Influenza Information.

The U.S. Department of Health and Human Services recently released an online resource that explains the circumstances and history of the 1918 influenza pandemic.

“The Great Pandemic: the United States in 1918-1919” is available at http://1918.pandemicflu.gov/index.htm . *** Immunization Conference (3/17-3/20).

Regular registration for the 42nd National Immunization Conference runs through February 29, 2008.

The conference will be held on March 17-20, 2008, in Atlanta, Georgia, and includes sessions covering on health education policy and legislation.

For more information, see http://www.cdc.gov/vaccines/events/nic/default.htm . “Climate change: the public health response” American Journal of Public Health (03/08) Howard Frumkin and others http://www.ajph.org/cgi/content/abst....2007.119362v1 (subscription required) The authors of this paper propose a public health approach to climate change based on the ten essential services of public health.

First, they review the links between weather, climate, and the health of the public.

As a result of climate change, public health practitioners can expect “injuries and fatalities related to severe weather events and heat waves;

Infectious diseases related to changes in vector biology, water, and food contamination;

Allergic symptoms related to increased allergen production;

Respiratory and cardiovascular disease related to worsening air pollution;

And nutritional shortages related to changes in food production.” The authors introduce principles of a proactive response to these issues, including preparedness, risk management, and ethics.

The standard framework for public health action is the ten essential services of public health, which include “mobilizing community partnerships to identify and solve health problems,” “developing policies and plans that support individual and community health efforts,” and “enforcing laws and regulations that protect health and ensure safety.” The authors point to several areas where coordination and collaboration with government agencies, non-governmental legal partners, and emergency planners could strengthen the public health response to challenges caused by climate change.

The authors also call on public health practitioners to share information with decision makers and to “explain the health rationale for climate change mitigation in terms of reduced morbidity and mortality,” and “provide evidence on the health impacts of various approaches to climate change mitigation.” [Editor’s note: To read more about climate change, visit the Intergovernmental Panel on Climate Change, a scientific intergovernmental body established by the World Meteorological Organization and the United Nations Environment Programme, at http://www.ipcc.ch/.] “U.S.: states better prepared for disasters” Associated Press (02/21/08) Mike Stobbe http://ap.google.com/article/ALeqM5j...G-6kAD8UUC9KO0 CDC’s Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER) has released its inaugural report on emergency public health preparedness in U.S.

States. The report was the first assessment of states’ readiness since 2001, when the federal government began investing what would become $5 billion to make the country better prepared.

The report considered the staffing, laboratory capabilities, and other resources available to local, state, and territorial health departments for response to bioterrorism or other public health disasters.

For example, more local and state health departments are now able to detect biological agents than in 2002;

Nearly 50 laboratories for detecting chemical agents exist now, up from zero in 2001.

COTPER also found that all states are now conducting year-round influenza surveillance, and have improved their ability to share information between laboratories and public health departments.

COTPER indicated that some areas are still in need of improvement: many states do not have enough epidemiologists;

State laws need to be updated;

And disease surveillance data exchange in 16 states appears to be inadequate.

Public health experts cited a steady decrease in funding from the federal government as an impediment to states’ readiness.

“You can’t expect states to be doing better if the federal government keeps cutting funding,” said Jeff Levi, executive director of Trust for America’s Health.

Overall, COTPER officials were positive about states’ progress.

“I think in terms of effort and progress, an ‘A.’ In terms of amount of work to be done, I would say that’s absolutely enormous,” said Director Richard Besser. [Editor’s note: To read “Public Health Preparedness: Mobilizing State by State: A CDC Report on the Public Health Emergency Preparedness Cooperative Agreement,” visit http://emergency.cdc.gov/publications/feb08phprep/.] Oklahoma: Poultry industry said to ‘infest’ waterways, threaten public health “State seeks injunction in poultry litter case” Daily Oklahoman (02/20/08) Jim Stafford http://newsok.com/article/3206454/1203479878 By Jim Stafford Business Writer TULSA — Attorney General Drew Edmondson told a federal judge here Tuesday that the poultry industry has "infested” waterways in northeastern Oklahoma with pollution that is a risk to the public's health. The state is seeking an injunction from Federal Judge Gregory K.

Frizzell barring the spread of poultry litter in the million-acres Illinois River watershed that stretches from northwest Arkansas through northeast Oklahoma to Lake Tenkiller. In a 20-minute opening statement, Edmondson claimed that the poultry industry has "infested rivers, streams and wells with biological pathogens” in the Illinois River watershed.

The request for the injunction against spread of poultry litter is a prelude to the multimillion-dollar lawsuit that Edmondson filed against the industry in 2005. The threat to people who live in the watershed area or recreate in its waters is so serious that an injunction can't wait until the state's pollution lawsuit against 13 poultry companies begins next year, Edmondson said. Opening statements in the hearing were delayed almost an hour as attorneys for both sides wrangled over three motions that involved the expected testimony of expert witnesses and the state's request to eliminate some data prepared by one of its witnesses. Edmondson outlined the state's case and the list of witnesses it expects to call over the three days that Frizzell has allotted it to make its case.

The poultry industry defense will have its turn after that. "Injunctive relief is authorized when there may be risk of harm,” Edmondson said.

"If an error is to be made, the error must be made in protecting the public health and the environment.” However, in his opening statement for the defense, Tyson Foods attorney Patrick Ryan told the judge that the state's request would harm the "little guy,” the poultry farmers who grow millions of chickens and turkeys on a contract basis for the corporations. Plus, the application of chicken litter on land throughout the Illinois River watershed is specifically authorized by the state through a permitting process by the state Agriculture Department, he said. "The state has not been able to identify a single person who has become ill because of contact with water in the watershed,” Ryan said. Edmond told the judge that there are 1,835 poultry houses in the Illinois River watershed area, 80 percent of which are on the Arkansas side of the border. Although the integrated poultry companies have tried to distance themselves from the poultry waste created by millions of birds each year, Edmondson said the birds are property of the corporations. "Farmers have never, ever owned the birds, unless, of course, if a bird dies,” he said.

"then it becomes the property of the farmer.” The state's first witness was Oklahoma Secretary of Environment Miles Tolbert, who along with Edmondson filed for the injunction on behalf of the state. Tolbert identified poultry waste as the "primary” source of fecal pollution in the watershed, although other sources such as cattle, humans and other wildlife also contribute to levels of bacteria that result in a state of "impairment” of the rivers and lakes in the area, he said. "We need to have this relief now in order to protect the public health this summer and ongoing,” Tolbert said from the witness stand. Under a contentious cross examination by Ryan, Tolbert said he had not considered taking similar enforcement steps against the cattle industry, despite documentation that showed cattle were the primary fecal source of pollution in every other watershed area of the state. "Have you filed lawsuits against ranchers and cattlemen,” Ryan asked? Tolbert answered "no.” When asked why he had filed a lawsuit against the poultry integrators, Tolbert replied that it was because it is the integrator's waste. "The farmers feed birds owned by the integrators,” Tolbert said.

"What comes out the other side is the result of the integrators' actions.” The hearing moved on to an afternoon session in which Judge Frizzell would not allow Dr.

Barry Wynn of Tahlequah to testify as an "expert” witness for the state, although he did permit his testimony. Wynn said he developed a strategy to treat patients injured in the Illinois River with a procedure similar to someone injured in a barnyard accident because of the frequency of infections that occurred in the wounds. The hearing is expected to continue through the end of this week, then break for a week and resume March 3.

Further excerpts.... Wednesday, March 5, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** SARS Series.

The South China Morning Post has published a five-part series on the severe acute respiratory syndrome (SARS) epidemic that began in 2003.

To access the articles, visit http://www.scmp.com/portal/site/SCMP...ame=After+Sars . *** Ethics, Human Rights, International Law Article.

A 2007 paper entitled “The Duty of States to Assist Other States in Need: Ethics, Human rights, and International Law,” written by Lawrence O.

Gostin and Robert Archer, has been released and is freely downloadable from http://papers.ssrn.com/sol3/papers.c...act_id=1095769 . “In a massive disaster, care will be scarce” Sacramento Bee (03/02/08) Dorsey Griffith http://www.sacbee.com/111/story/753359.html The California Department of Public Health (DPH) recently issued groundbreaking guidance for health care and emergency responders in the event of a disaster.

The guidance document comprises 1,900 pages and focuses on the need to suspend or flex established laws and to ration health care during catastrophes.

“I don’t know of any state that has taken it to this level of detail in outlining a surge plan for everyone who needs to respond to an emergency of this magnitude,” said Jeff Levi, executive director of Trust for America’s Health.

The guidelines go against the ingrained instincts of professionals who are trained to save lives at almost any cost, according to Betsey Lyman, deputy director for public health emergency preparedness at DPH.

“This is, ‘OK, we have limited resources.

How do we best save the greatest number of lives?’” Lyman said.

For instance, to minimize red tape, hospitals will not be required to report births, deaths, infectious disease outbreaks, medication errors, or suspected child or elder abuse.

Also, unlicensed or retired health care providers with lapsed licenses will be recruited to provide emergency care during a health care surge.

The guidance suggests that medical treatment go first to people who are more likely to survive with immediate intervention rather than to those who are most critically ill.

“Everybody will have to think differently,” said Duane Dauner, president of the California Hospital Association. [Editor’s note: To access “Standards and Guidelines for Healthcare Surge during Emergencies,” see http://bepreparedcalifornia.ca.gov/E...sGuidelines/.]

From the excerpt: “ This is , ‘ OK , we have limited resources .

How do we best save the greatest number of lives?’” "To be, or not to be", this is a question. Maybe a "will be terminated" question? To paraphrase the above OK in: "This is NOT OK, we have limited resources." Seems easier to change laws than to invest more money into.

Quote: : From the excerpt: “ This is , ‘ OK , we have limited resources .

How do we best save the greatest number of lives?’” Seems easier to change laws than to invest more money into.

[Editor’s note: To access “Standards and Guidelines for Healthcare Surge during Emergencies,” see http://bepreparedcalifornia.ca.gov/E...sGuidelines/.] California's guidelines may truly be "groundbreaking" - a paradigm shift in the way pandamic plans are conceptualized and developed. The guidelines deserve a separate thread, with full elucidation, comparison and debate, IMO. J.

Further excerpts Wednesday, March 12, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Emergency Legal Preparedness Webinar (3/27).

A Webinar on the newly updated CDC courses "Forensic Epidemiology 3.0" and "Public Health Emergency Law 3.0" will be held on March 27, 2008, at 2 p.m.

ET. The Webinar will be moderated by the Public Health Law Program's Dr.

Richard Goodman, who will also describe the new "National Action Agenda for Public Health Legal Preparedness." To register, please visit: http://webcasts.naccho.org/session.php?id=1235/ *** Emergency Preparedness Law.

The New Mexico Legislature recently enacted the Uniform Emergency Volunteer Practitioners Act, available at http://legis.state.nm.us/lcs/_sessio...er=348&year=08 . *** Pandemic Influenza Toolkit.

The Department of Health and Human Services and CDC have released a pandemic influenza toolkit providing information and resources for community leaders.

To access the toolkit, see http://takethelead.pandemicflu.gov/takethelead/ . *** Public Health and Disasters Conference (5/18-5/21).

The 7th UCLA Conference on Public Health and Disasters will be held in Torrance, California, on May 18-21, 2008.

For more information, see http://www.cphd.ucla.edu/conf2008.htm . "The up side of the SARS outbreak" Canadian Press (03/06/08) Helen Branswell http://telegraphjournal.canadaeast.c...article/231976 The 2003 outbreak of severe acute respiratory syndrome (SARS) is being viewed in retrospect by some Canadian public health officials as a catalyst for important changes there and around the world.

"If there's a silver lining out of SARS, it is that it did become part of the political, policy, public health and public consciousness that we have to be serious about these issues and we can't just wait for problems to happen to respond," said Dr.

David Butler-Jones, the first chief public health officer of the Public Health Agency of Canada.

The Agency itself was created on recommendation of the first inquiry into SARS (the Naylor Report) and was designed to give public health concerns more attention.

The Canadian government also enhanced the National Microbiology Laboratory, constructing an emergency operations center and expanding the laboratory's expertise in development of new vaccines.

Internationally, the memory of SARS and threat of H5N1 avian influenza prompted the World Health Organization (WHO) to strengthen the International Health Regulations (IHR), according to Dr.

David Heymann, WHO's assistant director general for health security and environment.

The IHR outline countries' responsibilities to report and control infectious diseases.

Some experts warn that all countries -- not just the ones that have already been affected by tragedy -- should be preparing for emergencies.

"We're much better than we were but you never should stop and say 'We've got it all right.' Because you don't," said Dr.

James Young, former deputy minister of Public Safety and Emergency Preparedness Canada. [Editor's note: To read a fact sheet produced by the Public Health Agency of Canada about the progress achieved since SARS, see http://www.phac-aspc.gc.ca/sars-sras...rs0308-eng.php .

See also "Lots of change for key players in '03 SARS battle," Canadian Press (03/08/08), at http://www.nugget.ca/ArticleDisplay.aspx?e=934961 .

For a related article, "Lesson from SARS outbreak 'not learned,'" South China Morning Post (03/07/08) Ella Lee and others, visit http://www.scmp.com/portal/site/SCMP...ng+Kong&s=News (subscription required).] "Some small time farmers are worried new chicken regs ignore 'the little guy'" Kamloops Daily News (05/06/08) Jody Spark http://www.kamloopsnews.ca/index.shtml It became illegal last October to sell chicken, beef, pork and sheep in British Columbia unless they have been inspected and processed in licensed facilities.

The regulations were promulgated in part to maintain consumer confidence in the wake of avian influenza, bovine spongiform encephalopathy, and E.

Coli infections associated with some of these products.

Though the goal is to ensure that food is safe for the consumer, the new regulations have had the immediate effect of decreasing the amount of poultry that some small-scale chicken farms can afford to produce.

So far there are no licensed slaughterhouses in the Interior region of the province that will process the limited volume of chickens that smaller chicken farmers can deliver.

"We're really caught between a rock and a hard place.

We cut out chicken production 90 per cent this year," said small-scale farmer Andrea Gunner, who said she was forced to cut production due to the new regulations.

Some consumers are upset, claiming that the supply of locally produced poultry will decline as a result of the regulations.

"This is just an easy way to justify making our society dependent on mass-produced food," said Diane James, a consumer of local meat and produce.

More licensed plants that service smaller chicken farms will come on board within two years, predicted David Charnuck, a meat liaison officer for the Interior Health Authority.

"B.C. is the last province to do this.

.This year is going to be very challenging for people," Charnuck said.

Something related - MMWR Weekly just arrived with a notice about a Beta version of a program to estimate the costs of surveillance systems.

Here's the notice and link to the spreadsheet: Notice to Readers: SurvCost: Tool for Estimating Cost of Surveillance Systems Since 1998, CDC, with support from the United States Agency for International Development (USAID), has been a technical partner with the World Health Organization Regional Headquarters for Africa (WHO/AFRO) in the design, development, implementation, monitoring, and evaluation of Integrated Disease Surveillance and Response systems.

The purpose of this strategy is to develop surveillance and response capacities in African countries to improve timely detection, confirmation, and response to infectious diseases of concern to African communities. To help national surveillance programs estimate the costs of initiating and operating an integrated surveillance system, CDC collaborated with WHO/AFRO to develop a spreadsheet-based tool, SurvCost, to estimate the costs of supporting a surveillance program.

SurvCost leads users through a series of guided prompts that require entry of actual program costs in categories such as personnel, laboratory, office, capital equipment, transportation, and treatment.

Users can analyze costs by health facility, surveillance activity, or disease.

Such data can help disease surveillance system managers plan their budgets and advocate for additional resources to improve such systems .

SurvCost is available at http://www.cdc.gov/idsr/survcost.htm .

This week's excerpt. Note the item on venitlator allocation... Wednesday, March 19, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ 2007 State Public Health Legislation.

The Healthy States Initiative has released a report detailing 2007 state legislative activity pertinent to public health.

The comprehensive report is available at http://www.healthystates.csg.org/ . Public Health Workforce Report.

The Association of State and Territorial Health Officials (ASTHO) has released "2007 State Public Health Workforce Survey Results," reporting on the shrinking number of staff working in public health departments across the country.

To read the report, see http://www.astho.org/pubs/WorkforceReport.pdf . Universal MRSA Screening Study.

An article in the March 12, 2008 issue of the Journal of the American Medical Association reports that a universal screening strategy for Methicillin-resistant Staphylococcus aureus (MRSA) did not reduce nosocomial MRSA infection in a surgical department with endemic MRSA prevalence but relatively low rates of MRSA infection.

The study, entitled "Universal Screening for Methicillin-Resistant Staphylococcus aureus at Hospital Admission and Nosocomial Infection in Surgical Patients," is available at http://jama.ama-assn.org/cgi/content...ct/299/10/1149 (subscription required). *** Another Universal MRSA Screening Study.

A study published in the March 18, 2008, edition of the Annals of Internal Medicine concluded that: "The introduction of universal admission surveillance for MRSA was associated with a large reduction in MRSA disease during admission and 30 days after discharge." To access the study, entitled "Universal Surveillance for Methicillin-Resistant Staphylococcus aureus in 3 Affiliated Hospitals," see http://www.annals.org/cgi/content/abstract/148/6/409 (subscription required). Emergency Preparedness Research Funding.

A committee at the Institute of Medicine identified four priority areas for public health preparedness research in response to the Pandemic and All Hazards Preparedness Act.

The priorities will be used by CDC's Coordinating Office for Terrorism Preparedness and Emergency Response to help develop a research agenda that will inform funding opportunity announcements.

The priority report is available at http://www.iom.edu/CMS/3740/48812/50685.aspx . *** Climate Change and Island Disaster Preparedness Hearing (03/19).

The United States Senate Committee on Commerce, Science and Transportation held a full committee hearing in Honolulu, Hawaii, today to address climate change issues, such as disaster preparedness, faced by Pacific island communities.

For more information, see http://commerce.senate.gov/public/in...earing_ID=1946 "Allocation of ventilators in a public health disaster" Disaster Medicine and Public Health Preparedness (03/08) Tia Powell and others http://www.dmphp.org/cgi/content/short/2/1/20 (subscription required) This article summarizes the development and content of first-in-the-nation guidelines developed by the New York State Workgroup on Ventilator Allocation in an Influenza Pandemic.

The Workgroup was organized in 2006 and comprises experts in medicine, policymaking, law, and ethics.

Using an ethical framework developed specifically to address the issue of how to equitably distribute ventilators during an influenza pandemic, the Workgroup drafted an "ethically and clinically sound set of guidelines." The draft guidelines were opened for public comment and presented publicly across the state.

Subcommittees focusing on critical care and legal issues were created to assess the public comments.

According to the authors, the Workgroup "began with the central concept that ethics cannot be set aside during a public health disaster." The framework incorporates the following elements: duty to care;

Duty to steward resources;

Duty to plan; distributive justice;

And transparency.

The guidelines were created to "permit patient extubation [removal of a ventilator] but aim to limit the times that clinicians face this most ethically and emotionally challenging aspect of the ventilator rationing system." Clinical protocols will be altered during a public health emergency, and the Workgroup's guidelines include an "ethically acceptable" protocol that address the following concerns: pre-triage requirements;

Patient categories;

Acute versus chronic care facilities;

Clinical evaluation, including exclusion criteria;

Triage decision makers;

Palliative care; review of triage decisions;

And communication.

The Workgroup suggests this process "could serve as a template for the development of other policies regarding the allocation of scarce resources in public health emergencies." [Editor's note: To read the "Allocation of Ventilators in an Influenza Pandemic: Planning Document," visit http://www.health.state.ny.us/diseas...ventilators/.] Addressing gaps in health care sector legal preparedness for public health emergencies" Disaster Medicine and Public Health Preparedness (03/08) Montrece Ransom and others http://www.dmphp.org/cgi/content/abstract/2/1/50 (subscription required) This article explains the pivotal role that health lawyers play in preparing "hospitals, health systems, and other health provider components" for public health emergencies.

The authors describe several legal issues faced by health care providers in such emergencies, noting that most providers' emergency plans and policies currently "reflect marginal recognition" of such issues.

For example, health lawyers should be familiar with laws under which emergency declarations "enable the health care sector to more effectively provide care.by temporary modification or waiver of specific requirements of certain laws applicable to the health care sector." The authors cite a waiver under the State Children's Health Insurance Program (SCHIP) granted in the immediate aftermath of Hurricane Katrina by the Secretary of the Department of Health and Human Services.

The waiver guaranteed providers reimbursement for furnishing services to eligible recipients even if the providers were unable to comply with all the applicable provisions.

Legal preparedness issue areas highlighted by the authors include: requirements for providers to detect public health threats, the procedures and consequences of emergency declarations, patient protection and management, emergency health care staffing, health care facility management, and volunteer health professionals.

Laws applicable during emergencies, such as the Emergency Medical Treatment and Active Labor Act, the Health Insurance Portability and Accountability Act, and the Stafford Act, in addition to jurisdiction-specific laws, illustrate the need for health lawyers "to take part in state and community preparedness task forces and in drafting state and community response plans," according to the authors. [Editor's note: For more on emergency legal preparedness issues and to access the "National Action Agenda for Public Health Legal Preparedness," see http://www2.cdc.gov/phlp/PHActionAgenda.asp.] Oklahoma: In closing arguments, state accused of lacking evidence of illness "Watershed polluted with chicken waste bacteria" Associated Press (03/13/08) Justin Juozapavicius http://www.nwaonline.com/articles/20...8okpoultry.txt

More excerpts.... Wednesday, March 26, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Public Health Emergency Law and Forensic Epidemiology CD-ROM.

PHLP has released version three of the Public Health Emergency Law and Forensic Epidemiology training materials on CD-ROM.

These self-contained training packages were developed by for use by instructors in any jurisdiction in the United States who provide public health preparedness training to front-line practitioners.

Public Health Emergency Law is targeted at public health practitioners and emergency management professionals to improve understanding of the role of law as a public health tool.

Forensic Epidemiology is designed to help public health and law enforcement agencies strengthen coordination of responses to pandemic influenza and similar threats.

To learn more about the courses or to order a free CD-ROM, visit http://www2a.cdc.gov/phlp/phel.asp . *** International Emergency Management Conference (6/17-6/19).

The International Emergency Management Society (TIEMS) will hold its first conference, entitled "Global Cooperation in Emergency and Disaster Management," on June 17 to 19, 2008, in Prague.

For more information, see http://www.tiems.org/index.php?id=53 . "A man's love of pigeons, and his fight to feed them" New York Times (03/20/08) Cara Buckley http://www.nytimes.com/2008/03/20/ny...igeons.html?hp A state trial judge will soon rule on what is thought to be a novel legal issue for New York City: whether feeding pigeons on private property is a nuisance.

"Clearly, people have bird feeders in their backyard.

And that's not a nuisance," said Gabriel Taussig, the city's lawyer in the case.

"However, when you start feeding in excess, so there's a level of bird droppings that's unhealthy, it rises to the level of nuisance." Cecil Pitts, a 65-year-old man who lives in Queens, filed the lawsuit against the city after learning that he faced a $500 fine stemming from a complaint lodged by one of his neighbors.

"I didn't intend to pay the fine.

And if I was incarcerated, my dogs would die," said Pitts, who lives on $450 a month from Social Security and spends $10 a week on 20 pounds of birdseed.

The health department inspector who issued the nuisance citation to Pitts reported that at least 150 pigeons occupied Pitts' backyard and that 25 to 30 were on the roof of Pitts' home.

He also noted "excessive pigeon droppings" in Pitts' and the neighbors' yards.

According to Pitts, he has been feeding pigeons at his family home since the 1950s, and no complaints have ever been made until now.

"They are my whole life, because all my relatives are gone," Pitts said of the pigeons and his two 12-year-old dogs.

Pitts will make his next court appearance before Justice Charles J.

Markey of State Supreme Court in Queens on April 3, 2008. East Coast: Article reviews pandemic planning in New Jersey, Connecticut, New York "What if a flu like 1918's broke out now?" New York Times (03/23/08) Avi Salzman http://www.nytimes.com/2008/03/23/ny...l2/23rflu.html United Kingdom: Government releases National Security Strategy "New network to protect against natural disasters, terrorism" Gazette Reporter (03/19/08) http://www.gazetteandherald.co.uk/mo..._terrorism.php LAW BEHIND THE NEWS

Wednesday, April 2, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Pandemic Planning Update.

The U.S. Department of Health and Human Services has released “Pandemic Planning: Update 5,” available at http://www.pandemicflu.gov/plan/pdf/panflureport5.pdf . *** Pandemic Preparedness Webinar.

The U.S. Department of Health and Human Services will make available a Webinar about pandemic preparedness on April 7, 2008.

For more information, see http://www.pandemicflu.gov/news/panflu_webinar.html . *** FEMA Hearing (4/3).

The Senate Committee on Homeland Security and Governmental Affairs will hold a hearing entitled “The New FEMA: Is the Agency Better Prepared for a Catastrophe Now Than It Was in 2005?” on April 3, 2008, at 10:00 a.m.

ET in Dirksen Senate Office Building Room 342.

For more details, see http://hsgac.senate.gov/public/index...4-e0dff6dd865b . *** National Public Health Week (4/7-4/13).

The American Public Health Association will emphasize the public health community’s role in lessening the impact of climate change during this year’s National Public Health Week, from April 7-13, 2008.

For more on this year’s theme, see http://www.nphw.org .

Wednesday, April 9, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ "Alaska public health law reform" Journal of Health Politics, Policy and Law (04/08) Benjamin Mason Meier and others http://jhppl.dukejournals.org/cgi/co...33/2/281?rss=1 (subscription required) This case study narrates how Alaska employed the Turning Point Model State Public Health Act to revise the state's public health law over two consecutive legislative sessions.

The authors analyze the political conditions during both sessions, providing the public health practice community with information to facilitate the modernization of public health statutes and informing "scholarship on the role of law and policy in building enhanced public health infrastructures." The Turning Point Act was published in September 2003 as a tool for use by tribal, state, and local governments to assess and modernize their public health laws.

Legislation introduced in 2004 in the Alaska legislature reproduced the entirety of the Act.

The 2004 proposal failed, but after the session the Alaska Office of the Attorney General compared the state's public health law with the Turning Point Act, inspiring state health officials to incorporate parts of the Act into "a bill commensurate with the public health needs of Alaska." The Governor introduced the bill in January 2005, and it was signed into law later that year.

The authors conclude that there were at least three fundamental reasons for the bill's success: 1) Alaska health officials' participation in the Turning Point Collaborative, which produced the Turning Point Act;

2) a "politics of fear" that employed the specific threat of SARS (severe acute respiratory syndrome);

And 3) a top-down approach that allowed drafters to develop proposed legislative language within the Governor's administration, without having to enlist "legislative support through collaboration prior to introduction." [Editor's note: This case study is the first in a series to "assess states' consideration of the Turning Point Act for the purpose of public health law reform." For more information about the Turning Point Public Health Statute Modernization National Excellence Collaborative, including access to the Turning Point Act, visit http://www.turningpointprogram.org/P...tat_mod.html.]

Wednesday, April 16, 2008 From the Public Health Law Program, Office of the Chief of Public Health Practice, CDC http://www2a.cdc.gov/phlp/ *** Pandemic Influenza Draft Comment Period.

The Association of State and Territorial Health Officials (ASTHO) has released a draft version of "At-Risk Populations and Pandemic Influenza Planning: Guidance for State, Territorial, Tribal, and Local Health Departments." The draft is open for public comment until May 14, 2008.

To access the document, visit http://www.astho.org/templates/displ...d=3062&admin=1 . "SDF to retrieve Japanese if new flu hits abroad" Asahi Shimbun (04/11/08) http://www.asahi.com/english/Herald-...804110070.html The Japanese government has compiled a package of measures to deal with the possibility of a virulent influenza strain outside the country.

The measures are based on a potential World Health Organization (WHO) Pandemic Alert Phase 4 situation, in which an influenza virus has mutated into a new strain that moves rapidly among humans.

Japanese health experts have warned that if such a strain hits Japan, an estimated 25 million people will need medical attention, and up to 640,000 will die.

The government's plan will control travel into Japan from countries already experiencing the more virulent strain.

For example, airlines will be asked to suspend regular services if the virus is found in cities with direct flights to Japan.

Airplanes leaving affected countries will only be allowed to land at four airports, and ships will only dock at three ports.

Japanese citizens who are suspected of being infected and who attempt to return to their country will be denied repatriation;

Entry of people from affected countries will be sharply curtailed.

However, military aircraft and ships will be sent to other countries to bring infected Japanese citizens home.

If an infected Japanese citizen is denied repatriation, embassies and other government offices will refer them to medical facilities and provide them with medicine.

According to government figures, about 300,000 Japanese nationals live in other Asian countries where health experts warn a mutated influenza virus could break out. LAW BEHIND THE NEWS

Discussion Title: CDC: Excerpts from Public Health Law News
Title Keywords: CDC:  Excerpts  from  Public  Health  News  FluTrackers 



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