Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative

Pivoting From Influenza to COVID-19 Vaccinations: How a Minnesota Vaccination Program Reduced Barriers for Refugee, Immigrant, and Migrant Communities Accessing Vaccines During the COVID-19 Pandemic

The Minnesota Immunization Networking Initiative (MINI) led by Fairview Health Services has addressed barriers to accessing immunizations through partnerships with community organizations to provide free influenza vaccinations to historically underserved communities, especially refugee, immigrant, and migrant communities. Once the COVID-19 vaccine was available, MINI quickly pivoted operations to distribute the vaccine and provide technical assistance to community partners amidst rapidly evolving guidance. With infrastructure and a vaccination team in place, MINI responded to new and emerging needs, eg, implementing a more accessible and low-tech scheduling system, increasing staffing to meet growing needs, and expanding partnerships with community organizations and leaders. From February 2021 to September 2023, MINI organized 1120 community-based vaccine clinics and administered 43,123 COVID-19 vaccinations. Of those vaccine recipients, 88% identified as Black, Indigenous, and other people of color, and for preferred language, over half stated that they preferred a language other than English. These demographics are similar to those of the earlier influenza clinics, even as average annual clinics have tripled and average total vaccinations have quadrupled since the pivot to COVID-19 vaccination clinics. Some keys to success were: (1) consistent, bidirectional communication and shared decision-making with community partners; (2) prioritizing sustainable staffing models with the support of administrative leadership and resources; and (3) having a community-informed approach supported by the practice of hiring staff from communities served. Because of the effectiveness of this model, MINI is primed to respond to planned and unplanned emergent public health crises.

Increasing Emotional Distress and Use of Health Services among Hospitality Industry Workers During and After the COVID-19 Lockdown

Objective

To examine the emotional distress situation among hospitality industry workers and their access to and use of health care including telehealth services during the COVID-19 pandemic.

Methods

A survey was administered on the Qualtrics platform both in English and Spanish from November 18, 2020, to November 30, 2020, through the Culinary Workers Union in Nevada. A total of 1182 union members participated in the survey, of whom 892 completed the survey. Descriptive and multivariable regression analyses were conducted.

Results

Among 892 respondents, 78% were people of color; 71% were laid off or furloughed during the COVID-related shutdown, but most had access to health care. Further, 78.8% experienced at least 2 or more signs of emotional distress during the pandemic. Females and unemployment status were positively associated with experiencing emotional distress. About 43.5% received care through telehealth, although most did not prefer telehealth (74.2%). Only 18.3% of non-telehealth users were interested in telehealth and 15.0% had never heard about telehealth.

Conclusions

Health insurance coverage is essential for access to health services regardless of employment status. Strengthening mental health services, including psychological counselling for hospitality workers, is needed in such public health emergency situations as the ongoing COVID-19 pandemic.

Exploring the experiences of pregnant women in the U.S. during the first year of the Covid-19 pandemic

In this paper, we integrate the stress process model with symbolic interactionism to frame our analysis of interviews with 35 women who were pregnant and/or gave birth during the first year of the Covid-19 pandemic. We detail three stressors, highlight their variation, and discuss how they coped with these stressors. Women reported having to navigate contradictory information about the public health crisis, but Black participants simultaneously endured added strain from a heightened awareness of racialized violence. To cope with an overabundance of precarious and contradictory messages, some women sought out information (i.e., information gatherers), others eschewed information (i.e., information avoiders), and most established protective "bubbles." Next, women experienced disruptions in pregnancy rituals but coped by reframing their expectations. This stressor, however, was less acute for women with a prior birth. Third, women shared feelings of social isolation and reduced social support, which were intensified if pregnancy complications occurred. Women coped by relying on telecommunication and at-home monitoring devices. Our study shows how pregnant women experienced and coped through adversity to mitigate stressors amid pandemonium.

Visualizing the Knowledge Base and Research Hotspot of Public Health Emergency Management: A Science Mapping Analysis-Based Study

Public health emergency management has been one of the main challenges of social sustainable development since the beginning of the 21st century. Research on public health emergency management is becoming a common focus of scholars. In recent years, the literature associated with public health emergency management has grown rapidly, but few studies have used a bibliometric analysis and visualization approach to conduct deep mining and explore the characteristics of the public health emergency management research field. To better understand the present status and development of public health emergency management research, and to explore the knowledge base and research hotspots, the bibliometric method and science mapping technology were adopted to visually evaluate the knowledge structure and research trends in the field of public health emergency management studies. From 2000 to 2020, a total of 3723 papers related to public health emergency management research were collected from the Web of Science Core Collection as research data. The five main research directions formed are child prevention, mortality from public health events, public health emergency preparedness, public health emergency management, and coronavirus disease 2019 (COVID-19). The current research hotspots and frontiers are climate change, COVID-19 and related coronaviruses. Further research is needed to focus on the COVID-19 and related coronaviruses. This study intends to contribute inclusive support to related academia and industry in the aspects of public health emergency management and public safety research, as well as research hotspots and future research directions.

Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave

The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.

Racial and ethnic disparities in viral acute respiratory infections in the United States: protocol of a systematic review

BACKGROUND

The COVID-19 pandemic caused by SARS-CoV-2 has highlighted consistent inequities in incidence, disease severity, and mortality across racial and ethnic minority populations in the United States (US) and beyond. While similar patterns have been observed with previous viral respiratory pathogens, to date, no systematic review has comprehensively documented these disparities or potential contributing factors. In response, this review aims to synthesize data on racial and ethnic disparities in morbidity and mortality due to viral acute respiratory infections (ARI) other than SARS-CoV-2. This review will focus on understanding structural health and social factors to contextualize race and ethnicity driving these disparities in the US.

METHODS

We will conduct a systematic review of studies published from January 1, 2002, onward. Our search will include PubMed/MEDLINE, EBSCO Host-CINAHL Plus, PsycInfo, EMBASE, and Cochrane Library databases to identify relevant articles. We will include studies of any design that describe racial/ethnic disparities associated with viral ARI conducted in the US. Primary outcomes include incidence, disease severity or complication, hospitalization, or death attributed to ARI. Secondary outcomes include uptake of preventive interventions including vaccination, handwashing, social distancing, and wearing masks. Two reviewers will independently screen all citations, full-text articles, and abstract relevant data. Data characterizing individual-, community-, and structural-level factors associated with these disparities will be abstracted to better understand the underlying structural inequities contributing to racial disparities in ARI. We will assess the methodological quality of all studies and will conduct meta-analyses using random effects models if appropriate.

DISCUSSION

Findings from this systematic review will shed light on patterns of racial and ethnic disparities in viral ARI in the United States to support mathematical modeling of epidemic trajectories, intervention impact, and structural drivers of transmission, including structural racism. Moreover, data emerging from this review may reignite pandemic preparedness focused on communities with specific vulnerabilities related to living and working conditions given prevailing structural inequities, thus facilitating improved future pandemic responses to novel or endemic viral respiratory pathogens.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020219771.

The Preparedness of Primary Health Care Network in terms of Emergency Risk Communication: A Study in Iran

OBJECTIVE

Emergency Risk Communication (ERC) is known as 1 of the important components of an effective response to public health emergencies. In this study, we aimed to investigate the preparedness of the Primary Health Care Network (PHCN) of Iran in terms of the ERC.

METHODS

This study was conducted in 136 Primary Health Care Facilities (PHCFs) affilated to Shahrekord University of Medical Sciences, Chaharmahal and Bakhtiari Province, Iran. Data in terms of ERC were collected using a checklist developed by the Center of Disease Control and Prevention (CDC).

RESULTS

The findings of the study revealed that 65.9% of the PHCFs had low preparedness in terms of the ERC, 33.3% had a moderate level and 0.8% had high preparedness in this regard. There was a significant difference between the level of ERC and the history of crisis in the past year, PHCF type, and the education level of the responsible employees in the crisis unit in the PHCF.

CONCLUSIONS

The results showed that the PHCFs studied need to increase their capacity and capability in the field of ERC. Further efforts to provide ERC components may increase the preparedness of PHCN in Iran in terms of the ERC.

A rapid review of the impact of quarantine and restricted environments on children's play and the role of play in children's health

Amidst the coronavirus disease 2019 (COVID-19) pandemic, there is uncertainty regarding potential lasting impacts on children's health and educational outcomes. Play, a fundamental part of childhood, may be integral to children's health during crises. We undertook a rapid review of the impact of quarantine, isolation and other restrictive environments on play and whether play mitigates adverse effects of such restrictions. Fifteen peer-reviewed studies were identified, spanning hospitals, juvenile and immigration detention and refugee camps. We found evidence of changes in children's access to play in crises and quarantine. These studies indicated how play might support children enduring isolation but lacked robust investigations of play as an intervention in mitigating impacts of restriction. Studies pertaining to children in isolation due to infectious disease outbreaks were notably absent. It is important that the potential effects of changes to such a crucial aspect of childhood are better understood to support children in this and future crises.

Risk factors for increased COVID-19 case-fatality in the United States: A county-level analysis during the first wave

The ongoing COVID-19 pandemic is causing significant morbidity and mortality across the US. In this ecological study, we identified county-level variables associated with the COVID-19 case-fatality rate (CFR) using publicly available datasets and a negative binomial generalized linear model. Variables associated with decreased CFR included a greater number of hospitals per 10,000 people, banning religious gatherings, a higher percentage of people living in mobile homes, and a higher percentage of uninsured people. Variables associated with increased CFR included a higher percentage of the population over age 65, a higher percentage of Black or African Americans, a higher asthma prevalence, and a greater number of hospitals in a county. By identifying factors that are associated with COVID-19 CFR in US counties, we hope to help officials target public health interventions and healthcare resources to locations that are at increased risk of COVID-19 fatalities.

Serving vulnerable populations under the threat of epidemics and pandemics

Purpose

Epidemics and pandemics can result in sudden morbidity and mortality as well as social and economic disruption. However, the humanitarian logistics and supply chain management (HLSCM) field has been mostly focusing on life saving operations after natural disasters such as earthquakes and hurricanes. There is no research within the HLSCM literature neither on the unique properties of vulnerable groups, nor their underlying risk factors or how to mitigate them. The COVID-19 pandemic highlighted the uniqueness of some vulnerable groups and motivated us to conduct a structured literature review to identify research needs in HLSCM with regards to vulnerable populations.

Design/methodology/approach

The authors conduct a systematic review of literature on the intersection of epidemics/pandemics, humanitarian operations and vulnerable populations. They utilize the Scopus database to search for peer-reviewed journal articles published in English. Our search results in 366 articles which we reduced to 139 after filtering.

Findings

There is no research within the HLSCM literature on the unique properties of various vulnerable populations. The authors show that HLSCM scholars can contribute to literature by investigating operational and logistical challenges of serving vulnerable populations through multi-disciplinary research, research on the intersection of public health and supply chain management, research on the intersection of ethics and operations management, and research on cross-sectoral partnerships.

Research limitations/implications

The authors’ work is limited to peer-reviewed journal articles published in English. They did not include books, conference proceedings and think-tank or NGO reports. However, the authors do recognize that these sources can be very valuable.

Originality/value

To best of authors’ knowledge, this is the first study to review the literature on vulnerable populations under the threat of epidemics and pandemics.

Social justice in pandemic immunization policy: We're all in this together

Policy decisions regarding immunization during a pandemic are informed by the ethical understandings of policy makers. With the possibility that a vaccine might soon be available to mitigate the deadly COVID-19 pandemic, policy makers can consider learnings from past pandemic immunization campaigns. This critical analysis of three policy decisions made in Alberta, Canada, during the 2009 H1N1 influenza pandemic demonstrates the predominance of distributive justice principles and the problems that this created for vulnerable groups. Vulnerable groups identified in Alberta include rural and First Nations populations. We propose a social justice approach as a viable alternative to inform pandemic immunization policy and invite debate.

Human activity pattern implications for modeling SARS-CoV-2 transmission

BACKGROUND AND OBJECTIVES

SARS-CoV-2 emerged in December 2019 and rapidly spread into a global pandemic. Designing optimal community responses (social distancing, vaccination) is dependent on the stage of the disease progression, discovery of asymptomatic individuals, changes in virulence of the pathogen, and current levels of herd immunity. Community strategies may have severe and undesirable social and economic side effects. Modeling is the only available scientific approach to develop effective strategies that can minimize these unwanted side effects while retaining the effectiveness of the interventions.

METHODS

We extended the agent-based model, SpatioTemporal Human Activity Model (STHAM), for simulating SARS-CoV-2 transmission dynamics.

RESULTS

Here we present preliminary STHAM simulation results that reproduce the overall trends observed in the Wasatch Front (Utah, United States of America) for the general population. The results presented here clearly indicate that human activity patterns are important in predicting the rate of infection for different demographic groups in the population.

CONCLUSIONS

Future work in pandemic simulations should use empirical human activity data for agent-based techniques.

Racial and Ethnic Disparities in Viral Acute Respiratory Infections in the United States: Protocol of a Systematic Review

Background:

The COVID-19 pandemic caused by SARS-CoV-2 has highlighted consistent inequities in the risk of infection, severity of disease, or mortality across racial and ethnic minority populations in the United States and beyond. Although novel, SARS-CoV-2 shares commonalities in transmission dynamics with other viral respiratory pathogens where similar disparities in morbidity and mortality have been documented. However, to date, there has not been a systematic review of disparities in viral respiratory pathogens. In response, this review aims to synthesize data on racial and ethnic disparities in morbidity and mortality due to viral acute respiratory infections (ARI) other than SARS-CoV-2. In particular, this review will focus on understanding structural health and social factors outside of race and ethnicity driving these disparities in the United States.

Methods:

We will conduct a systematic review of studies published between January 1, 2002 and September 30, 2020 that capture data on racial and ethnic disparities associated with increased incidence, disease severity, risk of hospitalization and/or death in viral ARI in the United States. Data characterizing individual-, community-, and structural-level factors associated with these disparities will be abstracted to better understand the underlying structural inequities contributing to racial disparities in ARI. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be used with reviewers employing COVIDENCE to conduct two independent rounds of title/abstract and full text reviews for all articles. A built-in tool in COVIDENCE will be used for data abstraction.

Discussion:

Findings from this systematic review will shed light on patterns of racial and ethnic disparities in viral ARI in the United States. Leveraging these data can support predictive studies of the differential impacts of COVID-19 across the United States as well as adaptive intervention strategies mitigating structural inequities, including structural racism, driving both incidence and disparities in marginalized communities. Moreover, data emerging from this review may reignite pandemic preparedness focused on vulnerable communities given structural inequities, facilitating improved future pandemic responses to novel or endemic viral respiratory pathogens in the United States.

Systematic review registration:

PROSPERO CRD42020219771

Changes in COVID-19 Knowledge, Beliefs, Behaviors, and Preparedness Among High-Risk Adults from the Onset to the Acceleration Phase of the US Outbreak

BACKGROUND

The US outbreak of coronavirus disease 2019 (COVID-19) accelerated rapidly over a short time to become a public health crisis.

OBJECTIVE

To assess how high-risk adults' COVID-19 knowledge, beliefs, behaviors, and sense of preparedness changed from the onset of the US outbreak (March 13-20, 2020) to the acceleration phase (March 27-April 7, 2020).

DESIGN

Longitudinal, two-wave telephone survey.

PARTICIPANTS

588 predominately older adults with ≥ 1 chronic condition recruited from 4 active, federally funded studies in Chicago.

MAIN MEASURES

Self-reported knowledge of COVID-19 symptoms and prevention, related beliefs, behaviors, and sense of preparedness.

KEY RESULTS

From the onset to the acceleration phase, participants increasingly perceived COVID-19 to be a serious public health threat, reported more changes to their daily routine and plans, and reported greater preparedness. The proportion of respondents who believed they were "not at all likely" to get the virus decreased slightly (24.9 to 22.4%; p = 0.04), but there was no significant change in the proportion of those who were unable to accurately identify ways to prevent infection (29.2 to 25.7%; p 0.14). In multivariable analyses, black adults and those with lower health literacy were more likely to report less perceived susceptibility to COVID-19 (black adults: relative risk (RR) 1.62, 95% confidence interval (CI) 1.07-2.44, p = 0.02; marginal health literacy: RR 1.96, 95% CI 1.26-3.07, p < 0.01). Individuals with low health literacy remained more likely to feel unprepared for the outbreak (RR 1.80, 95% CI 1.11-2.92, p = 0.02) and to express confidence in the federal government response (RR 2.11, 95% CI 1.49-3.00, p < 0.001) CONCLUSIONS: Adults at higher risk for COVID-19 continue to lack critical knowledge about prevention. While participants reported greater changes to daily routines and plans, disparities continued to exist in perceived susceptibility to COVID-19 and in preparedness. Public health messaging to date may not be effectively reaching vulnerable communities.

Spatial variation in socio-ecological vulnerability to Covid-19 in the contiguous United States

The health and economic impacts of the Covid-19 pandemic vary across space because social, economic, health and ecological factors are also spatially variable. Social vulnerability indices are attempts to create a relative ranking of vulnerability to a natural or anthropogenic hazard across space and have been widely used to quantify community vulnerability to natural disasters. Here, we develop a hierarchical socio-ecological vulnerability index that compares counties in the contiguous United States based on 18 variables grouped into four dimensions (ecological, social, health, and economic) in order to capture a range of factors that might contribute to community vulnerability to Covid-19. Variables were chosen based on a review of the emerging literature about the factors associated with poor health outcomes from Covid-19, information about the economic sectors most at risk from the pandemic and pandemic response, and existing social vulnerability indices. We find that socio-ecological vulnerability to Covid-19 and its related economic effects varies across the contiguous U.S., with especially high vulnerability in the Southeast U.S. and especially low vulnerability in the Upper Midwest, Great Plains, and Mountain West.

The First 60 Days: American Public Health Agencies' Social Media Strategies in the Emerging COVID-19 Pandemic

In this paper, we capture, identify, and describe the patterns of longitudinal risk communication from public health communicating agencies on Twitter during the first 60 days of the response to the novel coronavirus disease 2019 (COVID-19) pandemic. We collected 138,546 tweets from 696 targeted accounts from February 1 to March 31, 2020, employing term frequency-inverse document frequency to identify keyword hashtags that were distinctive on each day. Our team conducted inductive content analysis to identify emergent themes that characterize shifts in public health risk communication efforts. As a result, we found 7 distinct periods of communication in the first 60 days of the pandemic, each characterized by a differing emphasis on communicating information, individual and collection action, sustaining motivation, and setting social norms. We found that longitudinal risk communication in response to the COVID-19 pandemic shifted as secondary threats arose, while continuing to promote pro-social activities to reduce impact on vulnerable populations. Identifying patterns of risk communication longitudinally allows public health communicators to observe changes in topics and priorities. Observations from the first 60 days of the COVID-19 pandemic prefigures ongoing messaging needs for this event and for future disease outbreaks.

Developing and Maintaining Public Trust During and Post-COVID-19: Can We Apply a Model Developed for Responding to Food Scares?

Trust in public health officials and the information they provide is essential for the public uptake of preventative strategies to reduce the transmission of COVID-19. This paper discusses how a model for developing and maintaining trust in public health officials during food safety incidents and scandals might be applied to pandemic management. The model identifies ten strategies to be considered, including: transparency; development of protocols and procedures; credibility; proactivity; putting the public first; collaborating with stakeholders; consistency; education of stakeholders and the public; building your reputation; and keeping your promises. While pandemic management differs insofar as the responsibility lies with the public rather than identifiable regulatory bodies, and governments must weigh competing risks in creating policy, we conclude that many of the strategies identified in our trust model can be successfully applied to the maintenance of trust in public health officials prior to, during, and after pandemics.

Willingness to Self-Isolate When Facing a Pandemic Risk: Model, Empirical Test, and Policy Recommendations

Infected people are isolated to minimize the spread of pandemic diseases. Therefore, the factors related to self-isolation (SI) should not be neglected, and it is important to investigate the factors leading the infected (or possibly infected) people to choose to self-isolate. In this paper, we tried to show that the theory of planned behavior provides a useful conceptual framework for SI when facing a pandemic risk, and a regression method with Chinese provincial (Guangdong Province) data was applied to investigate how attitude (ATT), subjective norms (SN), and perceived behavioral control (PBC) influence SI when facing a pandemic emergency. The results and the robustness tests confirm that ATT, SN, and PBC have a significant positive influence on SI when facing a pandemic emergency. ATT plays the most important role, followed by SN and then PBC. Based on the factors of SI, we found, through theoretical and empirical analyses, at least three important aspects that local governments need to consider to encourage citizens to self-isolate when facing a pandemic.

Engaging Communities to Reach Immigrant and Minority Populations: The Minnesota Immunization Networking Initiative (MINI), 2006-2017

In Minneapolis-St Paul, Minnesota, factors such as cultural and linguistic diversity make it difficult for public health agencies to reach immigrant and racial/ethnic minority populations with health initiatives. Founded in 2006, the Minnesota Immunization Networking Initiative (MINI) is a community project that has provided more than 80 000 free influenza vaccinations to vulnerable populations, including immigrants and racial/ethnic minority groups. MINI administered 5910 vaccinations through 99 community-based vaccination clinics during the 2017-2018 influenza season and surveyed the clients in their own language about influenza vaccination knowledge and practices. Among those surveyed, 2545 (43.1%) were uninsured and 408 (6.9%) received a first-time influenza vaccination at the MINI clinic. A total of 2893 (49.0%) respondents heard about the clinic through their faith community. Lessons learned included the importance of building relationships with community leaders and involving them as full partners, holding clinics in community-based settings to bring vaccinations to clients, and reporting outcomes to partners.

Quantifying the impact of social groups and vaccination on inequalities in infectious diseases using a mathematical model

BACKGROUND

Social and cultural disparities in infectious disease burden are caused by systematic differences between communities. Some differences have a direct and proportional impact on disease burden, such as health-seeking behaviour and severity of infection. Other differences-such as contact rates and susceptibility-affect the risk of transmission, where the impact on disease burden is indirect and remains unclear. Furthermore, the concomitant impact of vaccination on such inequalities is not well understood.

METHODS

To quantify the role of differences in transmission on inequalities and the subsequent impact of vaccination, we developed a novel mathematical framework that integrates a mechanistic model of disease transmission with a demographic model of social structure, calibrated to epidemiologic and empirical social contact data.

RESULTS

Our model suggests realistic differences in two key factors contributing to the rates of transmission-contact rate and susceptibility-between two social groups can lead to twice the risk of infection in the high-risk population group relative to the low-risk population group. The more isolated the high-risk group, the greater this disease inequality. Vaccination amplified this inequality further: equal vaccine uptake across the two population groups led to up to seven times the risk of infection in the high-risk group. To mitigate these inequalities, the high-risk population group would require disproportionately high vaccination uptake.

CONCLUSION

Our results suggest that differences in contact rate and susceptibility can play an important role in explaining observed inequalities in infectious diseases. Importantly, we demonstrate that, contrary to social policy intentions, promoting an equal vaccine uptake across population groups may magnify inequalities in infectious disease risk.

Detection of Zika virus using reverse-transcription LAMP coupled with reverse dot blot analysis in saliva

In recent years, there have been increasing numbers of infectious disease outbreaks that spread rapidly to population centers resulting from global travel, population vulnerabilities, environmental factors, and ecological disasters such as floods and earthquakes. Some examples of the recent outbreaks are the Ebola epidemic in West Africa, Middle East respiratory syndrome coronavirus (MERS-Co) in the Middle East, and the Zika outbreak through the Americas. We have created a generic protocol for detection of pathogen RNA and/or DNA using loop-mediated isothermal amplification (LAMP) and reverse dot-blot for detection (RDB) and processed automatically in a microfluidic device. In particular, we describe how a microfluidic assay to detect HIV viral RNA was converted to detect Zika virus (ZIKV) RNA. We first optimized the RT-LAMP assay to detect ZIKV RNA using a benchtop isothermal amplification device. Then we implemented the assay in a microfluidic device that will allow analyzing 24 samples simultaneously and automatically from sample introduction to detection by RDB technique. Preliminary data using saliva samples spiked with ZIKV showed that our diagnostic system detects ZIKV RNA in saliva. These results will be validated in further experiments with well-characterized ZIKV human specimens of saliva. The described strategy and methodology to convert the HIV diagnostic assay and platform to a ZIKV RNA detection assay provides a model that can be readily utilized for detection of the next emerging or re-emerging infectious disease.

Planning for Pandemics: Lessons From the Past Decade

It is now 10 years since the disease we now know as SARS--severe acute respiratory syndrome--caused more than 700 deaths around the world and made more than 8,000 people ill. More recently, in 2009 the global community experienced the first influenza pandemic of the 21st century--the 2009 H1N1 influenza pandemic. This paper analyses the major developments in international public health law relating to infectious diseases in the period since SARS and considers their implications for pandemic planning.

Pandemics and health equity: lessons learned from the H1N1 response in Los Angeles County

BACKGROUND

Pandemic preparedness and response (as with all public health actions) occur within a social, cultural, and historical context of preexisting health disparities and, in some populations, underlying mistrust in government. Almost 200,000 people received H1N1 vaccine at 109 free, public mass vaccination clinics operated by the Los Angeles County Department of Public Health between October 23, 2009, and December 8, 2009. Wide racial/ethnic disparities in vaccination rates were observed with African Americans having the lowest rate followed by whites.

METHODOLOGY/PRINCIPAL FINDINGS

Demographic information, including race/ethnicity, was obtained for 163 087 of the Los Angeles County residents who received vaccine. This information was compared with estimates of the Los Angeles County population distribution by race/ethnicity. Rate ratios of vaccination were as follows: white, reference; African American, 0.5; Asian, 3.2; Hispanic, 1.5; Native American, 1.9; and Pacific Islander, 4.3.

SIGNIFICANCE

Significant political challenges and media coverage focused on equity in vaccination access specifically in the African American population. An important challenge was community-level informal messaging that ran counter to the "official" messages. Finally, we present a partnership strategy, developed in response to the challenges, to improve outreach and build trust and engagement with African Americans in Los Angeles County.

Reputation, relationships, risk communication, and the role of trust in the prevention and control of communicable disease: a review

Population-level compliance with health protective behavioral advice to prevent and control communicable disease is essential to optimal effectiveness. Multiple factors affect perceptions of trustworthiness, and trust in advice providers is a significant predeterminant of compliance. While competency in assessment and management of communicable disease risks is critical, communications competency may be equally important. Organizational reputation, quality of stakeholder relationships and risk information provision strategies are trust moderating factors, whose impact is strongly influenced by the content, timing and coordination of communications. This article synthesizes the findings of 2 literature reviews on trust moderating communications and communicable disease prevention and control. We find a substantial evidence base on risk communication, but limited research on other trust building communications. We note that awareness of good practice historically has been limited although interest and the availability of supporting resources is growing. Good practice and policy elements are identified: recognition that crisis and risk communications require different strategies; preemptive dialogue and planning; evidence-based approaches to media relations and messaging; and building credibility for information sources. Priority areas for future research include process and cost-effectiveness evaluation and the development of frameworks that integrate communication and biomedical disease control and prevention functions, conceptually and at scale.

Knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a low-income, public health clinic population

OBJECTIVE

The Public Health Center Vaccine Survey (PHCVS) examines the knowledge, attitudes, and beliefs about seasonal influenza and H1N1 vaccinations in a largely low-income, urban, public health clinic population in Los Angeles County, USA.

DESIGN

A cross-sectional survey of vulnerable individuals at risk for severe influenza infection was conducted in one of the nation's largest local public health jurisdictions.

SUBJECTS

A total of 1541 clinic patients were recruited in the waiting rooms of five large public health centers in Los Angeles County from June to August, 2010.

RESULTS

Among prospective respondents who met eligibility criteria, 92% completed the survey. The majority was black or Latino and most were between the ages of 18 and 44 years. More than half were unemployed; two-thirds had no health insurance; and nearly one-half reported having a high school education or less. About one-fifth reported they had received the H1N1 vaccine during the previous flu season. In comparative analyses, negative beliefs about vaccine safety and efficacy were highly predictive of H1N1 vaccination. Blacks were less likely than non-black respondents to report receiving the H1N1 vaccine (OR=0.7, 95% CI=0.6-1.0). Blacks were also less likely than other respondents to agree that vaccines can prevent disease (OR=0.4, 95% CI=0.3-0.5), that vaccines are safe (OR=0.5, 95% CI=0.4-0.6), and that they trust doctors/clinicians who recommend vaccines (OR=0.5, 95% CI=0.4-0.7).

CONCLUSIONS

Study findings provide a useful risk profile of vulnerable groups in Los Angeles County, which may be generalizable to other urban jurisdictions in the United States. They also describe real world situations that can be used to forecast potential challenges that vaccine beliefs may pose to national as well as local influenza pandemic planning and response, especially for communities with limited access to these preventive services.

A primer on strategies for prevention and control of seasonal and pandemic influenza

The United States has made considerable progress in pandemic preparedness. Limited attention, however, has been given to the challenges faced by populations that will be at increased risk of the consequences of the pandemic, including challenges caused by societal, economic, and health-related factors. This supplement to the American Journal of Public Health focuses on the challenges faced by at-risk and vulnerable populations in preparing for and responding to an influenza pandemic. Here, we provide background information for subsequent articles throughout the supplement. We summarize (1) seasonal influenza epidemiology, transmission, clinical illness, diagnosis, vaccines, and antiviral medications; (2) H5N1 avian influenza; and (3) pandemic influenza vaccines, antiviral medications, and nonpharmaceutical interventions.