Applying the 15 Public Health Emergency Preparedness Capabilities to Support Large-Scale Tuberculosis Investigations in Complex Congregate Settings

摘要

Public Health—Seattle and King County, a metropolitan health department in western Washington, experiences rates of tuberculosis (TB) that are 1.6 times higher than are state and national averages. The department’s TB Control Program uses public health emergency management tools and capabilities sustained with Centers for Disease Control and Prevention grant funding to manage large-scale complex case investigations. We have described 3 contact investigations in large congregate settings that the TB Control Program conducted in 2015 and 2016. The program managed the investigations using public health emergency management tools, with support from the Preparedness Program. The 3 investigations encompassed medical evaluation of more than 1600 people, used more than 100 workers, identified nearly 30 individuals with latent TB infection, and prevented an estimated 3 cases of active disease. These incidents exemplify how investments in public health emergency preparedness can enhance health outcomes in traditional areas of public health. Public Health—Seattle and King County is a metropolitan health department with 1300 employees, 40 sites, and a budget of $318 million that protects and improves the health and well-being of the 2 million residents of King County, Washington. 1 King County represents 28.6% of Washington state’s population and includes Seattle and 38 other incorporated cities; its 2134 square miles also encompass boundaries for the Snoqualmie and Muckleshoot tribes. Twenty-five percent of residents speak a language other than English, with more than 170 languages represented. Twenty-one percent of King County residents are foreign-born. Almost 10% of residents live in poverty, 2,3 and there is significant disparity in life expectancy, years of healthy life, levels of education, and causes of death across geographic and racial groups in King County. 4 Public Health—Seattle and King County established its Preparedness Program in 2002 with a grant from the Centers for Disease Control and Prevention to enhance local preparedness for a bioterror event. The program has been recognized as a national leader in public health preparedness planning. It develops and shares tools and model practices to enhance public health preparedness nationwide. The Preparedness Program receives no city or county funds; instead, it relies on grants from the Centers for Disease Control and Prevention, the US Department of Health and Human Services, the US Department of Homeland Security, the National Association of County and City Health Officials, universities, and other sources to accomplish its mission of anticipating and responding to the public health consequences of local emergencies. Public Health—Seattle and King County operates a Tuberculosis (TB) Control Program, which is funded by a combination of county current expense funds and state and federal dollars. The TB Control Program ensures that people with active TB receive appropriate treatment of their disease and that close contacts of those with infectious TB are evaluated and treated if appropriate. This foundational public health service protects King County residents, improves the community’s health, and saves money by interrupting the spread of TB—thus preventing outbreaks and the development of multidrug-resistant TB, which is difficult to cure and expensive to treat. Public Health—Seattle and King County also operates an award-winning medical reserve corps, called the Public Health Reserve Corps. Its more than 900 volunteers represent a variety of medical and nonmedical professions and backgrounds. Volunteer engagement is sustained by offering varied and frequent opportunities to support public health’s mission, such as responding to emergencies; providing basic medical services at locations such as homeless shelters, low-income housing, and food banks; completing mandatory training in the incident command system; and participating in optional training, such as psychological first aid, trauma-informed care, vaccinations, disease investigations, call center operations, and patient interviewing.