Learning from Experience: The Public Health Response to West Nile Virus, SARS, Monkeypox, and Hepatitis A Outbreaks in the United States

摘要

State and local public health systems play a critical role in responding to emergencies and are central to the nation's efforts to improve its preparedness for bioterrorism. But public health departments have faced some significant challenges over the years. During the last half of the 20th century, the capacity of state and local public health systems in the United States seriously declined. Problems in the systems -- such as weaknesses in laboratory capacity and poor communications with the public and health care professionals -- were vividly displayed during the anthrax attack in 2001. In the aftermath of these events. Congress and the Department of Health and Human Services (HHS) accelerated efforts to strengthen the public health infrastructure. In the spring of 2002. approximately $1.1 billion was distributed through the Office of Public Health Emergency Preparedness. the Centers for Disease Control and Prevention (CDC). and the Health Resources and Services Administration (HRSA) as part of cooperative agreements to strengthen state and local public health as well as hospital preparedness, with an additional $2.9 billion provided to the states in 2003 and 2004 (Schuler, 2004). After 3 years of major federal investment, it is appropriate to take stock of the current state of preparedness in local and state public health departments. Four recent disease outbreaks from 1999 to 2003 provide a rare opportunity to assess the quality of the public health response and to gain insights into overall preparedness for a bioterrorist attack. These outbreaks include Severe Acute Respiration Syndrome (SARS), monkeypox. and hepatitis A in 2003, and West Nile virus. Taken together, the four outbreaks tested a wide range of public health capabilities.