Section 2: Snapshots of Public Health Preparedness in States and Directly Funded Localities:New York City

Related Website: New York City Department of Public Health

New York City Responds to a Case of Inhalation Anthrax
Coordinated recovery efforts help communities return to normal after an emergency.

New York City Flag In February 2006, the New York City Department of Health and Mental Hygiene (NYC DOHMH) investigated a case of naturally occurring inhalation anthrax, the first case in the United States in 30 years. A New York City resident, a dancer and drummer, collapsed after a performance in Pennsylvania, and Pennsylvania authorities contacted New York City officials. Through telephone interviews and laboratory testing, NYC DOHMH epidemiologists confirmed that the inhalation anthrax case was contracted while the man was working with untreated animal hides used to make drums.

According to the New York City Department of Health and Mental Hygiene, the cooperative agreement is valuable because it has provided the city with resources to fund staff, equipment, and supplies (or contracts with vendors) to perform its preparedness activities. This funding stream has been critical in allowing every part of the agency to improve its emergency response role.

NYC DOHMH immediately contacted all potentially exposed individuals to determine if others were at risk for inhalation anthrax, arranged for preventive medication as necessary, conducted laboratory tests on collected samples, and collaborated with local, state, and federal agencies to design initial sampling plans. NYC DOHMH proactively alerted hospitals through its Health Alert Network and automated mass notification software. In addition, NYC DOHMH hosted citywide hospital teleconferences to address questions and concerns from providers. In collaboration with the Environmental Protection Agency and other agencies, NYC DOHMH coordinated efforts to examine and clear residences, workplaces, and vehicles associated with the anthrax case for re-occupancy.

NYC DOHMH also helped to effectively communicate public messages to schools and residents through community meetings, fact sheets, and media updates. Crisis counseling was available at all community meetings and provided to those who received preventive treatment. During this response, NYC DOHMH demonstrated its ability to coordinate response across regional and agency lines.

Snapshot of Public Health Preparedness

Below are activities conducted byNew York City in the area of public health preparedness. They support CDC preparedness goals in the areas of detection and reporting, control, and improvement; crosscutting activities help prepare for all stages of an event. These data are not comprehensive and do not cover all preparedness activities.

Disease Detection and Investigation

The sooner public health professionals can detect diseases or other health threats and investigate their causes and effects in the community, the more quickly they can minimize population exposure.

Table. Disease Detection and Investigation Activities in New York City
Category of Activities	Specific Activity	Response
Detect & Report	Could receive and investigate urgent disease reports 24/7/365¹	Yes
	Primary method for receiving urgent disease reports^*2	Telephone
	Linked state and local health personnel to share information about disease outbreaks across state lines (through the CDC Epi-X system)³	Yes
	Conducted year-round surveillance for seasonal influenza⁴	^__
* Telephone, fax, and electronic reporting are all viable options for urgent disease reporting, as long as the public health department has someone assigned to receive the reports 24/7/365. 1 CDC, DSLR; 2005 2 CDC, DSLR; 2006 3 CDC, Epi-X; 2007 4 HHS, OIG; 2007

Public Health Laboratories

Public health laboratories test and confirm agents that can threaten health. For example, advanced DNA “fingerprinting” techniques and subsequent reporting to the CDC database (PulseNet) are critical to recognize nationwide outbreaks from bacteria that can cause severe illness, such as E. coli O157:H7 and Listeria monocytogenes.

Table. Public Health Laboratory Activities in New York City
Category of Activities	Specific Activity	Response
Detect & Report	Number ofNew York City laboratories in the Laboratory Response Network¹	1
	Rapidly identified E. coli O157:H7 using advanced DNA “fingerprinting” techniques (PFGE):²


	Rapidly identified Listeria monocytogenes using advanced DNA “fingerprinting” techniques (PFGE):²


	Had a laboratory information management system that could create, send, and receive messages3 (8/05 – 8/06)	^__
	System complied with CDC information technology standards (PHIN)3 (8/05 – 8/06)	^__
	Had a rapid method to send urgent messages to frontline laboratories that perform initial screening of clinical specimens3 (8/05 – 8/06)	^__
Crosscutting	Conducted bioterrorism exercise that met CDC criteria4 (8/05 – 8/06)	Yes
Crosscutting	Conducted exercise to test chemical readiness that met CDC criteria4 (8/05 – 8/06)	N/A
1 CDC, DBPR; 2007 2 CDC, DSLR; 2007 3 APHL, Public Health Laboratory Issues in Brief: Bioterrorism Capacity; May 2007 4 CDC, DSLR; 2006

Response

Planning provides a framework for how a public health department will respond during an emergency. The plans can be tested through external reviews, exercises, and real events. After-action reports assess what worked well during an exercise or real event and how the department can improve.

Table. Response Activities in New York City
Category of Activities	Specific Activity	Response
Control	Developed a public health response plan, including pandemic influenza response, crisis and emergency risk communication, and Strategic National Stockpile (SNS)^{1, 2}	Yes
	Nebraska SNS plan reviewed by CDC²	Yes
	Score on CDC technical assistance review (1-100)	97
	Number ofNew York City cities in the Cities Readiness Initiative³	yes
Crosscutting	Developed roles and responsibilities for a multi-jurisdictional response (ICS) with:¹(8/05 – 8/06)
	Hospitals	Yes
	Local/regional emergency management agencies	Yes
	Federal emergency management agencies	Yes
	Public health department staff participated in training to support cooperative agreement activities⁴	Yes
	Public health laboratories conducted training for first responders⁵(8/05 – 8/06)	^__
	Activated public health emergency operations center as part of a drill, exercise, or real event^*†6 (partial year, 9/06 – 2/07)	Yes
	Conducted a drill or exercise for key response partners to test communications when power and land lines were unavailable^†6 (partial year, 9/06 – 2/07)	No
Improve	Finalized at least one after-action report with an improvement plan following an exercise or real event^†6(partial year, 9/06 – 2/07)	Yes
* Activation means rapidly staffing all eight core ICS functional roles in the public health emergency operations center with one person per position. This capability is critical to maintain in case of large-scale or complex incidents, even though not every incident requires full staffing of the ICS. † States were expected to perform these activities from 9/1/2006 to 8/30/2007. These data represent results from the first half of this period only. 1 CDC, DSLR; 2006 2 CDC, DSNS; 2007 3 CDC, DSNS CRI; 2007 4 CDC, DSLR; 1999-2005 5 APHL, Chemical Terrorism Preparedness; May 2007 6 CDC, DSLR; 2007