Appendix 3

Overview of CDC Preparedness Activities

The mission of CDC’s terrorism preparedness and emergency response activities is to prevent death, disability, disease, and injury associated with urgent health threats by improving preparedness of the public health system, the healthcare delivery system, and the public. CDC has made all-hazards preparedness and emergency response a priority and is building and enhancing systems at the local, state, and federal levels. For more information, see http:// emergency.cdc.gov/.

Coordinating Office for Terrorism Preparedness and Emergency Response (COTPER)

COTPER coordinates terrorism preparedness and emergency response activities across CDC and strategically distributes funds to other CDC centers and offices. COTPER is comprised of the following divisions:

The Division of State and Local Readiness (DSLR) administers the Public Health Emergency Preparedness cooperative agreement, which funds state and local efforts to build and strengthen their infrastructure and capabilities to respond to and recover from a public health emergency and provides consultation and technical assistance to promote these efforts. DSLR also manages the Centers for Public Health Preparedness program, located in 27 universities across the country, and supports eight Advanced Practice Centers, which are local public health departments that develop cutting-edge tools and resources that help other local public health departments prepare for, respond to, and recover from emergencies.
The Division of Strategic National Stockpile (DSNS) supports and maintains the Strategic National Stockpile (SNS), a national repository of antibiotics, antiviral drugs, chemical antidotes, antitoxins, life-support medications, intravenous administration equipment, airway maintenance supplies, and medical/surgical items. During a public health emergency, state and local public health systems and resources may become overwhelmed. The SNS is designed to supplement and re-supply state and local public health departments in the event of such an emergency. DSNS also provides technical assistance to local officials to help ensure that local, state, and federal agencies can work together to receive, stage, store, and distribute SNS assets.
The Division of Emergency Operations (DEO) is CDC’s command center for the coordination of emergency response to domestic and international public health threats and is staffed 24/7/365. The Director’s Emergency Operations Center (DEOC) is equipped with state-of-the-art communications technologies to support information pipelines with state, federal, and international partners. The DEOC is the CDC contact for state public health departments for reporting potential public health threats.
The Division of Select Agents and Toxins (DSAT) regulates the possession, use, and transfer of biological agents and toxins (select agents) that could pose a severe threat to public health and safety.
The Office of the Director (OD) manages strategy, goals setting, budget formulation, communication, and science for terrorism preparedness and emergency response activities. In addition, OD manages the Career Epidemiology Field Officer program, which recruits and supports skilled epidemiologists in state and local public healthdepartments. Public health departments can choose to spend cooperative agreement funds to support a field officer in their public health department.

Other centers within CDC also contribute to public health preparedness and are described below in alphabetical order.

Coordinating Center for Environmental Health and Injury Prevention (CCEHIP)

CCEHIP plans, directs, and coordinates public health research, programs, and laboratory sciences that improve health and eliminate illness, disability, and/or death caused by injuries or environmental exposures. The following highlights public health preparedness activities within national centers of CCEHIP:

The National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) conducts ongoing projects to improve surveillance systems, laboratory capacity, and emergency response. NCEH/ATSDR is improving various surveillance systems for chemical exposures, hazardous substance spills, and morbidity following disasters. Upgrades of CDC laboratories enhance their capacity to respond to chemical and radiological terrorism and to analyze toxins via improved analytical methods. NCEH/ATSDR is also working with state and local public health departments to improve response to chemical, nuclear, and radiological terrorism.
The National Center for Injury Prevention and Control (NCIPC) links to the injury care community to decrease morbidity and mortality from injuries caused by explosions. NCIPC is moving towards this goal through curriculum development for health care providers, the development of clinical guidelines in blast injury management, improvement of field triage for large-scale blast injuries, and translation of lessons learned from international and U.S. military experience.

Coordinating Center for Health Information and Service (CCHIS)

CCHIS provides leadership and promotes innovation in public health informatics, health statistics, health marketing, and scientific communications. The following describe the many ways in which the national centers within CCHIS are enhancing communications to help detect and respond to emergencies.

The National Center for Health Marketing (NCHM) strengthens health communications networks across federal, state, and local levels with such projects as Epi- X, the Public Health Training Network, and the National Public Health Radio Network. NCHM’s Emergency Communication Branch provides leadership for cross-agency emergency risk communication during emergencies, and ensures that CDC coordinates with state and local public health departments in providing critical health protection information to the public, clinicians, emergency responders, and other stakeholders. The emergency response component of the CDC-INFO Contact Center and Translation Services for Emergency Information enhances dissemination of emergency information to the public by translating emergency requests in up to 150 different languages.
The National Center for Public Health Informatics (NCPHI) coordinates BioSense, the near real-time biosurveillance system that provides health situational awareness using existing data from healthcare organizations across the country. Through PHIN, NCPHI provides technical assistance and guidance to state and local partners to implement interoperable public health information systems allowing for the exchange of data across organizational and jurisdictional boundaries. The LRN Real Time Laboratory Information Exchange also equips LRN labs to securely share data in real time according to industry standards.
The National Center for Health Statistics (NCHS) develops and conducts data collection activities to monitor the nation’s health and provides expertise in data collection and analysis to state and local partners through collaborative efforts. Examples of such efforts include the California Health Interview Survey and New York City’s Community Health and Nutrition Examination Survey, work with state vital statistics offices to improve state data collection activities, and assisting states in data collection needs related to disasters such as Hurricane Katrina. NCHS also provides leadership in developing classification standards for reporting morbidity and mortality and in monitoring adoption of electronic health records by health providers.

Coordinating Center for Health Promotion (CoCHP)

CoCHP seeks to increase the potential for full, satisfying, and productive living across the lifespan for all people, in all communities. CoCHP preparedness activities include providing technical expertise in epidemiology, surveillance and communications for populations with physical and development disabilities and chronic diseases, pregnant and lactating women, reproductive-age women, infants, the elderly, and school-age children in emergencies. Additional activities include:

The National Center on Birth Defects and Developmental Disabilities (NCBDDD) is conducting ongoing projects to develop and strengthen intramural research and surveillance capacity related to emergency preparedness for at-risk populations. In particular, NCBDDD is investigating the states of pre-event and post-event readiness among at-risk populations affected by Hurricanes Katrina and Rita.
The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) has a number of publications addressing the burden and needs surrounding persons with chronic diseases following natural disasters. Activities include strengthening emergency response surveillance efforts through rapid telephone surveys administered through the Behavioral Risk Factor Surveillance System; collaborating in the review of mental health response cards following Hurricane Katrina; examining agricultural issues to assist in achieving the goal of a safer, healthier, secure, and equitable food supply (e.g., food security, influences on economics and food production, food access); examining provisions for oral health following Hurricane Katrina; and developing conceptual models, analytic reports, guidance, and incident response plans for pregnant, postpartum, or lactating women and infants.

Coordinating Center for Infectious Diseases (CCID)

CCID strives to protect health related to infectious diseases. The following highlights CCID’s ongoing public health preparedness activities, including developing vaccines, enhancing diagnostic methods of select bioterrorism agents, and improving the LRN.

The Influenza Coordination Unit (ICU) is ensuring that the diverse activities related to pandemic or seasonal influenza preparedness and response activities are coordinated, effective, and efficient. ICU works with other CDC divisions and offices to continuously improve the CDC Pandemic Influenza Operations Plan, plan and participate in agencywide exercises, and manage portfolios of related pandemic influenza projects.
The National Center for Immunization and Respiratory Diseases (NCIRD), as part of the Anthrax Vaccine Research Program, is conducting a large-scale human clinical trial of the anthrax vaccine, as well as further immunological studies in animals. NCIRD is also developing an anthrax immune globulin for eventual storage in the SNS.
The National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) is working to improve surveillance, diagnostic and molecular methods, and laboratory capacities for a number of select bioterrorism agents, including smallpox, botulism and plague. NCZVED also seeks to quicken the detection and response to bioterrorism agents in water and food.
The National Center for Preparedness, Detection, and Control of Infectious Diseases (NCPDCID) manages the LRN, the global consortium of reference and national laboratories whose goal is to decrease the time needed to detect biological and chemical agents that can harm the public and respond to these events with detection and identification capacities and surveillance support. The Division of Bioterrorism Preparedness and Response (DBPR) is primarily responsible for managing the LRN and preparedness activities within CCID. In addition, NCPDCID tests for the continuing effectiveness of existing drugs against bioterrorism agents and prepares U.S. ports of entry to reduce the risk of natural or intentional introduction of infectious diseases into the country.

Coordinating Office for Global Health (COGH)

COGH provides leadership and works with global partners to increase life expectancy and years of quality of life, and also to increase global preparedness to prevent and control natural and manmade threats to health.

The Global Terrorism Preparedness and Emergency Response program is developing and implementing a pre-event strategy for CDC’s external engagements with international public health partners in terrorism preparedness and emergency response.
COGH also coordinates international response with the Director’s Emergency Operations Center during international emergency response events and serves as the principal CDC point-of-contact for CDC programs, federal agencies, foreign governments, and other organizations concerned with international terrorism preparedness and response.

National Institute for Occupational Safety and Health (NIOSH)

NIOSH provides leadership to prevent work-related illness, injury and death through information gathering, scientific research, and translation of knowledge gained into products and services. The NIOSH Emergency Preparedness and Response Office takes primary responsibility to serve as the focal point of technical expertise; facilitate rapid and specific onsite support; and advance research and collaboration to enhance preparedness and response efforts.

NIOSH is a cooperating agency in the Worker Safety and Health Support Annex of the National Response Plan. In the aftermath of disasters, NIOSH provides assistance on occupational exposure assessments, provides guidance on personal protective equipment, and develops and disseminates guidelines to integrate worker safety and health into site operations. NIOSH works with multidisciplinary teams to develop procedures for followup evaluations of worker injuries, conducts health hazards evaluations, and provides technical assistance to local, state, and federal governmental agencies to assess potential health effects from workers’ exposures in the recovery zone.
In addition, NIOSH has developed an aggressive research portfolio to address a wide range of research needs in the emergency response community. For example, NIOSH conducts research to address the critical need for effective personal protective technologies, such as respirators, chemical-resistant clothing, hearing protectors, and safety goggles and glasses that provide a barrier between the worker and an occupational safety or health risk.

Office of the Director (OD)

OD manages and directs the activities of CDC and coordinates the CDC response to emergencies. Public health preparedness activities within the OD include security, legal preparedness, and workforce training. OD also coordinates the placement of Senior Management Officials (SMOs), who function as the chief CDC representatives within selected states. SMOs oversee CDC resources, provide technical assistance, and serve as a point of contact during emergencies. In 2007, 11 states and DC had permanent SMOs, and 5 states and 2 territories had SMOs who provide support only during an emergency. The following offices participate in CDC preparedness activities:

The Office of the Chief Operating Officer (OCOO) ensures that federal assets and critical infrastructure are safeguarded by providing security for CDC facilities and the SNS. OCOO also manages secure intelligence communication systems and HealthImpact.net (an internal CDC system) to support terrorism preparedness projects.
The Office of Chief of Public Health Practice (OCPHP) develops the legal preparedness of CDC programs, front-line public health practitioners, policy makers, and partners in related sectors (e.g., emergency management, law enforcement, judiciary, and health care) to effectively address terrorism, other public health emergencies, and additional national public health priorities. OCPHP focuses on improving all four core elements of public health legal preparedness: laws and legal authorities; the competency of multi-sector practitioners to apply those laws effectively; coordinated implementation of laws across sectors and jurisdictions; and actionable information on best practices in legal preparedness. In addition, OCPHP is implementing the Social Distancing Law Project to assess 18 states’ capacity to implement quarantine and other nonpharmaceutical interventions during an influenza pandemic or other threat. 152
- The Office of Enterprise Communication (OEC) promotes effective and efficient communication networks both within CDC and with external partners. During an emergency situation that requires a CDC response, OEC provides information and communication support within the Joint Information Center. OEC developed the CDC Employee Guide for Influenza Pandemic Preparedness and conducted pandemic influenza crisis and emergency risk communication training in collaboration with HHS.
- The Office of Workforce and Career Development (OWCD) plans, directs and manages workforce training programs for public health preparedness. The Epidemic Intelligence Service (EIS) program trains high-level epidemiologists for placement in state and local public health departments. The management and staff of LRN reference laboratories are also trained in preparedness, implementation of the Select Agent Program, and testing protocols. In addition, OWCD provides targeted preparedness training for emergency responders.