title: Public health emergency preparedness: lessons learned about monitoring of interventions from the National Association of County and City Health Official's survey of nonpharmaceutical interventions for pandemic H1N1.
abstract: OBJECTIVE
  We assessed local health departments' (LHDs') ability to provide data on nonpharmaceutical interventions (NPIs) for the mitigation of 2009 H1N1 influenza during the pandemic response.
  
  
  METHODS
  Local health departments voluntarily participated weekly in a National Association of County and City Health Officials Web-based survey designed to provide situational awareness to federal partners about NPI recommendations and implementation during the response and to provide insight into the epidemiologic context in which recommendations were made.
  
  
  METHODS
  Local health departments during the fall 2009 H1N1 pandemic response.
  
  
  METHODS
  Local health departments that voluntarily participated in the National Association of County and City Health Officials Sentinel Surveillance Network.
  
  
  METHODS
  Local health departments were asked to report data on recommendations for and the implementation of NPIs from 7 community sectors. Data were also collected on influenza outbreaks; closures, whether recommended by the local health department or not; absenteeism of students in grades K-12; the type(s) of influenza viruses circulating in the jurisdiction; and the health care system capacity.
  
  
  RESULTS
  One hundred thirty-nine LHDs participated. Most LHDs issued NPI recommendations to their community over the 10-week survey period with 70% to 97% of LHDs recommending hand hygiene and cough etiquette and 51% to 78% voluntary isolation of ill patients. However, 21% to 48% of LHDs lacked information of closure, absenteeism, or outbreaks in schools, and 28% to 50% lacked information on outpatient clinic capacity.
  
  
  CONCLUSIONS
  Many LHDs were unable to monitor implementation of NPI (recommended by LHD or not) within their community during the 2009 H1N1 influenza pandemic. This gap makes it difficult to adjust recommendations or messaging during a public health emergency response. Public health preparedness could be improved by strengthening NPI monitoring capacity.
authors.affiliation: Division of Global Migration and Quarantine, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. pcantey@cdc.gov
authors.forename: Paul T
authors.initials: PT
authors.lastname: Cantey
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Chuk
authors.forename: Katrin S
authors.initials: KS
authors.lastname: Kohl
authors.forename: Jack
authors.initials: J
authors.lastname: Herrmann
authors.forename: Paul
authors.initials: P
authors.lastname: Weiss
authors.forename: Corinne M
authors.initials: CM
authors.lastname: Graffunder
authors.forename: Francisco
authors.initials: F
authors.lastname: Averhoff
authors.forename: Emily B
authors.initials: EB
authors.lastname: Kahn
authors.forename: John
authors.initials: J
authors.lastname: Painter
mesh_terms: D000041:Absenteeism; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002959:Civil Defense / Q000458:organization & administration* / Q000706:statistics & numerical data*; D063373:Hand Hygiene / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology*; D009111:Local Government; D008397:Masks / Q000706:statistics & numerical data; D058873:Pandemics / Q000706:statistics & numerical data*; D011634:Public Health; D011790:Quarantine / Q000706:statistics & numerical data; D012574:Schools / Q000706:statistics & numerical data