Public Health Response Activities

State and local public health departments will be responsible for many activities during a melioidosis public health emergency. While these activities are similar regardless of the type of emergency, the specifics will influence planning.

Epidemiological Investigation

Melioidosis does not occur naturally in the United States, except for Puerto Rico, so all cases should be investigated to identify where, when, and how patients were exposed to B. pseudomallei, the bacteria that cause it. An epidemiologist or designee from the state or local health department will need to interview each patient, focusing on:

• Travel history to endemic areas, both during the person’s lifetime and during the previous 21 days
• Places where the patient has been locally in the previous 21 days
• Any contact with imported animals

Exposure to the B. pseudomallei can occur through inhalation of contaminated dust or water droplets, ingestion of contaminated water, and contact with contaminated soil, especially through skin abrasions. It is very rare for people to get the disease from another person. Though melioidosis does not normally spread person-to-person, interviewers should ask patients about anyone they have spent time with during the previous 21 days, especially those who have similar symptoms. Positive identification of other people with symptoms will help investigators find the source of exposure. Identification will also enable these individuals to begin post-exposure prophylaxis or treatment of melioidosis. Interviewers do not need to wear personal protective equipment (PPE) during these interviews.

Enhanced Surveillance and Case Reporting

Once an emergency has been announced, state and local public health authorities will need to classify cases as probable or confirmed using the case definition for melioidosis. Federal and state public health authorities will use information gathered through enhanced surveillance and case reporting to monitor the extent of the emergency and effectiveness of response efforts. State and local preparedness efforts should include enhanced surveillance plans to:

• Ensure rapid identification and reporting of additional cases after initial case confirmation
• Estimate the size of the population at risk
• Identify unexpected epidemiological features of the outbreak
• Evaluate the characteristics and extent of the outbreak

Prepare for effective surveillance and case reporting during an emergency by:

• Educating medical and public health workers about melioidosis, its signs and symptoms, and its potential for use as a bioweapon
• Developing or adapting information management systems to monitor calls and reports received
• Designating a centralized location for reporting probable and confirmed melioidosis cases
• Identifying and testing emergency notification systems and ensuring that on-call staff has appropriate access to communication resources, such as cell phones and laptops

Medical Countermeasures

Currently, there are no FDA-approved therapeutic agents with the indication of post-exposure prophylaxis or treatment of melioidosis. However, in a public health emergency, CDC will recommend and provide certain antimicrobials through emergency use authorization (EUA). State health departments will be responsible for coordinating with CDC to ensure any medical countermeasures released from the Strategic National Stockpile (SNS) for post-exposure prophylaxis and/or treatment of melioidosis under Emergency Use Authorizations are distributed to local areas that need them. During an emergency, state and local public health departments will need to communicate regularly with CDC and share information to determine where medicines and supplies are needed.

Communications

Accurate and timely communication with different audiences will support a successful response to a melioidosis emergency. CDC and other federal partners will communicate about national-level efforts and will assist state and local efforts. State and local public health authorities will be responsible for communicating to people within their jurisdictions about the response efforts that affect them.

Examples of targeted communication efforts are:

• Alerting laboratory workers of the potential for working with specimens containing B. pseudomallei. These alerts should include actionable information on what to do to prevent exposure  and how to respond to an accidental exposure.
• Alerting healthcare facilities and healthcare workers within a specific area to be suspicious that patients with certain symptoms might have melioidosis, especially those with diabetes, lung diseases, chronic kidney disease, liver disease, and other preexisting conditions.
• Informing residents and visitors within areas of known or suspected exposure that they may have been recently exposed to the bacteria that cause melioidosis. Alerts and messages should give them instructions on how, where, and when to seek medical care.
• Providing regular updates to the public about the emergency and response efforts with the aim of giving people actionable, useful information to help themselves and their loved ones get medical care, if needed.

Preparing to communicate effectively during a melioidosis emergency is similar to preparing for any public health emergency:

• Be ready to answer questions from the media and the public about melioidosis. Make sure you have knowledgeable people on staff who are able to talk to the media and the public. CDC’s Crisis & Emergency Risk Communications website has training and materials to help you prepare.
• Make arrangements to establish a hotline.
• Identify the media outlets to use to inform the public about actions they should take if they were exposed to the bacteria that cause melioidosis. Keep in mind how to reach and communicate with people in the community with functional, language, or cognitive needs.
• Review rapid-alert communication systems to ensure rapid communication capability between the state and local public health and medical communities. Upgrade the systems if necessary.
• Clearly identify the relative roles of state and local public relations offices.
• Prepare sample alert messages for the community and other partners. Format these messages for different media, including broadcast, print, web, and social media.
• Translate messages into different languages spoken in the community. Confirm accuracy and cultural appropriateness of the messages.

Resource Coordination

During a melioidosis emergency, state and local public health agencies should coordinate with healthcare facilities treating patients with melioidosis to ensure facilities have adequate supplies, such as ventilators. The state Medical Countermeasure Coordinator can communicate with CDC to request additional supplies from the Strategic National Stockpile as necessary. The Strategic National Stockpile works with governmental and nongovernmental partners to upgrade the ability to respond to a national public health emergency, ensuring that federal, state, and local agencies are ready to receive, stage, and distribute products.