Domain
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State/Local
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Federal
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Incident management
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- Continue or initiate actions described for the recognition interval.
- Consider activation of state/local emergency operations center.
- Consider declaring a public health emergency.
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- Continue or initiate actions described for the recognition interval.
- Consider declaring a public health emergency.
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Surveillance and epidemiology
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- If affected, continue enhanced surveillance; conduct case investigation and response.
- If unaffected, prepare for investigation and response.
- Consider surveillance for influenza hospitalizations and deaths if not already a component of state-based influenza surveillance.
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- Deploy federal responders to states that were initially affected as appropriate.
- Conduct analyses and field studies; disseminate data regarding transmission, treatment, and prognosis.
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Laboratory
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- Continue to confirm all suspected cases at a public health laboratory, resources permitting; prepare a plan for limiting testing using surveillance criteria.
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- Remove select agent status and U.S. Department of Agriculture regulations for the novel influenza virus strain.
- Continue monitoring virus characteristics to identify changes in virulence, transmission, or antiviral resistance markers.
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Community mitigation
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- Consider implementing appropriate community mitigation measures* in selected affected locations or institutions as indicated by the results of the Pandemic Severity Assessment Framework.
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- Maintain situation-appropriate border and travelers' health measures.
- Evaluate recommendations for appropriate community mitigation measures.
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Medical care and countermeasures
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- Monitor the surge in health-care needs and assess whether assistance is needed to mitigate the surge.
- Review and prepare to deploy a mortuary surge (mass mortality) plan.
- Consider deployment of state/local caches.
- Consider implementation of voluntary quarantine of contacts and chemoprophylaxis of exposed persons based on current recommendations.
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- Initiate targeted studies of the clinical course of the illness, treatment responses, and disease transmission.
- Monitor the health-care surge and stress on the health-care system, including provision of key medical resources and tools, as needed.
- Consider deployment of Strategic National Stockpile antiviral drugs and other material reserves.
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Vaccine
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- Implement stockpiled pandemic vaccination campaigns if a stockpiled pandemic vaccine is available, appropriate for the emerging virus, and the U.S. government has made the decision to do so.
- Update the state distribution plan based on CDC prioritization guidelines, estimated state allocation of vaccine, and epidemiology of pandemic influenza in the state.
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- Provide technical support and guidance to state, local, tribal, and territorial (SLTT) and private sector partners in preparation for and during a potential pandemic vaccination response in the United States.
- Implement and monitor vaccine distribution as appropriate.
- Monitor and assess pandemic vaccine adverse events, coverage, and effectiveness.
- Work with the Advisory Committee on Immunization Practices and others to refine policies for vaccine use and prioritization.
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Risk communication
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- Disseminate updated risk messages, including providing anticipatory guidance or information on what might be expected.
- Share information regarding antivirals and the possibility of implementation of community mitigation measures as appropriate.
- Continue to provide regular updates to key partners, stakeholders, elected officials, and the media.
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- Disseminate updated risk messages, including providing anticipatory guidance or information on what might be expected.
- Share information regarding antivirals and the possibility of implementation of community mitigation measures as appropriate.
- Continue to coordinate and provide regular updates to key partners, stakeholders, elected officials, and the media.
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State/Local coordination
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- Continue to coordinate with all partners.
- Prepare to receive funds to support response, if available.
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- Continue to coordinate with SLTT public health and other partner organizations.
- If funds are available to support an SLTT response, initiate action to award funds.
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